Shock Wave Therapy and Shoulder

SHOCK WAVE THERAPY AND SHOULDER TENDINITIS

Calcific tendinitis of the shoulder

Calcific tendinitis of the rotator cuff is a common condition characterised by the deposit of calcium crystals (hydroxyapatite) within one or more tendons of the rotator cuff. The supraspinatus tendon is most frequently affected. This calcification can cause significant pain, limited shoulder movement and highly disabling acute episodes.

The condition classically progresses through three phases: a formative phase (often silent), a resting phase (stable calcification, variable pain) and a resorptive phase (which may be accompanied by an acute inflammatory flare).

Consultations take place at the clinic located at 9 Rue du Regard, 75006 Paris, in the 6th arrondissement.

WHY SHOCK WAVE THERAPY FOR THE SHOULDER?

Shock wave therapy is one of the best-documented non-surgical treatments for calcific tendinitis of the shoulder. It represents an alternative to invasive techniques (ultrasound-guided needle aspiration, arthroscopic surgery) and is recommended after failure of first-line conservative treatment.

Unlike tendinopathies without calcification, where the efficacy of shock waves remains debated, the scientific literature shows particularly favourable results for calcific tendinitis.

MECHANISM OF ACTION ON CALCIFICATIONS

Shock waves act on tendon calcification through several mechanisms:

• Mechanical fragmentation: high-energy acoustic waves exert mechanical stress on the calcium deposits, promoting their fragmentation into smaller particles that can be resorbed by the body.
• Stimulation of neovascularisation: improved local perfusion facilitates the biological resorption process of the calcification.
• Calcium dissolution: shock waves modify the local biochemical environment, promoting the dissolution of hydroxyapatite crystals.
• Analgesic effect: pain reduction allows progressive functional recovery of the shoulder.

TREATMENT PROTOCOL

The protocol generally consists of 3 to 5 sessions, spaced 7 to 10 days apart. Each session lasts approximately 10 minutes. The calcification zone is located by palpation and, where possible, correlated with prior imaging (X-ray or ultrasound).

Treatment efficacy depends on several factors: the size and stage of the calcification, the duration of symptoms and the patient's compliance with the associated rehabilitation programme. Results are generally assessed 3 to 6 months after the end of treatment.

SHOCK WAVES OR OTHER TREATMENTS?

The management of calcific tendinitis follows a stepwise approach:

1. Initial conservative treatment: analgesics, physiotherapy, activity modification.
2. Shock wave therapy (ESWT): in cases of persistent symptoms beyond 3 months. A non-invasive option with a favourable risk-benefit ratio.
3. Ultrasound-guided needle aspiration (needling): a reference interventional technique, performed by a specialist physician.
4. Arthroscopic surgery: reserved for cases resistant to all conservative treatments.

Shock wave therapy occupies an intermediate position, after failure of first-line treatments and before more invasive interventions.

ASSOCIATED OSTEOPATHIC TREATMENT

The osteopathic approach complements shock wave treatment by addressing associated biomechanical factors:

• Glenohumeral mobility: restoration of shoulder range of motion, particularly external rotation and abduction.
• Acromioclavicular and sternoclavicular joints: assessment and treatment of mobility restrictions within the shoulder girdle.
• Thoracic and cervical spine: thoracic mobility directly influences scapular biomechanics. Excessive thoracic kyphosis or a stiff cervical spine can contribute to subacromial impingement.
• Muscular balance: advice on strengthening the rotator cuff and scapular stabilisers.

FREQUENTLY ASKED QUESTIONS

Can shock wave therapy eliminate a shoulder calcification?

Shock wave therapy can promote the fragmentation and progressive resorption of calcium deposits. Studies report complete or partial disappearance of the calcification in 60 to 80% of cases, depending on the size and stage of the deposit.

Is a shock wave session on the shoulder painful?

The sensation varies according to individual sensitivity and the location of the calcification. The intensity is gradually adjusted during the session. Most patients describe moderate discomfort that remains bearable. Some local tenderness may persist for a few hours after the session.

How many shock wave sessions are needed for calcific tendinitis?

The protocol generally consists of 3 to 5 sessions, spaced 7 to 10 days apart. The full benefit may take several weeks to develop after the final session. Follow-up imaging may be performed at a later stage to assess calcification resorption.

References

• Ioppolo F, Tattoli M, Di Sante L et al. (2013). Clinical improvement and resorption of calcifications in calcific tendinitis of the shoulder after shock wave therapy at 6 months' follow-up: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 94(9):1699-1706. PMID 23499780
• Albert JD, Meadeb J, Guggenbuhl P et al. (2007). High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial. The Journal of Bone and Joint Surgery (British), 89(3):335-341. PMID 17356145