SHOULDER PAIN HELPED WITH EXTRACORPOREAL SHOCKWAVE THERAPY IN THE BAY AREA

  • CALCIFIC TENDONITIS OF THE SHOULDER

  • FROZEN SHOULDER (scroll down)

WHAT IS CALCIFIC TENDONITIS OF THE SHOULDER? Shoulder Pain from Calcific Tendonitis and Frozen Shoulder is helped with ESWT

Frozen shoulder is adhesions (calcification) in the joint capsule of the shoulder. To break it down, calcific tendonitis is a calcification of the tendons of the rotator cuff muscles in your shoulder.  It starts when there is inflammation from an injury or micro-trauma in the shoulder.  The tendons heal by collagen forming cells called fibroblasts.  With calcific tendonitis, on the other hand, fibroblasts are replaced with osteoblasts.  Osteoblasts make a bone-like tendon.  Therefore, these are bone forming cells that, literally, stimulate bone growth in the tendons of the shoulder.  

It follows that when rotator cuff tendons calcify, the space between the tendon and the top of the shoulder (acromion) decreases and this causes impingement. This leads to further tendonitis and bursitis.

Calcific tendonitis tends to give some of the following SYMPTOMS:

  • Decreased shoulder mobility
  • Shoulder weakness
  • Soreness that is worse in the morning
  • Inflammation/swelling
  • Shoulder makes sounds on movement
  • Palpable painful lump on the tendon
  • Pain moving arm overhead

7 STEP TREATMENT FOR CALCIFIC TENDONITIS

  1. First of all, stop painful activities and apply heat (no anti-inflammatories)
  2. Most importantly, regain range of motion by breaking up calcifications with ESWT in our Los Gatos office
  3. Mobilize scapular movement with adjustments and exercises (see below for some exercises)
  4. While doing all of this, optimize spinal movement to restore neurology to shoulder
  5. At the prescribed time, strengthen rotator cuff muscles (see below)
  6. Now, build on your strength by adding challenging neuromuscular movements
  7. Finally, get back to your Bay Area life of fun and work

HOW CAN SHOCKWAVES HELP MY CALCIFIC TENDONITIS?

Piezowave ESWT being used to treat frozen shoulder

Dr. Fields of San Jose, CA demonstrating the use of ESWT for shoulder dysfunction

The Piezowave 2 sends acoustic waves traveling the speed of sound into your calcified tendon. The wave energy causes wave-like movement of the tissue.  Because it is pliable, normal tissue just ripples.  However, calcified tissue breaks up like hard spaghetti that is bent. As a result, there is a cascade of events that spawn healing. First, new blood vessels come into the injured tendon (this is called angiogenesis). This allows your body to bring in healing properties and to flush out old inflammatory waste products.  Most noteworthy is new collagen fibers are allowed to grow and flourish. Consequently, you are left with a stronger and more adaptable tendon that is better able to handle the mechanical stresses of life.

RESEARCH ON CALCIFIC TENDONITIS AND ESWT

Research papers on ESWT are extensiveLet’s be very clear, the research on calcific tendonitis and ESWT is excellent. The success rate is between 78% and 91%[1, 2, 3, 4, 5, 6, 7, 8, 9, 10].  In a study with patients between 40 and 50 years of age, ESWT fragmented the calcifications which resulted in full range of motion and complete pain relief even 2 years post treatment [11].

Furthermore, studies show via x-ray that the calcium deposits can be broken up and eliminated and that the more they are broken up the better the result [12].

It just gets better.  MRI analysis has shown extracorporeal shockwave therapy not to have caused any damage to bone or soft tissue[13, 14].

In addition, Rompe et al showed such improvement he stated that extracorporeal shockwave therapy has equal or better results than surgery in people with calcific tendonitis of the shoulder [15][16].

