Arm position during extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: a randomized study

Abstract

Objective: To generate data on optimal shoulder position comparing two ultrasound-guided extracorporeal shock wave therapy techniques for the treatment of calcifying tendinitis of the shoulder. Design: Random assignment to two groups of treatment with three months follow-up. Setting: The data were collected in outpatients. Subjects: Thirty-five subjects affected by calcifying tendinitis of the shoulder were examined. Interventions: Each subject received three sessions of ultrasound-guided extracorporeal shock wave therapy (performed weekly). Neutral position technique was used in group A (n = 17, mean age 53 ± 9.2 years) and the hyperextended internal rotation technique was used in group B (n = 18, mean age 52.2 ± 10.8 years). Main outcome measures: The Constant and Murley method and radiographs were used to evaluate each subject before the treatment and at three months follow-up. Results: There were no significant differences between changes in Constant total score and pain, activity of daily living and range of motion subscales of the two groups. Only the pain subscale showed a significant difference in favour of group B. Significant differences in the radiographic outcome were observed between the two groups: the percentage of total or subtotal resorption of the calcified deposits was 35.3% in group A (neutral position technique) versus 66.6% in group B (hyperextended internal rotation technique). The resorption of the calcific deposit positively influenced the clinical outcome. Conclusions: Positioning the shoulder in hyperextension and internal rotation during extracorporeal shock wave therapy seems to be a useful technique to achieve resorption of calcific deposits.