Extracorporeal shockwave lithotripsy for calcific tendonitis (tendinopathy) of the shoulder

NICE interventional procedures guidance [IPG21] Published date:

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The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on extra-corporeal shockwave lithotripsy for calcific tendonitis (tendinopathy) of the shoulder.

  • Description

    Calcifying tendonitis most commonly occurs in the shoulder joint, specifically the supraspinatus tendon of the rotator cuff, where crystalline calcium phosphate is deposited in the tendon.

    Treatment includes non-steroidal anti-inflammatory drugs, corticosteroids, regular physiotherapy, aspiration and lavage.

    For patients refractory to these approaches, open shoulder surgery has been offered and the introduction of shoulder arthroscopy introduced a minimally invasive approach.

    Extracorporeal shock wave lithotripsy (ESWT) may be an alternative to surgery.  ESWT allows controlled sonic pulses of short duration to produce transient pressure disturbances in the shoulder with the aim of fragmenting deposits. The procedure aims to improve shoulder function and reduce pain. The mechanism of ESWT on calcifying tendonitis is unknown. ESWT is an established technique for the treatment of renal calculi and has since been used in orthopaedics. 

  • OPCS4.6 Code(s)

    T74.5 Extracorporeal shockwave lithotripsy of calculus of tendon

    Z54.9 Muscle of shoulder or upper arm NEC

    Includes: Tendon of muscle of shoulder or upper arm

     The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding

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