Ultrasound therapy for calcific tendinitis of the shoulder

Background and Methods Although ultrasound therapy is used to treat calcifi c tendinitis of the shoulder, its efficacy has not been rigorously evaluate d. We conducted a randomized, double-blind comparison of ultrasonography an d sham insonation in patients with symptomatic calcific tendinitis verified by radiography. Patients were assigned to receive 24 15-minute sessions of either pulsed ultrasound (frequency, 0.89 MHz; intensity, 2.5 W per square centimeter; pulsed mode, 1:4) or an indistinguishable sham treatment to th e area over the calcification. The first 15 treatments were given daily (fi ve times per week), and the remainder were given three times a week for thr ee weeks. Randomization was conducted according to shoulders rather than pa tients, so a patient with bilateral tendinitis might receive either or both therapies. Results We enrolled 63 consecutive patients (70 shoulders). Fifty-four pati ents (61 shoulders) completed the study. There were 32 shoulders in the ult rasound-treatment group and 29 in the sham-treatment group. After six weeks of treatment, calcium deposits had resolved in six shoulders (19 percent) in the ultrasound-treatment group and decreased by at least 50 percent in n ine shoulders (28 percent), as compared with respective values of zero and three (10 percent) in the sham-treatment group (P=0.003). At the nine-month follow-up visit, calcium deposits had resolved in 13 shoulders (42 percent ) in the ultrasound-treatment group and improved in 7 shoulders (23 percent ), as compared with respective values of 2 (8 percent) and 3 (12 percent) i n the sham-treatment group (P=0.002). At the end of treatment, patients who had received ultrasound treatment had greater decreases in pain and greate r improvements in the quality of life than those who had received sham trea tment; at nine months, the differences between the groups were no longer si gnificant. Conclusions In patients with symptomatic calcific tendinitis of the shoulde r, ultrasound treatment helps resolve calcifications and is associated with shortterm clinical improvement. (N Engl J Med 1999;340:1533-8.) (C)1999, M assachusetts Medical Society.