THU0485 EFFICACY OF EXTRACORPOREAL SHOCK-WAVE THERAPY IN THE TREATMENT OF SHOULDER CALCIFIC TENDINITIS IN INSUFFICIENT RESPONDERS TO LOCAL STEROID INJECTION THERAPY: A RETROSPECTIVE ANALYSIS

Abstract

Background: Calcific tendinitis (CT) results from the deposition of calcium hydroxyapatite crystals in periarticular muscular attachments, and most commonly affects the tendons of the shoulder (1). Extracorporeal shock wave therapy (ESWT) is based on the use of shock waves, and used for pain reduction and tissue healing (2). Objectives: The aim of this analysis is to demonstrate the effects of ESWT in patients with shoulder CT with inefficient response to local steroid injection. Methods: 2-year data of shoulder outpatient clinic were scanned. 10 patients with shoulder calcific tendinitis without satisfying response to local steroid injection (less than 50% decrease in pain-visual analogue scale (VAS) score) who were treated with ESWT were reviewed. Results: 10 patients (9 women, 1 man) fulfilled the inclusion criteria. The mean patient age was 51.3 years (range, 32-70 years) and body mass index was 26.2 kg/m2. The affected shoulder was left in 6 (60%) patients and right in 4 (40%). The calcific tendinitis involved the dominant side in 5 (50%) patients and non-dominant side in other 5 (50%). All patients had one peritendinous local steroid injection-2 ml 2% prilocain and 1 ml steroid (5 mg of betamethasone dipropionate p 2 mg betamethasone sodium phosphate). Mean time from symptom onset to the ESWT treatment was 3.5 weeks (range, 2-6 weeks). Mean VAS score was 9 and Shoulder Disability Index (SDI) score was 84.4 before ESWT treatment. ESWT system Elmed-Vibrolith ver.3.0 was used in the treatments, each treatment consisted 2000 shocks with a frequency of 150 shocks a minute with maximum tolerable energy density (range, 3.2-3.4 bar). Mean ESWT session was 3.3 (8 patients had 3, 1 patient had 4 and 1 patient had 5 sessions of treatment). Mean post-treatment VAS score was 4.2 (53.3% decrease) and SDI score was 43.8 (48.1% decrease) which were evaluated after the last ESWT session. Conclusion: With its good tolerance and safety, ESWT might be an alternative treatment method for calcific tendinitis of the shoulder. Although limited number of patients, we hope that this study might give rise to future randomized-controlled studies about the efficacy of ESWT in acute-subacute shoulder calcific tendinitis.