Extracorporeal shock wave therapy in the treatment of chronically painful calcifying tendinitis: Comparison of two treatment protocols.

Aim of the study: Extracorporeal shock wave therapy (ESWT) is a new therape utic procedure for chronically painful calcifying tendinitis of the rotator cuff. The therapy may vary with the number of applied impulses or with imp ulse energy. Shock waves with an energy of 0.04 to 0.12 mJ/mm(2) define low -dose ESWT, in contrast to high-dose ESWT (>0.12 mJ/mm(2)). The aim of the study was to verify the hypothesis that either high-dose or low-dose ESWT c ould be effective if the total amount of applied energy was similar. Method : Fifty patients were assigned at random to 2 groups. The treatment consist ed of 3 x 5000 low-dose impulses without anesthesia (group 1) and 1 x 5000 high-dose impulses with intravenous analgesia (group 2). The patients were examined at 6 weeks, 3 and 6 months after treatment. X-rays were perfomed a t each visit. Results: The Constant Score improved from 64,5 to 77,5 (group 1) and from 67,2 to 79,4 (group 2) before and 6 months after treatment (p< 0,05). The values on the visual analog scale which ranges from 0 (no pain) to 100 (maximal pain) improved from 76,8 to 48,8 (group 1) and from 75,4 to 45,6 (group 2) before and 6 months after treatment respectively. The final results for both Constant Score and visual analog scale were obtained afte r 3 months. X-rays showed a complete or subtotal calcific resorption in 8 ( group 1,32%) and 12 (group 2, 48%) patients. Conclusion: Extracorporeal sho ck wave therapy may be an alternative treatment of calcifying tendinitis of the shoulder. Both treatment protocols gave equivalent results.