Results of focal shock-wave therapy for calcifying tendinitis of the rotator cuf
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Published:
Jan 19, 2013
Keywords:
Calcification, Rotator cuff, Shock waves, Shoulder,
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Abstract
Background:The aim of this study is to prospectively assess the results of the application of focal shock waves in a group of patients with rotator cuff calcifications.Methods:We included 44 consecutive cases of calcifications in one of the rotator cuff tendons in 43 patients with failed surgeries or previous conservative treatment for at least 6 months, with persistent symptoms.Results:One year later, the calcification had disappeared completely in 20 patients (45.5%). In 13 cases (29.5%) there was a significant change in size or density. In 11 cases (25%) there were no modifications. Pain, according to the visual analogue scale, decreased from a mean of 5.5 to 1.4 (p <0.0001). The UCLA score increased from an initial average value of 15.7 to a final value of 29.3 (p <0.0001). The Self ASES evaluation scored 84.6 compared to the initial value of 48 (p <0,0001). In 77% of cases, patients were satisfied with the procedure.Conclusion:The study suggests that the shock-wave therapy is a valid alternative for patients in whom conservative or even surgical treatments have faile
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Moya, D., & Patiño, O. (2013). Results of focal shock-wave therapy for calcifying tendinitis of the rotator cuf. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 77(4), 223-232. https://doi.org/10.15417/109
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Clinical Research
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References
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2. Sems A, Dimeff R, Iannotti JP. Extracorporeal shock wave therapy in the treatment of chronic tendinopathies. J Am Acad Orthop Surg 2006;14(4):195-204.
3. Wang CJ. Biological mechanism of musculoskeletal shockwaves. ISMST Newsletter 2006;1(1):5-11.
4. Moya D. Terapia por onda de choque. Rev Asoc Argent Ortop Traumatol 2002;67(4):273-86.
5. Codman EA. Rupture tendon of the supraspinatus tendon and other lesion in or about the subacromial bursa. In: Codman EA. The Shoulder. Boston: Thomas Todd; 1984, p. 178-215.
6. Hajiroussou VJ, Webley M. Familial calcific periarthritis. Ann Rheum Dis 1983;42:469-70.
7. Harvie P, Pollard PC, Carr AJ. Calcific tendinitis: natural history and association with endocrine disorders. J Shoulder Elbow Surg 2007;16(2):169-73.
8. Mavrikakis ME, Drimis S, Kontoyannis DA, Rasidakis A, Moulopoulou ES, Kontoyannis S. Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: a controlled study. Ann Rheum Dis 1989;48:211-4.
9. Moseley HF. The natural history and clinical syndromes produced by calcified deposits in the rotator cuff. Surg Clin North Am 1963;43:1489-93.
10. Sengar D, McKendry RJ, Uhthoff HK. Increased frequency of HLA-A1 in calcifying tendinitis. Tissue Antigens 1987;29:173-4.
11. Simon WH. Soft tissue disorders of the shoulder. Frozen shoulder, calcific tendinitis, and bicipital tendinitis. Orthop Clin North Am 1975;6:521.
12. Uththoff H, Sarkar K, Maynard JA. Calcifying tendinitis: a new concept of its pathogenesis. Clin Orthop Relat Res 1976;118:164-8.
13. Sarkar K, Uhthoff H. Ultrastructural localization of calcium in calcifying tendinitis. Arch Patol Lab Med 1978;102:266-9.
14. Postacchini F, Gumina S. Calcific tendinopathy of the rotator cuff in asymptomatic subjects. European Federation of National Associations of Orthopaedics and Traumatology (EFORT): Oral Presentations: rotator cuff disorders and brachial plexus, Helsinki, 2003.
15. Uhthoff HK. Calcifying tendinitis. Ann Chir Gynaecol 1996;85:111-5.
16. Uhtthoff H, Loehr JW. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis and management. J Am Acad Orthop Surgeons 1997;5(4):183-91.
17. Bosworth BM. Calcium deposits in the shoulder and subacromial bursitis. A survey of 12,122 shoulders. JAMA 1941;2477-82.
