Chronic Calcific Rotator Cuff Tendinopathy

Rotator cuff injuries are common among sports with overhead movements such as the serve or smash in tennis. Injury to the rotator cuff can be either overuse (excessive repetition) or traumatic (sudden pain after an action). The most common types of injury include strains or tears and tendinopathy (tendon pain), usually to the supraspinatus muscle. Occasionally the tendon may become calcified. Symptoms include pain, restriction in shoulder mobility and difficulty with overhead movements.

Avoidance of the aggravating movements is encouraged as well as icing. Treatment and rehabilitation may be required to fully alleviate the symptoms as well as correction of any biomechanical abnormalities of shoulder, arm, spine and shoulder blade which may have predisposed to the injury. Rehabilitation also includes progressive strengthening and stretching as well as looking at any possible technique/training faults.
Current evidence for the use of shockwave in rotator cuff tendinopathy is promising in calcific tendons but very limited. Evidence is poor for use of shockwave in non-calcific rotator cuff tendinopathy.

A systematic review performed in 2011 concluded that only high energy shockwave had any therapeutic benefits for chronic calcific tendinopathy of the shoulder and that there was no benefit of shockwave for non-calcific rotator cuff tendinopathy.

A systematic review performed in 2014 concluded that focused shockwave therapy had some benefits in the treatment of calcific rotator cuff tendinopathy.

Another systematic review carried out in 2014 specifically looking at the use of shockwave therapy for calcific tendinopathy also concluded the shockwave therapy can improve symptoms and function n chronic calcific shoulder tendinopathies. However, it should be made clear that there are only a small number of randomised control studies and further research is required.

Shockwave may be used as a possible treatment modality for the treatment of chronic calcific tendinopathy (diagnosed by ultrasound) but no evidence exists for the benefits of shockwave therapy for non-calcific tendinopathy. However, the evidence is very limited for its efficacy in the treatment of rotator cuff tendinopathy.

• Huisstede BM et al. Evidence for the effectiveness of extracorporeal shock-wave therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis: a systematic review. Man Ther. 2011;16(5):419-33.
• Speed C. A systematic review of shockwave therapies in soft-tissue conditions: focussing on the evidence. Brit Jour Sports Med. 2014;48(21)
• Bannuru RR, Flavin NE, Vaysbrot E et al. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review. Ann Intern Med. 2014;160(8):542-9.