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Shocking Sore Shoulders Back to Health

Sound waves successfully treat tendonitis of the rotator cuff

TUESDAY, Nov. 18, 2003 (HealthDayNews) -- Sound waves to tame tendonitis in the shoulder?

German researchers say they've done just that -- using extracorporeal shock wave therapy to successfully treat chronic calcifying tendonitis of the rotator cuff in patients who'd otherwise need surgery.

"For the first time in the treatment of chronic calcifying tendonitis of the rotator cuff we have found a nonsurgical technique that is effective," says lead researcher Dr. Ludger Gerdesmeyer, an orthopedic surgeon at the Technical University of Munich.

How ESWT works is not fully known. It delivers shock -- or sound -- waves that may disrupt calcium deposits, increase the spread of enzymes across blood vessel walls, stimulate blood vessel growth, and/or promote new bone formation. One or more of these mechanisms may aid in healing, the researchers say.

According to a report in the Nov. 19 issue of the Journal of the American Medical Association, Gerdesmeyer and his colleagues studied 144 patients with chronic tendonitis of the rotator cuff. The rotator cuff is comprised of the muscles and tendons that surround the top of the upper arm bone and hold it in the shoulder joint. These patients had all undergone other therapies, including massage therapy and steroid injections, which did not fix the problem.

Gerdesmeyer's team divided the patients into three groups. Some patients received low-energy ESWT, some got high-energy ESWT, and the remainder were given a sham procedure that had no therapeutic effect.

The patients were given two treatment sessions that were administered two weeks apart. After treatment, the patients also received additional physical therapy.

During six months of follow-up, those who received ESWT showed significant improvement, compared with patients who did not receive the treatment, the researchers report. They also found that patients receiving high-energy ESWT showed greater improvement than those who got low-energy ESWT.

Normally, these patients would have to undergo surgery, Gerdesmeyer says. However, given these findings, "people with chronic pain of the rotator cuff should be treated with ESWT, not surgery," he adds.

Gerdesmeyer and his group are looking to refine their treatment by finding the best energy levels and the most effective number of treatments.

Dr. David S. Bailie, an orthopedic surgeon and a sports medicine expert, says, "ESWT is effective for this problem, and we have had some success in our practice with low-energy ESWT treatment."

Bailie notes that ESWT is noninvasive and takes only several treatments. "Early results from an ongoing study demonstrate about an 85 percent success rate thus far," he adds.

"ESWT can be viewed as an alternative to surgery with few, if any, side effects. And it's probably better and safer than repeated steroid injections," Bailie says.

"Before undergoing any treatment, patients with tendonitis of the rotator cuff should ask about all options and consider the risk/benefit of all treatments," he advises. "A procedure should not 'burn a bridge' for successful subsequent procedures, should they be needed."

More information

To learn more about rotator cuff problems, visit the American Orthopaedic Society for Sports Medicine. For more on extracorporeal shock wave therapy, visit the American College of Foot and Ankle Surgeons.

SOURCES: Ludger Gerdesmeyer, M.D., Department of Orthopedic Surgery and Sportstraumatology, Technical University of Munich, Germany; David S. Bailie, M.D., chairman, orthopedic surgery, Scottsdale Healthcare, Scottsdale, Ariz.; Nov. 19, 2003, Journal of the American Medical Association
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