From the Guidelines
Extracorporeal Shock Wave Therapy (ESWT) appears to be a safe, noninvasive, and effective means of pain relief for chronic tendinopathies, including shoulder impingement syndrome, as evidenced by a 2005 study published in the American Family Physician 1.
Efficacy of ESWT for Shoulder Impingement Syndrome
The study suggests that ESWT can be a valuable treatment option for patients with shoulder impingement syndrome, particularly those who have not responded well to other conservative treatments.
- The treatment protocol typically involves 3-5 sessions, spaced 1 week apart, with each session lasting about 10-15 minutes.
- The recommended intensity is usually between 0.08 and 0.28 mJ/mm², with 2000-3000 pulses per session.
- Patients may experience mild discomfort during the procedure, but it's generally well-tolerated.
Mechanism of Action and Benefits
ESWT works by stimulating blood flow, promoting tissue regeneration, and reducing inflammation in the affected area, leading to decreased pain and improved shoulder function.
- Patients often notice improvement after 2-3 sessions, with full benefits typically realized within 3 months post-treatment.
- In addition to ESWT, patients should continue with a prescribed physical therapy program to strengthen the shoulder muscles and improve flexibility.
Safety and Contraindications
While generally safe, ESWT is not recommended for patients with blood clotting disorders, those on anticoagulants, or for use directly over any metal implants.
- Pregnant women should also avoid this treatment.
- Minor side effects may include temporary redness, swelling, or bruising at the treatment site. It is essential to weigh the benefits and risks of ESWT and consider individual patient factors before initiating treatment, as supported by the evidence from the American Family Physician study 1.
From the Research
Efficacy of Extracorporeal Shock Wave Therapy (ESWT) for Treating Shoulder Impingement Syndrome
- The efficacy of ESWT for treating shoulder impingement syndrome is supported by some studies, with one systematic review and meta-analysis finding that ESWT was superior to sham therapy 2.
- The study found that ESWT had a small to moderate standardized mean difference (SMD) of -0.39 compared to sham therapy, indicating a significant improvement in symptoms 2.
- However, the quality of evidence for ESWT was rated as very low, and more research is needed to confirm its effectiveness 2.
- Other studies have focused on the comparison between conservative and surgical interventions for shoulder impingement syndrome, with some finding no significant differences in outcomes between the two approaches 3, 4.
- Exercise therapy, including specific exercises and manual therapy, has been shown to be effective in improving symptoms and function in patients with shoulder impingement syndrome 5, 2, 6.
- The use of ESWT as a conservative intervention for shoulder impingement syndrome may be considered as an adjunct to exercise therapy and other conservative treatments, but its effectiveness and safety need to be further established 2.