Treatment Protocol for Rotator Cuff Calcific Tendinitis Using a Single-Crystal Piezoelectric Focused Shock Wave Source
December 23rd, 2022
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.
To begin, position the patient comfortably in a way that allows exposure to the area to be treated. For a supraspinatus or infraspinatus tendon location, treat by placing the patient in the supine or sitting position. For a subscapularis place the patient in the supine position.
For tares minor, place the patient in the sitting lateral decubitus or oblique decubitus position for better access to the posterior aspect of the shoulder. Then select a coupling pad size depending on the required penetration depth of the focused point. The selection of the coupling pad varies in shoulder calcification cases according to the build.
The most frequently used sizes are large and medium. Next, locate the area to be treated, considering anatomical landmarks and with the help of ultrasound images if necessary. Also, position an operator to support in using the applicator and ensure working in an ergonomic position.
Apply adequate contact gel to the skin in the area to be treated, then turn on the device and access the touch screen. Select the MANUAL option at the top of the screen. The controls of the various treatment parameters are displayed.
Use the rotary selection knob to set the treatment parameters. Set the initial intensity of the treatment. Increase the intensity progressively as tolerated by the patient, starting with low intensity.
Reach at least an energy level above 0.40 millijoules per millimeter squared to obtain reproducible results. Then select a frequency to be used, between four to six hertz. Select the number of shocks to be applied using the rotary selection knob.
Apply at least 4, 000 shocks per session. Modify the frequency or the intensity during the application. Use the display located and the applicator head to easily modify the application parameters during the the treatment without having to interrupt the procedure.
Retrospective study of a series of patients with shoulder pain due to calcium deposits in the rotator cuff tendons was carried out. The study group consisted of 13 female and 10 male patients with an average age of 52.8 years. The supraspinatus muscle was affected in 82.6%of cases, the infraspinatus in 13%and the subscapularis in 4.4%In all cases, only one tendon was involved.
The minimum follow up was six months with an average of 14 months. In 82.6%of the cases, complete reabsorption of the calcification was achieved. In 8.7%partial disappearance with symptomatic improvement was obtained.
In the remaining 8.7%there were no significant changes and an ultrasound guided puncture was performed. With the exception of one case of fainting during application and two cases of transient pain during the resorption process, there were no complications. Disappearance of calcification was observed for the tendon of the subscapularis muscle after six weeks, and also for the supraspinatus muscle tendon after 12 weeks.
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Overview
Calcific tendinitis of the shoulder is a common condition that can be treated using focused shock waves generated by a single-crystal piezoelectric device. This article discusses treatment protocols and presents preliminary results.
Key Study Components
Area of Science
- Neuroscience
- Orthopedics
- Physical Therapy
Background
- Calcific tendinitis affects the shoulder, causing pain and limited mobility.
- Various treatment options exist, including shock wave therapy.
- Focused shock waves can target specific areas for effective treatment.
- Understanding the positioning of patients is crucial for effective treatment.
Purpose of Study
- To evaluate the effectiveness of focused shock wave therapy for calcific tendinitis.
- To establish a treatment protocol for clinicians.
- To present preliminary results from initial treatments.
Methods Used
- Patient positioning based on tendon location.
- Selection of coupling pad size for treatment.
- Application of focused shock waves using a piezoelectric device.
- Assessment of treatment outcomes.
Main Results
- Preliminary results indicate positive outcomes from the treatment.
- Patient positioning significantly affects treatment efficacy.
- Coupling pad selection is crucial for optimal results.
- Further studies are needed to confirm long-term benefits.
Conclusions
- Focused shock wave therapy shows promise for treating calcific tendinitis.
- Establishing a clear treatment protocol can enhance patient outcomes.
- Continued research is essential to validate findings.
Frequently Asked Questions
Executive Industry Relevance
Single-crystal piezoelectric focused shock wave therapy offers a standardized, noninvasive modality for addressing calcific tendinitis of the rotator cuff, supporting reproducible biological outcomes. Quantitative radiographic endpoints and protocolized energy delivery enable robust hypothesis testing and mechanistic de-risking at the interface of device-based intervention and musculoskeletal biology. This approach informs translational research and portfolio decisions for non-pharmacologic musculoskeletal therapeutics.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables interrogation of tissue response to focused mechanical energy in disease-relevant tendon models.
- Supports biological de-risking by quantifying calcification resorption as a functional endpoint.
- Facilitates predictive confidence in device-based intervention strategies for musculoskeletal targets.
Screening & Assay Development
- Standardizes treatment parameters for reproducible application across patient-derived or preclinical models.
- Delivers quantitative radiographic and symptomatic readouts for downstream comparative studies.
- Establishes a platform for evaluating adjunctive therapies or combination regimens in controlled settings.
Translational & Preclinical Research
- Aligns with disease-relevant endpoints such as calcification resorption and pain reduction.
- Enables continuity from mechanistic studies to clinical protocol development for device-based therapies.
- Supports risk-adjusted advancement of noninvasive interventions in musculoskeletal portfolios.
Pipeline & Workflow Integration
This protocol positions focused shock wave therapy as a bridge from mechanistic discovery to translational validation in musculoskeletal research pipelines.
- Discovery Biology: Quantifies tissue-level response to mechanical energy, informing target validation.
- Screening: Provides standardized, reproducible treatment parameters for comparative studies.
- Analytics: Enables radiographic and symptomatic measurement of intervention efficacy.
- Translational Research: Connects device-based intervention to clinically meaningful endpoints.
- Enterprise Reuse: Establishes a protocolizable platform for future device or combination therapy studies.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence and reduces mechanistic ambiguity in device-based interventions.
- Operational Value: Delivers standardized, scalable, and reproducible treatment protocols.
- Strategic Value: Informs go/no-go decisions for noninvasive musculoskeletal therapies.
- Portfolio Impact: Supports risk-adjusted prioritization of device-based therapeutic candidates.
Implementation Considerations
- Requires expertise in musculoskeletal anatomy and device operation.
- Needs access to piezoelectric shock wave instrumentation and radiographic imaging for endpoint assessment.
- Demands cross-team standardization of treatment parameters and outcome measures.
- Adaptation may be needed for different tendon locations or patient anatomies.
- Limitations include patient tolerance thresholds and the need for radiographic follow-up.
