Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I have some calcium deposits in the tendons of my shoulder. Nothing has worked to get rid of these. My doctor wants me to try shock therapy. I'm a little nervous to try something like this. How does it work and does it hurt?

Answer:

The use of extracorporeal shockwave therapy (ESWT) has been shown successful in the treatment of calcific tendinitis (the medical term for your condition). It is not clear if ESWT is the best treatment approach (that remains to be determined in future studies), but a recent review of studies shows very favorable results. Researchers from the Department of Trauma and Orthopaedic Surgery in England sorting through five years of data from recently published studies. All studies showed improvement after treating calcifying tendinitis of the rotator cuff with extracorporeal shockwave therapy (ESWT). ESWT is the use of sound waves to create enough energy to disintegrate the calcium deposits. It has been used with good results for other problems like gallstones and kidney stones. Once the calcium crystals have been broken up, it appears that the body absorbs them because X-rays show they disappear. Most of the studies included patients with Types I and II calcification. There are three types of calcifying tendinitis diagnosed by X-rays. Type I has deposits that have clear outlines. A line can be drawn around the dense deposits to show exactly where they are, their size, and their shape. Type II disease has a clear outline but tends to be spread out more through the tissue and harder to see as a distinct shape. Type III lesions look cloudy without a specific form, shape, or outline. All studies used a scoring system called the Constant-Murley score to measure results before and after treatment. Having one test used by everyone made it possible to compare the outcomes from one study to the next -- even when the studies weren't all conducted exactly the same way. Extracorporeal shockwave therapy was deemed safe and effective for this potentially disabling condition. Significant improvement in motion, pain, strength, and function was consistently reported in all studies included in the review. Improvements were reported using both high-energy and low-energy shockwave therapy but high-energy had the best results. Low-energy therapy was better than no treatment or sham (placebo) groups. The procedure is not painful and has few adverse side effects. Some patients notice redness of the skin around the shoulder area after the treatment, but it doesn't last. For a few patients, a small amount of bleeding occurs under the skin. This condition is benign (harmless) and is called petechiae (tiny dots of blood). Before undergoing the procedure, let your doctor know of your concerns and questions. Find out what to expect in terms of the actual treatment and short-term and long-term results. Adnan Saithna, BMedSci(Hons), MBChB, MRCSEd, et al. Is Extracorporeal Shockwave Therapy for Calcifying Tendinitis of the Rotator Cuff Associated with a Significant Improvement in the Constant-Murley Score? A Systematic Review. In Current Orthopaedic Practice. September/October 2009. Vol. 20. No. 5. Pp. 566-571.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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