With such great results, there’s no reason to wait.  Come visit our Los Gatos location- (408) 274-2244

WHAT IS FROZEN SHOULDER OR ADHESIVE CAPSULITIS?Frozen Shoulder helped with ESWT by Dr. Adam Fields

As calcific tendonitis is a calcification of the tendons of the shoulder, frozen shoulder is a calcification of the joint capsule of the shoulder. The symptoms of frozen shoulder are pain and decreased range of motion.  The condition is common after an injury and prolonged immobilization.  It can be challenging when sleeping on the shoulder or during overhead activities like painting, washing your hair, throwing a ball, etc..

THREE PHASES TO A FROZEN SHOULDER

  1. First, there is a thickening of the joint capsule, with fluid loss and decreased range of motion.  Initially, many people are unaware that this phase is underway.  It lasts 2-8 months.
  2. Next is called the frozen phase.  Here tendons of the shoulder thicken and  the joint space is decreased.  Lasts 4-12 months.
  3. Finally, the resolution phase is where range of motion somewhat comes back.  Another 12-42 months.

CAN EXTRACORPOREAL SHOCKWAVE THERAPY DECREASE HEALING TIMES FOR FROZEN SHOULDER?

An article in the Journal of Preventative Medicine said it best when they stated, “Through generating low-energy waves and electromagnetic excitation could be effective in this condition due to increasing the regional blood flow, neovascular changes, enzymes release, reduction of inflammatory cytokines, and increasing the flexibility of the collagen fibers and tendons in that area.”  They concluded with saying, “The use of ESWT seems to have positive effects on treatment, quicker return to daily activities, and quality-of-life improvement on frozen shoulder [17].”

To point back to the 3 phases of frozen shoulder, the shockwave treatment gets you out of the frozen phase and through the resolution phase.

When it comes to frozen shoulder and extracorporeal shockwave therapy, we’ll let the scientists speak for the results.  Now add to this the rehab you will receive in our office.  Adding to these key healing ingredients, will also receive specific spinal techniques to add better neurological brain-shoulder connection for improved mechanics, home care recommendations for mobilization and, eventually, strengthening exercises.  

SAMPLE EXERCISES FOR FROZEN SHOULDER AND ADHESIVE CAPSULITIS REHAB:

Pendulum exercise for frozen shoulder

Pendulum exercise for frozen shoulder

Hanging for frozen shoulder

Hanging exercise for frozen shoulder

Supraspinatus strengthening

Supraspinatus strengthening in the later phase of your rehab.

Teres minor strengthening is vital to shoulder stability

Strengthening your external rotators will be crucial down the line.

We are honored to put our knowledge to work on your shoulder in our San Jose or Los Gatos locations.  The Piezowave 2 is available only in Los Gatos (408) 274-2244

