Importance of accurately focussing extracorporeal shock waves in the treatment of calcifying tendinitis - A prospective randomized study

A controlled randomized study was designed to analyse the effect of extraco rporeal shockwave therapy (ESWT) focussed on either the calcified region or the insertion of the supraspinatus tendon. The study included 50 patients who were treated with a Storz Minilith SI-1 prototype shockwave generator. In the treated group, 4000 impulses (ED+ 0.78 ml/mm(2)) were applied, under local anaesthesia to the insertion of the supraspinatus in 2 treatment ses sions. Control patients received ESWT focussed on the calcified region. Fol low-up examinations were carried out 12 weeks after treatment by an indepen dent observer. We found functional improvement and pain reduction in both g roups. Statistical analyses showed significant superiority of ESWT focussed on the calcified region for the parameters constant-score (primary endpoin t, p < 0.001) and pain intensity (p = 0.001). For the treatment of calcific tendinitis affecting the supraspinatus, we recommend accurate fluoroscopy- controlled focussing of ESWT on the calcification. Focussing on the calcifi cation rather than on the insertion of the supraspinatus tendon is signific antly more effective. On the basis of our results, ESWT requires the use of suitable shockwave generators that permit accurate Focussing.