Shockwave therapy versus local steroid injection in chronic supraspinatus tendinopathy

The effects of focused extracorporeal shockwave therapy versus deep friction massage in supraspinatus tendinopathy: A randomized controlled trial

PURPOSE

The purpose of this study was to compare the efficacy of extracorporeal shock wave therapy (ESWT) and deep friction massage (DFM) in treating supraspinatus tendinitis in non-professional athletes.

METHODS

Thirty-two non-professional athletes diagnosed with supraspinatus tendinitis were randomly assigned to either the ESWT group with therapeutic exercise or the DFM group with therapeutic exercise. Outcome assessments were conducted before the intervention, after 12 sessions, and one week later. The primary outcomes measured were pain intensity and the pressure pain threshold (PPT) of the supraspinatus and deltoid muscles. Secondary outcomes included shoulder abduction, external rotation, supraspinatus strength, and quality of life. Between-group comparisons were performed using one-way ANOVA/ANCOVA, and effect sizes were calculated.

RESULTS

The group × time interaction was significant for pain (p = 0.011), PPT (p = 0.04), and shoulder abduction (p = 0.04), while no significant interaction was found for shoulder external rotation or supraspinatus strength (p > 0.05). Within-group analysis revealed significant improvements in all outcomes compared to baseline in both groups.Between-group comparisons demonstrated the superior effectiveness of shockwave therapy in improving pain (p = 0.024, effect size = -0.84), increasing the PPT of the supraspinatus (p = 0.0001, effect size = 1.65) and deltoid (p < 0.0001, effect size = 2.61), and enhancing shoulder abduction (p = 0.001, effect size = 1.31). Effect sizes indicated high efficacy (greater than 0.8) favoring shockwave therapy. However, no significant differences were observed between the groups in shoulder external rotation (p = 0.2), supraspinatus strength (p = 0.42), or quality of life (p = 0.97).

CONCLUSIONS

This study concludes that shockwave therapy is significantly more effective than deep friction massage for managing supraspinatus tendinitis.

Efficacy of Ultrasound-Guided Injections in Patients Unable to Access or Benefit From Physical Therapy: A Comparative Study of Subacromial Corticosteroid Injection, Suprascapular Nerve Block, and Their Combination in Shoulder Impingement Syndrome

Background This study aims to compare the efficacy of ultrasound (US)-guided subacromial bursa steroid injection (SABSI), suprascapular nerve block (SSNB), and combined injection therapy (SABSI + SSNB) on pain and shoulder function in patients with subacromial impingement syndrome who either did not respond to physical medicine and rehabilitation (PM&R) or reported being unable to attend the PM&R unit regularly. Methodology In this prospective, comparative cohort study, patients were randomly assigned using the envelope method to ensure an unbiased distribution. In total, 95 patients with subacromial impingement syndrome were divided into three groups according to the injection technique applied. All injections were applied to Group 1 (SABSI), Group 2 (SSNB), and Group 3 (SABSI + SSNB) under US guidance. Pain and shoulder function levels of the groups before and after treatment at one month and three months were evaluated using the Visual Analog Scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) scale, respectively. For statistical analysis, the Shapiro-Wilk test was used to assess the normality of continuous data. One-way analysis of variance with Bonferroni correction was applied for normally distributed variables, while the Kruskal-Wallis test was used for non-normally distributed data. Pearson's chi-square test was performed to compare categorical variables. Results Between pre-treatment and one month post-treatment, there were statistically significant differences in the percentage change of VAS rest, VAS activity, and DASH scores among the groups (p = 0.004, <0.001, and <0.001, respectively). These significant differences persisted over the period from pre-treatment to three months post-treatment, with all p-values being ≤0.002. Throughout both assessment intervals, Groups 1 and 2 displayed statistically similar percentage changes across all parameters; however, these changes were significantly lower than those observed in Group 3. Patients unable to attend PM&R units displayed a longer symptom duration compared to patients who were non-responders to PM&R (p = 0.015). The distribution of these three injection techniques across the two groups was similar (p = 0.831), and both groups showed similar responses to US-guided injections in terms of pain and functionality (all p > 0.05). Conclusions US-guided SABSI combined with SSNB in patients with shoulder impingement was found to be superior compared to their sole applications in terms of improvement in shoulder pain and function. These findings suggest that the combined approach is a promising alternative for managing shoulder impingement syndrome, particularly in patients facing barriers to PM&R access.