18. Gärtner J, Heyer A. Tendinosis calcarea der Schulter. Orthopade 1995;24:284-302.
19. Aina R, Cardinal E, Bureau NJ, Aubin B, Brassard P. Calcific shoulder tendinitis: treatment with modified US-guided fineneedle technique. Radiology 2001;221:455-61.
20. Ciccone C. Does acetic acid iontophoresis accelerate the resorption of calcium deposits in calcific tendinitis of the shoulder? Phys Ther 2003;83(1):68-74.
21. Ebenbichler GR, Erdogmus CB, Resch KL, Funovics MA, Kainberger F, Barisani G, et al. Ultrasound therapy for calcific tendinitis of the shoulder. N Engl J Med 1999;340:1533-8.
22. Ellman H. Arthroscopic subacromial decompression. Analysis of one to three year results. J Arthroscopy 1987;3(3):173-81.
23. Flax HJ. Ultrasound treatment for peritendinitis calcarea of the shoulder. Am J Phys Med Rehabil 1964;43:117-24.
24. Gärtner J. Tendinosis calcarea: results of treatment with needling. Z Orthop Ihre Grenzgeb 1993;131:461-9.
25. Harmon PH. Methods and results in the treatment of 2,580 painful shoulders, with special reference to calcific tendinitis and the frozen shoulder. Am J Surg 1958;95:527-44.
26. Loew M, Jurgowski W, Mau HC, Thomsen M. Treatment of calcifying tendinitis of rotator cuff by extracorporeal shock waves: a preliminary report. J Shoulder Elbow Surg 1995;4:101-6.
27. Rockwood CA Jr, Matsen FA 3rd, Wirth MA, Lippitt SB (eds.). The Shoulder, 3rd ed. Philadelphia: WB Saunders; 2004, p. 1046-55.
28. Perron M, Malouin F. Acetic acid iontophoresis and ultrasound for the treatment of calcifying tendinitis of the shoulder: a randomized control trial. Arch Phys Med Rehabil 1997;78:379-84.
29. Uhthoff HK, Sarkar K. Surgical repair of rotator cuff ruptures. The importance of sub-acromial bursa. J Bone Joint Surg Br 1991;73:399-401.
30. Weber SC. Arthroscopic treatment of calcific tendinitis. AANA 17th Annual Fall Course Palm Desert, 1998.
31. Wittenberg RH, Rubenthaler F, Wölk T, Ludwig J, Willburger RE, Steffen R. Surgical or conservative treatment for chronic rotator cuff calcifying tendinitis - a matched-pair analysis of 100 patients. Arch Orthop Trauma Surg 2001;121:56-9.
32. Lam F, Bhatia D, Van Rooyen K, de Beer JF. Modern management of calcifying tendinitis of the shoulder. Curr Orthop 2006;20:446-52.
33. De Sèze S, Welfling J. Tendinites calcifiantes. Rhumatologie 1970;22:45-50.
34. Litchman HM, Silver CM, Simon SD, Eshragi A. The surgical management of calcific tendinitis of the shoulder. Int Surg 1968;50:474-82.
35. DePalma AF, Kruper JS. Long-term study of shoulder joints afflicted with and treated for calcific tendinitis. Clin Orthop 1961;20:61-72.
36. Ogon P, Bornebusch L, Izadpanah K, Suedkamp NP. Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulder. Arthritis Rheum 2009;60(10):2978-84.
37. Speed CA. Corticosteroid injections in tendon lesions. BMJ 2001;232:382-6.
38. Partington PF. Diagnostic injection around the shoulder: hit and miss? A cadaveric study of injection accuracy. J Shoulder Elbow Surg 1998;7(2):147-50.
39. Iwanami K. Intratendinous corticosteroid injection induces apoptosis of the rat tendon fibroblasts. Dokyo J Med Sci 2005;32:39-46.
40. Tempfer H, Gehwolf R, Wagner A, Resch H, Hirzinger C, Augat P. Effects of crystalline glucocorticoid triamcinolone acetonide on cultured human supraspinatus tendon cells. Acta Orthopaedica 2009;80(3):357-62.
41. Tillander B, Franzén LE, Karlsson MH, Norlin R. Effect of steroid injections on the rotator cuff: an experimental study in rats. J Shoulder Elbow Surg 1999;8:271-4.
