Effectiveness of Focused Shockwave Therapy versus Radial Shockwave Therapy for Noncalcific Rotator Cuff Tendinopathies: A Randomized Clinical Trial
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(4):16 Biomed Res Int. 2021 Jan 9;2021:6687094What this means for my practice?
Study findings may suggest that in patients with noncalcific rotator cuff tendinopathy, focused shockwave therapy can perhaps provide significant advantages in pain reduction and functional improvement over radial shockwave therapy at 24-48 weeks after treatment. This study was limited by the differences in energy level between the two treatments: the F-SWT was applied at a lower energy relative to the R-SWT, which may have influenced the results. Moreover, the sample size was very small. Future studies with larger sample sizes examining differing frequencies and energy levels are of interest to identify the optimal protocol for shockwave therapy in the treatment of noncalcific rotator cuff tendinopathy.
Resumo do estudo
Forty-six patients with non-calcific rotator cuff tendinopathy were randomized to receive 4 weekly sessions of focused shockwave therapy (F-SWT; n=23) or radial shockwave therapy (R-SWT; n=23) for the improvement of symptoms. The primary outcome of interest was pain evaluated on a Numeric Rating Scale (NRS) at 24 weeks. Secondary outcomes of interest included the Constant-Murley Scale (CMS) total score and associated sub-score (i.e., pain, activities of daily living [ADL], range of motion, and power), and NRS pain scores. All outcomes were assessed at 4, 12, 24, and 48 weeks post-treatment. Results revealed statistically significantly lower NRS pain scores at 24 and 48 weeks in favour of the F-SWT group compared to the R-SWT group (p<0.001 for both). Similarly, CMS total scores, pain sub-scores, and ADL sub-scores were statistically significantly in favour of the F-SWT group at 24 and 48 weeks post-treatment (p<0.05 for all). Moreover, the CMS range of motion sub-scores were statistically significantly in favour of the F-SWT group at 48 weeks only (p=0.035). No statistical significant differences were observed between the two groups in the CMS power sub-scores at any timepoint (p>0.05 for all). In addition, 5 cases of moderate pain, 1 case of syncope, and 2 cases of redness were reported in the F-SWT group, whilst 3 cases of moderate pain and 1 case of migraine were reported in the R-SWT group.
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