Our aim was to evaluate, in a large group of patients, whether ESWT is an effective therapeutic procedure without side effects for chronically painful calcifying tendinitis of the shoulder refractory to other conventional conservative therapies. Study subjects were 135 patients (90 females and 45 males) aged 35–68 years, with a mean of 49, showing chronic, symptomatic, calcifying tendinitis of the shoulder. The average duration of symptoms was 12 months (range 9–16). Inclusion criteria were: shoulder pain for a minimum of 9 months (a period of time that is useful for indicating a chronic pathology that is resistant to other therapies) along with a calcification of the rotator cuff (in anteroposterior X-ray films), and unsuccessful conservative therapy during the 6 months before referral to our hospital. According to sonography, all calcifications were located in the supraspinatus tendon. Calcifications were type I or type II according to the classification of Gartner, and with a minimum diameter of 10 mm. Patients were excluded if they had partial or complete rupture of the rotator cuff observed by sonography and/or magnetic resonance imaging, dysfunction in the neck or thoracic region or both, local and generalized arthritis, osteoarthritis, algodystrophy, pregnancy, infectious or tumorous diseases, skin ulcerations, and neurological abnormalities. All patients had used analgesics and non steroidal antiinflammatory drugs, 98 patients had received local steroid injections, 123 had undergone physiotherapy, and 35 patients had undergone needling with no response. Informed consent was obtained from all patients. No other treatments or drugs were administered during the 4 weeks prior to the trials or during the study period. An ESWT system was used (Orthima, Direx Medical System Ltd). The therapy comprised four treatments (one every 4–7 days), each consisting of 1200 shocks with a frequency of 120 shocks per minute. As the treatment may initially be painful, the energy density utilized on starting treatment was 0.03 mJ/mm2 and it was increasingly augmented up to 0.28 mJ/mm2. In subsequent treatments an energy density of 0.28 mJ/mm2 was used. The patients were seated in front of the shock wave generator and the shock wave source was placed in the direction of the calcification that was identified during sonographic examination. Neither local anesthetics, analgesics nor non-steroidal anti-inflammatory drugs were used during the procedure. Using the Constant and Murley score, this study showed a significant decrease in pain and a significant increase in shoulder function. One month after the end of the treatment partial resorption of the calcium deposits was observed in 60 patients (44.5%), complete resorption was observed in 30 patients (22.3%), and no modification in the calcium deposits was observed in 45 patients (33.2%). Radiological disintegration or dissolution of the calcification was significant (p<0.001). No side effects were observed. In conclusion, this study demonstrated a good tolerance, safety and clinical–radiologic response, therefore ESWT should be considered as an alternative therapy for chronic calcific tendinitis of the shoulder refractory to conventional therapies.
Scheda prodotto non validato
Scheda prodotto in fase di analisi da parte dello staff di validazione
|Titolo:||Extracorporeal shock wave therapy for chronic calcific tendinitis of theshoulder.|
|Citazione:||Cosentino, R., Selvi, E., De Stefano, R., Frati, E., Manca, S., Hammoud, M.M., et al. (2004). Extracorporeal shock wave therapy for chronic calcific tendinitis of theshoulder. CLINICAL RHEUMATOLOGY, 23(5), 475-477.|
|Appare nelle tipologie:||1.1 Articolo in rivista|