42. Neer CS. Shoulder Reconstruction. Philadelphia: WB Saunders; 1990, p. 43.
43. Gschwend N, Patte D, Zippel J. Therapy of calcific tendinitis of the shoulder. German Arch Orthop Unfallchir 1972;73:120-35.
44. Ark JW, Flock TJ, Flatow EL, Bigliani LU. Arthroscopic treatment of calcific tendinitis of the shoulder. Arthroscopy 1992;8:183-8.
45. McKendry RJR, Uhthoff HK, Sarkar K, Hyslop PS. Calcifying tendinitis of the shoulder: prognostic value of clinical, histologic, and radiologic features in 57 surgically treated cases. J Rheumatol 1982;9:75-80.
46. Seil R, Litzenburger H, Kohn D, Rupp S. Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy 2006;22(5):521-7.
47. Jacobs R, Debeer P. Calcifying tendinitis of the rotator cuff: functional outcome after arthroscopic treatment. Acta Orthop Belg 2006;72(3):276-81.
48. Ellman H, Bigliani LU, Flatow E, Esch IC, Snyder SJ, Oglivie-Harris D, et al. Arthroscopic treatment of calcifying tendinitis: the American experience. 5th International Conference on Shoulder Surgery, Paris, France, 1992.
49. Moke-Nancy D, Walch G, Kemp IF, Gleyze P. Arthroscopic treatment of calcifying tendinitis. Results of the Multicentric European study. 5th International Conference on Shoulder Surgery, Paris, France, 1992.
50. Cosentino R, De Stefano R, Selvi E. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study. Ann Rheum Dis 2003;62:248-50.
51. 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):425-6.
52. Gerdesmeyer L, Wagenpfeil S, Haake M. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA 2003;290:2573-80.
53. 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.
54. Vavken P, Holinka J, Rompe JD, Dorotka R. Focused extracorporeal shock wave therapy in calcifying tendinitis of the shoulder: a meta-analysis. Sports Health 2009;1(2):137-44.
55. Rompe JD, Zollner J, Nafe B, Freitag C. Significance of calcium deposit elimination in tendinosis calcarea of the shoulder. Z Orthop Ihre Grenzgeb 2000;138: 335-9.
56. Rompe JD, Rumler F, Hopf C, Nafe B, Heine J. Extracorporeal shockwave therapy for calcifying tendinitis of the shoulder. Clin Orthop 1995;321:196-201.
57. Rompe JD, Bürger R, Hopf C, Eysel P. Shoulder function after extracorporeal shock wave therapy for calcific tendinitis. J Shoulder Elbow Surg 1998;7:505-9.
58. Schmitt J, Haake M, Tosch A, Hildebrand R, Deike B, Griss P. Low-energy extracorporeal shock-wave treatment (ESWT) for tendinitis of the supraspinatus: a prospective, randomised study. J Bone Joint Surg Br 2001;83:873-6.
59. Speed CA, Richards C, Nichols D, Burnet S, Wies JT, Humphreys H, Hazleman BL. Extracorporeal shock-wave therapy for tendonitis of the rotator cuff: a double-blind, randomised, controlled trial. J Bone Joint Surg Br 2002;84(4):509-12.
60. Thiele R. Tratamiento de las tendinosis calcificadas de hombro mediante ondas de choque. Experiencia de 1800 casos y seguimiento
a 5 años. Bienal Bosque Ortopedia. Universidad del Bosque, Bogotá, 2004.
61. Durst HB, Blatter G, Kuster MS. Osteonecrosis of the humeral head after extracorporeal shock-wave lithotripsy. J Bone Joint Surg Br 2002;84(5):744-6.
62. Liu HM, Chao CM, Hsieh JY, Jiang CC. Humeral head osteonecrosis after extracorporeal shock-wave treatment for rotator cuff tendinopathy. A case report. J Bone Joint Surg Am 2006;88:1353-6.
63. Hearnden AJ, Flannery MC. Extracorporeal shock wave therapy in the treatment of calcific tendonitis of the shoulder. J Bone Joint Surg 2003;85(Suppl II):96.
