Treatment Protocol for Rotator Cuff Calcific Tendinitis Using a Single-Crystal Piezoelectric Focused Shock Wave Source

Summary

Calcific tendinitis of the shoulder is a relatively common condition with numerous treatment options. Here, we discuss the indications of focused shock waves generated by a single-crystal piezoelectric device, describe a treatment protocol, and present the preliminary results.

Abstract

Focused shock waves have emerged as a highly effective noninvasive therapeutic option for the treatment of calcific tendinitis of the shoulder. There are three types of focused shock wave generators: electrohydraulic, electromagnetic, and piezoelectric. According to our literature search, there are no reports of results with the use of single-crystal piezoelectric generators in calcific tendinitis of the shoulder. In a consecutive retrospective series of 23 patients with Gärtner type I and II calcifications of the rotator cuff, we performed three applications of high-energy piezoelectric focused waves (4,000 pulses per session with a frequency of 6 Hz). At the final follow-up (average of 14 months), 82.6% of the cases showed complete resorption of the calcification in radiographic controls. In 8.7% of the cases, partial disappearance of the calcification was achieved, and in the remaining 8.7% there were no significant changes. Single-crystal piezoelectric generators have a success rate comparable to those already reported with electrohydraulic and electromagnetic devices.

Introduction

Calcium crystal deposits can appear in different regions of the musculoskeletal system, but their most frequent location is in the shoulder region. Gondos¹ reported that 69% of calcification cases occur in the shoulder location. Calcific shoulder tendinopathies are characterized by the presence of hydroxyapatite deposits in the rotator cuff tendons. It is estimated that the prevalence in the general population ranges from 2.7% to 20%².

Calcific tendinitis of the shoulder typically affects patients between 30 to 60 years old². It is also more frequent in women (57%-76.7%....

Protocol

The protocol follows the guidelines of the Buenos Aires British Hospital's human research ethics committee.

1. Patient evaluation

1. Clinical evaluation
   1. Evaluate patients clinically to rule out symptoms propagating from other anatomical regions or other associated pathology in the shoulder that may be the source of symptoms.
   2. Include shoulder inspection and palpation, evaluate the active and passive range of motion, and perform pain provocative maneuvers and integrity tests. In addition, evaluate the cervical spine and the elbow joint.
2. Radiological evaluation

Results

A retrospective study of a series of patients with shoulder pain due to calcium deposits in the rotator cuff tendons was carried out in our institution. The inclusion criteria were Gärtner stage I and II calcifications and at least 3 months of previous conservative treatment without satisfactory results. Patients with Gärtner III calcifications, other associated pathology in the affected shoulder, previous local cortisone injection, and a history of surgery in the affected shoulder were excluded.

Discussion

This study shows encouraging results with the application of focused shock waves generated by a single-crystal piezoelectric device in a series of retrospectively evaluated patients with calcific tendinitis of the shoulder. According to the bibliographic search we carried out, this is the first study that reports results with a single-crystal piezoelectric device. Recently, Louwerens³⁹ published a study using a piezoelectric shock wave device for the treatment of rotator cuff calcifications. Howev.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
BTL 6000 FSWT	BTL	09400B001107	Focused Shock Wave Piezoelectric Source
Ultrasound & SWT Gel 300 mL	BTL	237-GEL102	Alcohol free hypoallergic gel