Extracorporeal shockwave therapy for calcific tendinopathy in the shoulder

2.1 Calcific tendinopathy (also known as calcific tendonitis) is a disorder of the shoulder characterised by the formation of deposits of calcium crystals in 1 or more of the rotator cuff tendons. It can cause symptoms such as pain in the upper arm and shoulder, reduced range of movement, stiffness and weakness. The exact cause is unknown.

2.2 Most cases of calcific tendinopathy resolve in time without treatment. In the early stages, symptom management includes painkillers and anti-inflammatory medication. If symptoms persist, physiotherapy may be needed. Other treatment options include steroid injection, percutaneous lavage or barbotage (using a needle to suck up or break up the calcium deposits), or surgery.

2.3 Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment in which a device is used to pass controlled, short-duration acoustic shockwaves through the skin to the affected area. This produces transient pressure disturbances, which break up calcium deposits. There are 2 different types of ESWT. In focused ESWT the energy generated converges at a selected depth in the body tissues where the maximal pressure is reached. In radial ESWT the maximal pressure is at the skin surface and then diverges as it penetrates deeper.

2.4 Local anaesthesia is sometimes used for pain relief during the procedure and ultrasound guidance can be used to assist with positioning the device.

2.5 Treatment protocols for ESWT vary according to the energy density and frequency of shockwaves.