64. Dubs B. Efficacy and economical aspects: comparison ESWT versus alternate therapies in the treatment of calcifying tendinitis. 6th Congress of the International Society for Musculoskeletal Shockwave Therapy, Orlando, USA, 2003.
65. Eid J. Economic aspects in the treatment of tendinosis calcarea of the shoulder. 9th International Congress of the International Society for Musculoskeletal Shockwave Therapy, 2006.
66. 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.
67. Lorbach O, Kusma M, Pape D, Kohn D, Dienst M. Influence of deposit stage and failed ESWT on the surgical results of
arthroscopic treatment of calcifying tendonitis of the shoulder. Knee Surg Sports Traumatol Arthrosc 2008;16(5):516-2
2. Sems A, Dimeff R, Iannotti JP. Extracorporeal shock wave therapy in the treatment of chronic tendinopathies. J Am Acad Orthop Surg 2006;14(4):195-204.
3. Wang CJ. Biological mechanism of musculoskeletal shockwaves. ISMST Newsletter 2006;1(1):5-11.
4. Moya D. Terapia por onda de choque. Rev Asoc Argent Ortop Traumatol 2002;67(4):273-86.
5. Codman EA. Rupture tendon of the supraspinatus tendon and other lesion in or about the subacromial bursa. In: Codman EA. The Shoulder. Boston: Thomas Todd; 1984, p. 178-215.
6. Hajiroussou VJ, Webley M. Familial calcific periarthritis. Ann Rheum Dis 1983;42:469-70.
7. Harvie P, Pollard PC, Carr AJ. Calcific tendinitis: natural history and association with endocrine disorders. J Shoulder Elbow Surg 2007;16(2):169-73.
8. Mavrikakis ME, Drimis S, Kontoyannis DA, Rasidakis A, Moulopoulou ES, Kontoyannis S. Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: a controlled study. Ann Rheum Dis 1989;48:211-4.
9. Moseley HF. The natural history and clinical syndromes produced by calcified deposits in the rotator cuff. Surg Clin North Am 1963;43:1489-93.
10. Sengar D, McKendry RJ, Uhthoff HK. Increased frequency of HLA-A1 in calcifying tendinitis. Tissue Antigens 1987;29:173-4.
11. Simon WH. Soft tissue disorders of the shoulder. Frozen shoulder, calcific tendinitis, and bicipital tendinitis. Orthop Clin North Am 1975;6:521.
12. Uththoff H, Sarkar K, Maynard JA. Calcifying tendinitis: a new concept of its pathogenesis. Clin Orthop Relat Res 1976;118:164-8.
13. Sarkar K, Uhthoff H. Ultrastructural localization of calcium in calcifying tendinitis. Arch Patol Lab Med 1978;102:266-9.
14. Postacchini F, Gumina S. Calcific tendinopathy of the rotator cuff in asymptomatic subjects. European Federation of National Associations of Orthopaedics and Traumatology (EFORT): Oral Presentations: rotator cuff disorders and brachial plexus, Helsinki, 2003.
15. Uhthoff HK. Calcifying tendinitis. Ann Chir Gynaecol 1996;85:111-5.
16. Uhtthoff H, Loehr JW. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis and management. J Am Acad Orthop Surgeons 1997;5(4):183-91.
17. Bosworth BM. Calcium deposits in the shoulder and subacromial bursitis. A survey of 12,122 shoulders. JAMA 1941;2477-82.
18. Gärtner J, Heyer A. Tendinosis calcarea der Schulter. Orthopade 1995;24:284-302.
19. Aina R, Cardinal E, Bureau NJ, Aubin B, Brassard P. Calcific shoulder tendinitis: treatment with modified US-guided fineneedle technique. Radiology 2001;221:455-61.
20. Ciccone C. Does acetic acid iontophoresis accelerate the resorption of calcium deposits in calcific tendinitis of the shoulder? Phys Ther 2003;83(1):68-74.
21. Ebenbichler GR, Erdogmus CB, Resch KL, Funovics MA, Kainberger F, Barisani G, et al. Ultrasound therapy for calcific tendinitis of the shoulder. N Engl J Med 1999;340:1533-8.