SOME OF THE MANY RESEARCH ARTICLES FOR CALCIFIC TENDONITIS AND FROZEN SHOULDER

  1. Cacchio A, Paoloni M, Barile A, Don R, de Paulis F, Calvisi V, Ranavolo A, Frascarelli M, Santilli V, Spacca G: Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder:single-blind, randomized clinical study. Phys Ther. 2006, 86 (5): 672-82.PubMedGoogle Scholar
  2. Daecke W, Kusnierczak D, Loew M: Long-term effects of extracorporeal shockwave therapy in chronic calcific tendinitis of the shoulder. J Shoulder Elbow Surg. 2002, 11 (5): 476-80. 10.1067/mse.2002.126614.PubMedView ArticleGoogle Scholar
  3. Hsu CJ, Wang DY, Tseng KF, Fong YC, Hsu HC, Jim YF: Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. J Shoulder Elbow Surg. 2008, 17 (1): 55-9. 10.1016/j.jse.2007.03.023.PubMedView ArticleGoogle Scholar
  4. Jakobeit C, Winiarski B, Jakobeit S, Welp L, Spelsberg G: Ultrasound-guided, high-energy extracorporeal shock-wave treatment of symptomatic calcareous tendinopathy of the shoulder. ANZ J Surg. 2002, 72 (7): 496-500. 10.1046/j.1445-2197.2002.02423.x.PubMedView ArticleGoogle Scholar
  5. Krasny C, Enenkel M, Aigner N, Wlk M, Landsiedl F: Ultrasound-guided needling combined with shock-wave therapy for the treatment of calcifying tendonitis of the shoulder. J Bone Joint Surg Br. 2005, 87 (4): 501-7. 10.1302/0301-620X.87B4.15769.PubMedView ArticleGoogle Scholar
  6. Pan PJ, Chou CL, Chiou HJ, Ma HL, Lee HC, Chan RC: Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study. Arch Phy Med Rehab. 2003, 84 (7): 988-93. 10.1016/S0003-9993(03)00010-8.View ArticleGoogle Scholar
  7. Peters J, Luboldt W, Schwarz W, Jacobi V, Herzog C, Vogl TJ: Extracorporeal shock wave therapy in calcific tendinitis of the shoulder. Skeletal Radiol. 2004, 33 (12): 712-8. 10.1007/s00256-004-0849-8.PubMedView ArticleGoogle Scholar
  8. Pleiner J, Crevenna R, Langenberger H, Keilani M, Nuhr M, Kainberger F, Wolzt M, Wiesinger G, Quittan M: Extracorporeal shockwave treatment is effective in calcific tendonitis of the shoulder. A randomized controlled trial. Wien Klin Wochenschr. 2004, 116 (15-16): 536-41. 10.1007/BF03217707.PubMedView ArticleGoogle Scholar
  9. Rompe JD, Burger R, Hopf C, Eysel P: Shoulder function after extracorporal shock wave therapy for calcific tendinitis. J Shoulder Elbow Surg. 1998, 7 (5): 505-9. 10.1016/S1058-2746(98)90203-8.PubMedView ArticleGoogle Scholar
  10. Wang CJ, Ko JY, Chen HS: Treatment of calcifying tendinitis of the shoulder with shock wave therapy. Clin Orthop. 2001, 387: 83-9.PubMedView ArticleGoogle Scholar
  11. Spindler A, Berman A, Lucero E, Braier M: Extracorporeal shock wave treatment for chronic calcific tendinitis of the shoulder. J Rheum. 1998, 25 (6): 1161-3.PubMedGoogle Scholar
  12. Wang CJ, Yang KD, Wang FS, Chen HH, Wang JW: Shock wave therapy for calcific tendinitis of the shoulder: a prospective clinical study with two-year follow-up. Am J Sports Med. 2003, 31 (3): 425-30.PubMedGoogle Scholar
  13. Jurgowski W, Loew M, Cotta H, Staehler G: Extracorporeal shock wave treatment of calcareous tendonitis of the shoulder. J Endourol. 1993, 7 (Suppl 1): 13-17.Google Scholar
  14. Loew M, Daecke W, Kusnierezak D, Rahmanzadeh M, Ewerbeck V: Shock wave application in calcifying tendinitis of the shoulder: prediction of outcome by imaging. Arch Orthop Trauma Surg. 2000, 120: 43-8.Google Scholar
  15. Rompe JD, Eysel P, Hopf C, Krischek O, Vogel J, Burger R, Jage J, Heine J: [Extracorporeal shockwave therapy in orthopedics. Positive results in tennis elbow and tendinosis calcarea of the shoulder]. Fortschritte der Medizin. 1997, 26 (18): 29-33.Google Scholar
  16. Rompe JD, Zoellner J, Nafe B: Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder. Clin Orthop. 2001, 387: 72-82.PubMedView ArticleGoogle Scholar
  17. Int J Prev Med. Jul 2014; 5(7): 875–881.PMCID: PMC4124565 Babak Vahdatpour, Parisa Taheri,  Abolghasem Zare Zade, and Saeed Moradian Efficacy of Extracorporeal Shockwave Therapy in Frozen Shoulder Int J Prev Med. Jul 2014; 5(7): 875–881.PMCID: PMC4124565