Efficacy of Focused Shockwave Therapy for Treating Chronic Non-calcific and Calcific Rotator Cuff Tendinopathy
Keywords:rotator cuff tendinopathy, focused shockwave therapy, Constant-Murley score, เอ็นไหล่เสื่อมเรื้อรัง, คลื่นกระแทกแบบหัวตำแหน่งเฉพาะ, คะแนนคอนสแตนท์-เมอร์เลย์
Objectives: To evaluate efficacy of focused shockwave therapy in patients with chronic non-calcific and calcific rotator cuff tendinopathy.
Study design: Experimental clinical study
Setting: Rehabilitation Medicine Department, Faculty of Medicine, Ramathibodi Hospital.
Subjects: Patients with chronic rotator cuff tendinopathy aged 18 or older.
Methods: All participants’ shoulder were evaluated by using diagnostic shoulder ultrasonography, and later received weekly focused shockwave therapy (FSWT) at energy flux density of 0.20-0.25 mJ/mm2, frequency of 4-5 Hz, 2,000 pulses per session for 3 weeks with standard exercises for chronic rotator cuff tendinopathy. Constant-Murley score (CMS) were evaluated before, 3, 6 and 12 weeks after treatment.
Results: Twenty-four patients (27 shoulders) with mean age (SD) of 60.30 (9.62) were recruited including 8 males and 16 females. Mean CMS (SD) at pre- and 12 weeks post- treatment in non-calcific group were 55.47 (14.83) and 75.07 (12.60) whereas in calcific group were 47.17 (9.67) and 75.75 (6.50), respectively. When comparing between pre- and 12 weeks post- treatment, the CMS increased significantly in both non-calcific and calcific groups (p<0.0001) but no significant difference between groups at pre- (p=0.1070) and 12 weeks post-treatment (p=0.8662).
Conclusion: Focused shockwave therapy with standard exercises for chronic rotator cuff tendinopathy is effective in chronic rotator cuff tendinopathy either non-calcific and calcific.
Keywords: rotator cuff tendinopathy, focused shockwave therapy, Constant-Murley score
2. Littlewood C, May S, Walters S. Effectiveness of conservative interventions for rotator cuff tendinopathy: a review of systematic reviews. J Shoulder Elbow Surg. 2013;5:151-67.
3. Louwerens JK, Sierevelt IN, Van Noort A, Van den Bekerom MP. Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2014;23:1240-9.
4. Mouzopoulos G, Stamatakos M, Mouzopoulos D, Tzurbakis M. Extracorporeal shock wave treatment for shoulder calcific tendonitis: a systematic review. Skeletal Radiol. 2007;36:803-11.
5. Ogden JA, Tóth-Kischkat A, Schultheiss R. Principles of shock wave therapy. Clin Orthop Relat Res. 2001;387:8-17.
6. Huisstede BM, Gebremariam L, Van der Sande R, Hay EM, Koes BW. Evidence for effectiveness of extracorporal shock-wave therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis: a systematic review. Man Ther. 2011;16:419-33.
7. Bannuru RR, Flavin NE, Vaysbrot E, Harvey W, Mc Alindon T. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review. Ann Intern Med. 2014;160:542-9.
8. Harniman E, Carette S, Kennedy C, Beaton D. Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review. J Hand Ther. 2004;17:132-51.
9. Haake M, Deike B, Thon A, Schmitt J. Exact focusing of extracorporeal shock wave therapy for calcifying tendinopathy. Clin Orthop Relat Res. 2002;397:323-31.
10. Loppolo F, Tattoli M, Di Sante L, Venditto T, Tognolo L, Delicata M, et al. Clinical improvement and resorption of calcifications in calcific tendinitis of the shoulder after shock wave therapy at 6 months’ follow-up: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2013;94:1699-706.
11. Hsu CJ, Wang DY, Tseng KF, Fong YC, Hsu HC, Jim YF. Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. J Shoulder Elbow Surg. 2008;17:55-9.
12. Sabeti-Aschraf M, Dorotka R, Goll A, Trieb K. Extracorporeal shock wave therapy in the treatment of calcific tendinitis of the rotator cuff. Am J Sports Med. 2005;33:1365-8.
13. Farr S, Sevelda F, Mader P, Graf A, Petje G, Sabeti-Aschraf M. Extracorporeal shockwave therapy in calcifying tendinitis of the shoulder. Knee Surg Sports Traumatol Arthrosc. 2011;19:2085-9.
14. Perlick L, Luring C, Bathis H, Perlick C, Kraft C, Diedrich O. Efficacy of extracorporal shock-wave treatment for calcific tendinitis of the shoulder: experimental and clinical results. J Orthop Sci. 2003;8:777-83.
15. Pan PJ, Chou CL, Chiou HJ, Ma HL, Lee HC, Chan RC. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study. Arch Phys Med Rehabil. 2003;84:988-93.
16. Speed CA, Richards C, Nichols D, Burnet S, Wies JT, Humphreys H, et al. Extracorporeal shock-wave therapy for tendonitis of the rotator cuff: a double-blind, randomised, controlled trial. J Bone Joint Surg Br. 2002;84:509-12.
17. Schofer MD, Hinrichs F, Peterlein CD, Arendt M, Schmitt J. High-versus low-energy extracorporeal shock wave therapy of rotator cuff tendinopathy: a prospective, randomised, controlled study. Acta Orthop Belg 2009; 75:452.
18. Galasso O, Amelio E, Riccelli DA, Gasparini G. Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial. BMC Musculoskelet Disord. 2012;13:13:86.
19. Schmitt J, Haake M, Tosch A, Hildebrand R, Deike B, Griss P. Low-energy extracorporeal shock-wave treatment (ESWT) for tendinitis of the supraspinatus: a prospective, randomised study. J Bone Joint Surg Br. 2001;83:873-6.
20. Katolik LI, Romeo AA, Cole BJ, Verma NH, Hayden JK, Bach BR. Normalization of the Constant score. J Shoulder Elbow Surg. 2005;14:279-85.