22. Ellman H. Arthroscopic subacromial decompression. Analysis of one to three year results. J Arthroscopy 1987;3(3):173-81.
23. Flax HJ. Ultrasound treatment for peritendinitis calcarea of the shoulder. Am J Phys Med Rehabil 1964;43:117-24.
24. Gärtner J. Tendinosis calcarea: results of treatment with needling. Z Orthop Ihre Grenzgeb 1993;131:461-9.
25. Harmon PH. Methods and results in the treatment of 2,580 painful shoulders, with special reference to calcific tendinitis and the frozen shoulder. Am J Surg 1958;95:527-44.
26. Loew M, Jurgowski W, Mau HC, Thomsen M. Treatment of calcifying tendinitis of rotator cuff by extracorporeal shock waves: a preliminary report. J Shoulder Elbow Surg 1995;4:101-6.
27. Rockwood CA Jr, Matsen FA 3rd, Wirth MA, Lippitt SB (eds.). The Shoulder, 3rd ed. Philadelphia: WB Saunders; 2004, p. 1046-55.
28. Perron M, Malouin F. Acetic acid iontophoresis and ultrasound for the treatment of calcifying tendinitis of the shoulder: a randomized control trial. Arch Phys Med Rehabil 1997;78:379-84.
29. Uhthoff HK, Sarkar K. Surgical repair of rotator cuff ruptures. The importance of sub-acromial bursa. J Bone Joint Surg Br 1991;73:399-401.
30. Weber SC. Arthroscopic treatment of calcific tendinitis. AANA 17th Annual Fall Course Palm Desert, 1998.
31. Wittenberg RH, Rubenthaler F, Wölk T, Ludwig J, Willburger RE, Steffen R. Surgical or conservative treatment for chronic rotator cuff calcifying tendinitis - a matched-pair analysis of 100 patients. Arch Orthop Trauma Surg 2001;121:56-9.
32. Lam F, Bhatia D, Van Rooyen K, de Beer JF. Modern management of calcifying tendinitis of the shoulder. Curr Orthop 2006;20:446-52.
33. De Sèze S, Welfling J. Tendinites calcifiantes. Rhumatologie 1970;22:45-50.
34. Litchman HM, Silver CM, Simon SD, Eshragi A. The surgical management of calcific tendinitis of the shoulder. Int Surg 1968;50:474-82.
35. DePalma AF, Kruper JS. Long-term study of shoulder joints afflicted with and treated for calcific tendinitis. Clin Orthop 1961;20:61-72.
36. Ogon P, Bornebusch L, Izadpanah K, Suedkamp NP. Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulder. Arthritis Rheum 2009;60(10):2978-84.
37. Speed CA. Corticosteroid injections in tendon lesions. BMJ 2001;232:382-6.
38. Partington PF. Diagnostic injection around the shoulder: hit and miss? A cadaveric study of injection accuracy. J Shoulder Elbow Surg 1998;7(2):147-50.
39. Iwanami K. Intratendinous corticosteroid injection induces apoptosis of the rat tendon fibroblasts. Dokyo J Med Sci 2005;32:39-46.
40. Tempfer H, Gehwolf R, Wagner A, Resch H, Hirzinger C, Augat P. Effects of crystalline glucocorticoid triamcinolone acetonide on cultured human supraspinatus tendon cells. Acta Orthopaedica 2009;80(3):357-62.
41. Tillander B, Franzén LE, Karlsson MH, Norlin R. Effect of steroid injections on the rotator cuff: an experimental study in rats. J Shoulder Elbow Surg 1999;8:271-4.
42. Neer CS. Shoulder Reconstruction. Philadelphia: WB Saunders; 1990, p. 43.
43. Gschwend N, Patte D, Zippel J. Therapy of calcific tendinitis of the shoulder. German Arch Orthop Unfallchir 1972;73:120-35.
44. Ark JW, Flock TJ, Flatow EL, Bigliani LU. Arthroscopic treatment of calcific tendinitis of the shoulder. Arthroscopy 1992;8:183-8.
45. McKendry RJR, Uhthoff HK, Sarkar K, Hyslop PS. Calcifying tendinitis of the shoulder: prognostic value of clinical, histologic, and radiologic features in 57 surgically treated cases. J Rheumatol 1982;9:75-80.
