Treating calcific tendinitis with shock waves

If the shoulder hurts at night and this prevents you from sleeping, or hair combing seems almost impossible - then a calcified shoulder can be the cause. Surgery may be possible but extracorporeal shock wave therapy (ESWT) can be a gentle alternative.

Particularly affected are people between 35 and 50 years of age

If the shoulder hurts at night and this prevents you from sleeping, or hair combing seems almost impossible - then a calcified shoulder can be the cause. In the case of calcium accumulation, which causes severe pain, the patient is sometimes advised to undergo surgery. Extracorporeal shock wave therapy (ESWT) can be a gentle alternative. The attending physician uses an ultrasound device to direct high-energy shock or pressure waves specifically at the affected shoulder. The ultrasound procedure can also be very helpful for diagnosis.

In the case of calcific tendinitis, calcification accumulates in a tendon in the shoulder. This can be caused by mechanical factors as well as local circulatory or metabolic disorders. "Movements over the head, but also backward or sideways are extremely painful," is how Dr. Rainer Berthold, one of the German Society for Ultrasound in Medicine’s deputy section heads for surgery, (in German: Deutsche Gesellschaft für Ultraschall in der Medizin or DEGUM)  described the symptoms of a calcified shoulder.

The variety of symptoms makes calcific tendinitis appear like a chameleon. Because of the severe pain, patients can often hardly move their arm and cannot lie on the affected shoulder; a gentle posture can even cause the shoulder to stiffen.

Diagnosis of calcific tendinitis: therapy options

People between the ages of 35 and 50 are mainly affected by calcific tendinitis, around two-thirds of whom are women. The disease is usually diagnosed quite late because as long as the deposits are small, they do not cause any symptoms. It can be assumed that about 40% of asymptomatic calcium deposits cause discomfort in the further course of the disease.

"We can confirm the suspected diagnosis, which we have made on the basis of the symptoms and the movement restrictions, with the help of the ultrasound procedure and an X-ray examination," explained Dr. Berthold. "Compared to magnetic resonance imaging, this combination is highly accurate and can be performed quickly and inexpensively. 

Why the calcium accumulations form has not yet been clarified. One cause could be a lack of blood circulation and thus a lack of oxygen in the shoulder tendons. A therapeutic approach is, therefore, the activation of the metabolism - and thus also the blood circulation - through targeted movement. Special stretching exercises help to alleviate the pain. If necessary, doctors can also prescribe medication for pain or inflammation in order to relieve patients, who are often severely restricted in their everyday lives and at work, at short notice. Sometimes physiotherapists also use therapeutic ultrasound to support pain treatment.

As long as the patients cope well with their complaints, the usually benign yet spontaneous course of the disease can be managed. This is because calcifications often dissolve on their own over time - but this can take months and is associated with severe pain. Patients are sometimes advised to undergo surgery if there is a large accumulation of calcium.

Shock waves as a gentle alternative to surgery

However, shock wave therapy can be a gentle alternative. The benefits of the treatment in terms of improving symptoms and reducing calcium deposits have now been proven in many studies. Physicians use ultrasound not only for diagnosis but also for more precise treatment.

Focused extracorporeal shock wave therapy (ESWT) uses piezoelectric technology to generate impulses outside the body that are effective inside the body. In calcific tendinitis therapy, focused shock waves are directed specifically at the calcific deposits in the shoulder tendon. This focus can be calculated and the device adapted according to the position of the calcium deposit. The shock wave effect can then be precisely aligned to the desired zone. The tissue around the calcium accumulation - i.e. the skin, the muscles, and connective tissue - is therefore not affected.

"It is often assumed that the shock waves destroy the calcium deposit. However, this is not correct - rather the pressure impulse causes the induction of cellular reactions", Dr. Berthold explained the procedure further. "The increased blood circulation with new blood vessels in the affected area then leads to the dissolution of the calcium deposits.

Alternatively, there is the cheaper radial shock wave therapy. It usually works with compressed air. The impact of a projectile on an applicator generates the unfocused pressure waves. However, the effectiveness of this low-energy procedure is lower - the number of necessary treatments is therefore usually higher.

"One to three treatments, each lasting about ten minutes, are often sufficient for the focused shock wave," Dr. Berthold assured. "The side effects are minimal, the patients often become pain-free and flexible in the shoulder again through this gentle procedure. The duration of the disease is shortened and surgery is usually avoided."