Treatment Protocol for Rotator Cuff Calcific Tendinitis Using a Single-Crystal Piezoelectric Focused Shock Wave Source

To begin, position the patient comfortably in a way that allows exposure to the area to be treated. For a supraspinatus or infraspinatus tendon location, treat by placing the patient in the supine or sitting position. For a subscapularis place the patient in the supine position.

For tares minor, place the patient in the sitting lateral decubitus or oblique decubitus position for better access to the posterior aspect of the shoulder. Then select a coupling pad size depending on the required penetration depth of the focused point. The selection of the coupling pad varies in shoulder calcification cases according to the build.

The most frequently used sizes are large and medium. Next, locate the area to be treated, considering anatomical landmarks and with the help of ultrasound images if necessary. Also, position an operator to support in using the applicator and ensure working in an ergonomic position.

Apply adequate contact gel to the skin in the area to be treated, then turn on the device and access the touch screen. Select the MANUAL option at the top of the screen. The controls of the various treatment parameters are displayed.

Use the rotary selection knob to set the treatment parameters. Set the initial intensity of the treatment. Increase the intensity progressively as tolerated by the patient, starting with low intensity.

Reach at least an energy level above 0.40 millijoules per millimeter squared to obtain reproducible results. Then select a frequency to be used, between four to six hertz. Select the number of shocks to be applied using the rotary selection knob.

Apply at least 4, 000 shocks per session. Modify the frequency or the intensity during the application. Use the display located and the applicator head to easily modify the application parameters during the the treatment without having to interrupt the procedure.

Retrospective study of a series of patients with shoulder pain due to calcium deposits in the rotator cuff tendons was carried out. The study group consisted of 13 female and 10 male patients with an average age of 52.8 years. The supraspinatus muscle was affected in 82.6%of cases, the infraspinatus in 13%and the subscapularis in 4.4%In all cases, only one tendon was involved.

The minimum follow up was six months with an average of 14 months. In 82.6%of the cases, complete reabsorption of the calcification was achieved. In 8.7%partial disappearance with symptomatic improvement was obtained.

In the remaining 8.7%there were no significant changes and an ultrasound guided puncture was performed. With the exception of one case of fainting during application and two cases of transient pain during the resorption process, there were no complications. Disappearance of calcification was observed for the tendon of the subscapularis muscle after six weeks, and also for the supraspinatus muscle tendon after 12 weeks.