46. Seil R, Litzenburger H, Kohn D, Rupp S. Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy 2006;22(5):521-7.
47. Jacobs R, Debeer P. Calcifying tendinitis of the rotator cuff: functional outcome after arthroscopic treatment. Acta Orthop Belg 2006;72(3):276-81.
48. Ellman H, Bigliani LU, Flatow E, Esch IC, Snyder SJ, Oglivie-Harris D, et al. Arthroscopic treatment of calcifying tendinitis: the American experience. 5th International Conference on Shoulder Surgery, Paris, France, 1992.
49. Moke-Nancy D, Walch G, Kemp IF, Gleyze P. Arthroscopic treatment of calcifying tendinitis. Results of the Multicentric European study. 5th International Conference on Shoulder Surgery, Paris, France, 1992.
50. Cosentino R, De Stefano R, Selvi E. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study. Ann Rheum Dis 2003;62:248-50.
51. 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):425-6.
52. Gerdesmeyer L, Wagenpfeil S, Haake M. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA 2003;290:2573-80.
53. 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.
54. Vavken P, Holinka J, Rompe JD, Dorotka R. Focused extracorporeal shock wave therapy in calcifying tendinitis of the shoulder: a meta-analysis. Sports Health 2009;1(2):137-44.
55. Rompe JD, Zollner J, Nafe B, Freitag C. Significance of calcium deposit elimination in tendinosis calcarea of the shoulder. Z Orthop Ihre Grenzgeb 2000;138: 335-9.
56. Rompe JD, Rumler F, Hopf C, Nafe B, Heine J. Extracorporeal shockwave therapy for calcifying tendinitis of the shoulder. Clin Orthop 1995;321:196-201.
57. Rompe JD, Bürger R, Hopf C, Eysel P. Shoulder function after extracorporeal shock wave therapy for calcific tendinitis. J Shoulder Elbow Surg 1998;7:505-9.
58. Schmitt J, Haake M, Tosch A, Hildebrand R, Deike B, Griss P. Low-energy extracorporeal shock-wave treatment (ESWT) for tendinitis of the supraspinatus: a prospective, randomised study. J Bone Joint Surg Br 2001;83:873-6.
59. Speed CA, Richards C, Nichols D, Burnet S, Wies JT, Humphreys H, Hazleman BL. Extracorporeal shock-wave therapy for tendonitis of the rotator cuff: a double-blind, randomised, controlled trial. J Bone Joint Surg Br 2002;84(4):509-12.
60. Thiele R. Tratamiento de las tendinosis calcificadas de hombro mediante ondas de choque. Experiencia de 1800 casos y seguimiento
a 5 años. Bienal Bosque Ortopedia. Universidad del Bosque, Bogotá, 2004.
61. Durst HB, Blatter G, Kuster MS. Osteonecrosis of the humeral head after extracorporeal shock-wave lithotripsy. J Bone Joint Surg Br 2002;84(5):744-6.
62. Liu HM, Chao CM, Hsieh JY, Jiang CC. Humeral head osteonecrosis after extracorporeal shock-wave treatment for rotator cuff tendinopathy. A case report. J Bone Joint Surg Am 2006;88:1353-6.
63. Hearnden AJ, Flannery MC. Extracorporeal shock wave therapy in the treatment of calcific tendonitis of the shoulder. J Bone Joint Surg 2003;85(Suppl II):96.
64. Dubs B. Efficacy and economical aspects: comparison ESWT versus alternate therapies in the treatment of calcifying tendinitis. 6th Congress of the International Society for Musculoskeletal Shockwave Therapy, Orlando, USA, 2003.
65. Eid J. Economic aspects in the treatment of tendinosis calcarea of the shoulder. 9th International Congress of the International Society for Musculoskeletal Shockwave Therapy, 2006.
66. 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.
67. Lorbach O, Kusma M, Pape D, Kohn D, Dienst M. Influence of deposit stage and failed ESWT on the surgical results of
arthroscopic treatment of calcifying tendonitis of the shoulder. Knee Surg Sports Traumatol Arthrosc 2008;16(5):516-2