Shoulder Calcific Tendinitis

Calcific tendinitis (also called calcific/calcifying/calcified/calcareous tendinitis/tendonitis/tendinopathy, tendinosis calcarea, hydroxyapatite deposition disease (HADD) and calcific periarthritis) is a form of tendinitis. It is a condition where deposits of hydroxyapatite (a crystalline calcium phosphate) form in a tendon of the body, most commonly in the tendons of the rotator cuff. It can easily be seen on xray as shown below:

Success rates of shockwave therapy in patients with calcific tendinitis of the shoulder are reported ranging from 78% to 91% (Cacchio et al, 2006, Daecke, Kusnierczak & Loew, 2002, Hsu et al, 2008, Jakobeit et al, 2002, Krasny et al, 2005, Pan et al, 2003, Peters et al, 2004, Pleiner et al, 2004, Rompe et al, 1998, Wang, Ko & Chen, 2001).

Most of the studies on calcific tendinitis have been done in the shoulder.

Consentino et al (2003) found that calcification was resolved in 31% of their cases with a further 40% having at least partial re-absorption (as seen on x-ray). These improvements translated into reduced pain, better range of motion and increased function. Spindler et al (1998) reported complete pain relief and full shoulder joint movement in three patients two years after shockwave therapy, and a fragmentation of calcification was achieved in only a day.

Wang et al (2003) compared the results of shockwave therapy with a control group. At 2 to 3 year follow-up, the overall results of the shockwave group were complaint free in 60.6%, significantly better in 30.3%, slightly better in 3.0% and unchanged in 6.1%. Only 6% showed recurrent pain of lesser intensity and none showed worse symptoms. The control group results reported slightly better in 16.7% and unchanged in 83.3%. Radiographs showed complete elimination of calcium deposits in 57.6%, partial elimination or fragmentation in 15.1%, and unchanged in 27.3% for the shockwave group. No one showed recurrence of calcium deposit 2 years after shockwave therapy.

There is a correlation of functional improvement with the elimination of calcium deposit (Wang et al, 2003). Jurgowski et al (1993) treated patients with two sessions of shockwave at 2,000 impulses per session and reported a marked reduction of symptoms with an average of 30% improvement in the Constant score at the 12 week follow-up. Radiographs showed complete elimination of the calcification in over 60% of the patients, and partial elimination in the rest. Magnetic resonance imaging did not show any lasting damage to bone or soft tissue (Jurgowski et al, 1993, Loew et al, 2000).

Rompe et al (1997) reported significant improvement in 72.5% of the patients and only 15% of the patients treated reported no improvement. Complete or partial disintegration of the calcium deposits was observed in 62.5% of the patients.

In another study, Rompe, Zoellner & Nafe (2001) reported that shockwave therapy provides equal or better results than surgery in patients with calcifying tendinitis of the shoulder.

It appears that the most popular method for treating calcific tendinitis is to use high energy at lower frequency.
Settings: Anywhere from 3.0 bar or 120mj upwards (may need to start low in the shoulder as it can be very painful). Normally 10hz or lower (lower is more painful so often people start higher and work down) for 1000 to 2000 shocks (1000 at one spot or 2000 across a tendon).
Frequency: Repeated every 5-7 days. Sessions as required to eliminate the calcification (normally 4-6 but can be more on chronic shoulders).