Focus of the Report: The focus of this Health Technology Assessment is on the use of extracorporeal shock wave therapy (ESWT) as a noninvasive treatment for symptomatic calcific tendinitis of the shoulder when other conservative therapies have failed.
Technology Description: ESWT devices are similar to the lithotripters used for breaking up kidney stones. They produce low-energy (LE) or high-energy (HE) pulses arising from 3-dimensional (3D) acoustic energy, called shock waves, which can be focused and then propagated through water within body tissues. Shock waves can be focused or radial. ESWT is performed in an outpatient setting, usually with the use of local anesthesia or a regional block. After the treatment site is localized by ultrasound or fluoroscopy or by patient feedback, 1000 to 3000 pulses of LE to HE shock waves are administered to the painful site by an ESWT device during each of several sessions.
Controversy: The effectiveness of ESWT in the treatment of calcific tendinitis of the shoulder is controversial. Despite years of use, there are no established treatment parameters for ESWT, which vary widely across study protocols, including energy density, number of sessions and shocks used, type of device used, and whether local anesthesia is used. In addition, patients with calcific tendinitis of the shoulder may recover spontaneously over time.
Is extracorporeal shock wave therapy (ESWT) effective for the treatment of calcific tendinitis of the shoulder?
How does ESWT compare with alternative therapies for the treatment of calcific tendinitis of the shoulder?
Is ESWT in patients with calcific tendinitis of the shoulder safe?
Have definitive patient selection criteria been identified for ESWT for the treatment of calcific tendinitis of the shoulder?
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