Effect of extracorporeal shock wave therapy and ultrasound-guided percutaneous lavage in reducing the pain of rotator cuff calcific tendinopathy; an updated systematic review and meta-analysis

Background

Extracorporeal shockwave therapy (ESWT) and ultrasound-guided percutaneous lavage (UGPL or barbotage) are among those used to treat the pain of rotator cuff calcific tendinopathy (RCCT). This meta-analysis was done to review the effect ESWT and UGPL in reducing the pain of RCCT.

Methods

A comprehensive search was done based on the PRISMA. PubMed, Web of Science, Scopus, Cochrane Library and Google Scholar were reviewed for articles published by Feb 1, 2024, on ESWT vs. UGPL. The main keywords searched are as follows: "rotator cuff calcific tendinopathy", "tendinitis", " ESWT", " ultrasound-guided percutaneous lavage", " RCCT ″, " UGPL", " extracorporeal shock wave therapy" and titles or abstracts may contain one or a mix of these elements. This study was registered at PROSPERO with code" CRD42022385068". STATA version 13 was applied to analyze.

Results

In general, 779 patients from 22 studies were analyzed. The mean age was 51.85 ± 3.41 years. The patients were referred after 18.69 months of suffering from tendinopathy symptoms. Right-sided and supraspinatus locations were affected more. ESWT has been effective in a decrease of calcium deposit (-1.70 SMD after 1 week for ESWT, -0.96 SMD after 12 weeks for ESWT and -1.20 SMD after 12 weeks UPGL). ESWT has been effective in decreasing VAS by -4.32 SMD after 1 week while UPGL showed -0.23 SMD reductions in VAS After 1 week but in time >1 week, UPGL showed better effect by more reduction in VAS. ESWT has been effective in an increase of CMS by 1.60 SMD after 4-6 weeks, by 1.79 SMD after 12 weeks, by 2.44 SMD after 24 weeks, and 2.53 SMD after 48 weeks.

Conclusion

Based on the results, ultrasound-guided lavage is more effective in reducing pain than ESWT, and this effect becomes more evident in the long term. In terms of CMS score, over time, the efficiency of ESWT becomes more visible. In long-term follow-up, UPGL had a better effect on the calcium deposit reduction.

Effects of adjuvant application of corticosteroid and ozone after ultrasound-guided puncture and lavage for the treatment of rotator cuff calcific tendinitis: study protocol for a non-inferiority randomized controlled trial

BACKGROUND

Steroid injection after percutaneous irrigation of calcific deposits is a common method for the treatment of rotator cuff calcific tendinitis (RCCT). However, steroids may prevent calcification resorption and cause potentially irreversible damage to tendons. Recent studies have confirmed the positive effects of ozone injection in shoulder tendinopathies, but no RCCTs have been reported. Thus, our study aims to evaluate the non-inferiority of ozone versus steroid injection.

METHODS

This is a prospective, randomized, parallel control and non-inferiority trial. A total of 100 patients with unilateral symptomatic RCCT will be enrolled and randomized in a 1:1 ratio to two groups: ultrasound-guided injection with ozone or corticosteroid. The primary outcome is the numeric rating scale for pain (NRS) at 1 week and 3 months following the procedure. Secondary outcomes include a multi-dimensional evaluation of shoulder disability and quality of life improvement, the degree of calcification absorption after treatment, and the number of multiple treatments.

DISCUSSION

The results of this study will provide short-term and long-term evidence for the effectiveness of ozone treatment in RCCT in relieving pain or improving shoulder function.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2200063469. Registered on 7 September 2022.

Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

Background

Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments.

The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment.

Results

Forty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness.

Conclusion

ESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

Platelet rich plasma versus extracorporeal shock wave therapy in patients with non-calcific supraspinatous tears

Background

To compare the clinical efficacy of platelet rich plasma (PRP) subacromial injection and extracorporeal shock wave therapy (ESWT) on refractory non-calcific partial thickness supraspinatous tendon tear.

Results

Significant improvement in all outcome measures achieved in both groups at 4 weeks follow-up period (the end of treatment course) (P< 0.05). At 12 weeks follow-up period, group I, showed significant improvement in all outcome measures compared to baseline and group II; however, in group II, there was no significant difference compared to baseline; moreover, deterioration in the previous improvement was noticed.

Conclusion

Both PRP (group I) and ESWT (group II) are effective therapeutic methods in the management of refractory non-calcific partial thickness supraspinatous tendon tear; however, PRP (group I) has better long-term effects on both pain and function.