High-energy Versus Low-energy Extracorporeal Shock Wave Therapy for Calcifying Tendinitis of the Shoulder: Which is Superior? A Meta-analysis

Background There are several treatment options for calcifying tendinitis of the shoulder. The next step treatment after conservative treatment fails is still a matter of dispute. Extracorporeal shock wave therapy (ESWT) has been shown to be a good alternative to surgery, but the best treatment inten...

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Bibliographic Details
Published in:Clinical orthopaedics and related research 2014-09, Vol.472 (9), p.2816-2825
Main Authors: Verstraelen, F. U., in den Kleef, N. J. H. M., Jansen, L., Morrenhof, J. W.
Format: Article
Language:English
Subjects:
Calcinosis - complications
Calcinosis - radiotherapy
Conservative Orthopedics
High-Energy Shock Waves - therapeutic use
Humans
Medicine
Medicine & Public Health
Orthopedics
Shoulder
Shoulder Joint
Sports Medicine
Surgery
Surgical Orthopedics
Survey
Tendinopathy - etiology
Tendinopathy - therapy
Treatment Outcome
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Summary:Background There are several treatment options for calcifying tendinitis of the shoulder. The next step treatment after conservative treatment fails is still a matter of dispute. Extracorporeal shock wave therapy (ESWT) has been shown to be a good alternative to surgery, but the best treatment intensity remains unknown. High-energy ESWT is much more painful, more expensive, and usually is done in an inpatient setting, whereas low-energy ESWT can be performed in an outpatient setting by a physical therapist. Questions/purposes A systematic review and meta-analysis of randomized trials was performed to answer two clear research questions: (1) Is there a greater increase in the Constant-Murley score in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? (2) Is there a greater chance of complete resorption of the calcifications in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? Methods Five relevant electronic online databases, Medline (through PubMed), EMBASE (through OVID), Cinahl (through EBSCO), Web of Science, and the Cochrane Central Register of Controlled Trials, were systematically searched. We also crosschecked the reference lists of articles and reviews for possible relevant studies. Eligible for inclusion were all randomized controlled trials (RCTs) that compared high-energy ESWT (> 0.28 mJ/mm 2 ) with low-energy ESWT (
ISSN:0009-921X
1528-1132
DOI:10.1007/s11999-014-3680-0