Shockwave Therapy versus Local Steroid Injection in Treatment of Chronic Supraspinatous Tendinopathy

Abstract

Rotator cuff tendinopathy is one of the commonest causes of shoulder pain, mostly affecting the supraspinatus tendon. It is a common disabling condition that affects females more than males with predominance in the 3rd to 5th decades of life. Supraspinatus tendinopathy is a degenerative condition termed as angiofibroblastic hyperplasia with a secondary neurogenic inflammatory component outside the tendon in the surrounding tissues, occurring with microtrauma mostly due to ischemia and release of inflammatory mediators. Calcific supraspinatus tendinopathy is believed to occur in 3 stages; pre-calcific stage, calcific stage which is subdivided into: formative phase, resting phase and resorptive phase and the post-calcific phase. Non-calcific supraspinatus tendinopathy is considered as the pre-calcific stage by some authors. Shoulder pain in the deltoid region is the presenting symptom, with worsening at night or after overhead activities with functional impairment. It leads to deltoid muscle wasting, decreasing the shoulder range of motion, decreasing shoulder girdle muscle power. Complications of supraspinatus tendinopathy includes subacromial impingement syndrome and microtears of the tendons that may progress to partial tears and in rare cases complete tears occur. Investigations include X-ray, MRI and MSUS are done to confirm the diagnosis and to exclude other causes that mimic the clinical picture. MSUS is used for both diagnosis and in some cases treatment guidance.