Shockwave therapy for calcific shoulder tendinopathy
Calcium deposits in a rotator cuff tendon can produce shoulder pain that is out of proportion to anything visible on movement. It is the one shoulder presentation with a NICE assessment of shockwave behind it.
What you're seeing
Understanding calcific shoulder tendinopathy
Calcific tendinopathy is the deposition of calcium within a rotator cuff tendon, most often supraspinatus. It produces shoulder pain that is often worse at night and worse reaching overhead or behind the back, and during a resorptive phase it can become severe quickly. It is visible on plain X-ray and on ultrasound, which sets it apart from most tendon problems, where imaging adds little.
The natural history is unusual and it shapes every treatment decision. Deposits frequently resorb on their own, sometimes over months and sometimes over years, and the most painful phase is often the phase in which the body is actively breaking the deposit down. A shoulder that has become suddenly much more painful can therefore be a shoulder that is resolving.
NICE assessed shockwave for this condition in interventional procedures guidance IPG21, which covers calcific tendonitis of the shoulder. This is an older document than the other three musculoskeletal assessments and it sits apart from them, so results and conclusions from the plantar fasciitis or tennis elbow guidance do not carry across to it.
Imaging comes first here more than anywhere else on this site, because several shoulder conditions look alike from the outside and take entirely different paths. Extracorporeal shockwave therapy covers what a course involves, and radial and focused shockwave compared matters particularly for a deposit sitting several centimetres down.
Why it happens
What causes calcific shoulder tendinopathy?
- Calcium deposition within a rotator cuff tendon, most often supraspinatus
- A resorptive phase in which the body breaks the deposit down, which is frequently the most painful stage
- Overhead loading that the cuff had not adapted to, at work or in sport
- Reduced rotator cuff and scapular strength, so the tendon takes more of each load
- Age, with the presentation most common between the fourth and sixth decades
- A previous episode in the same shoulder that was never fully rehabilitated
Treatment approach
Where shockwave therapy fits for calcific shoulder tendinopathy
FAQ
Shockwave therapy for calcific shoulder tendinopathy
questions people ask
What is calcific tendinopathy of the shoulder?
Calcium deposited within a rotator cuff tendon, most often supraspinatus. It causes pain that is typically worse at night and worse reaching overhead. Unlike most tendon problems it is visible on plain X-ray and on ultrasound, so the diagnosis can usually be confirmed rather than inferred.
Do calcium deposits in the shoulder go away?
Frequently, yes, and often without any intervention. Deposits resorb over months or years. The resorptive phase, when the body is actively breaking the deposit down, is often the most painful stage, so a sharp increase in pain can accompany the shoulder resolving rather than deteriorating.
Why does a shoulder need a scan before shockwave?
Because several shoulder conditions produce similar pain and take different paths. A rotator cuff tear, adhesive capsulitis and calcific tendinopathy can all present as a painful stiff shoulder. Ultrasound or X-ray confirms which is present before anyone commits to a course of treatment.
Does shockwave work for frozen shoulder?
Frozen shoulder is adhesive capsulitis, a different condition from calcific tendinopathy, and there is no NICE assessment of shockwave for it. The calcific presentation is the one covered here. A clinician who examines you can tell the two apart, and the distinction changes the treatment entirely.
Does the type of shockwave device matter for the shoulder?
It can. Radial devices deliver most of their energy near the surface while focused devices concentrate energy at depth, and a cuff deposit can sit several centimetres in. Asking which device a clinic uses is a reasonable question, and the answer determines which evidence is relevant.
Get Started
Describe the problem and what has been tried.
UNTIL Health Concierge arranges the examination.
London Shockwave Therapy • UNTIL, 280 Bishopsgate, London EC2M 4RB
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