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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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European Journal of Physical and Rehabilitation Medicine 2016 Nov 08
Focused extracorporeal shock wave therapy combined with supervised eccentric training for supraspinatus calcific tendinopathy
Ettore CARLISI 1, Claudio LISI 1, Anna DALL'ANGELO 2, Serena MONTELEONE 2, Vincenza NOLA 1, Carmine TINELLI 3, Elena DALLA TOFFOLA 1 ✉
1 Rehabilitation Unit, I.R.C.C.S. Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy; 2 Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; 3 Department of Clinical Biometrics and Epidemiology, I.R.C.C.S. Policlinico San Matteo Foundation, Pavia, Italy
BACKGROUND: Extracorporeal shock wave therapy is effective in reducing shoulder pain and improving function in calcific supraspinatus tendinopathy. Eccentric exercise has been introduced as an effective treatment choice for Achilles tendinopathy, but poor evidence exists about its role in the treatment of rotator cuff tendinopathy.
AIM: To investigate if adding a supervised eccentric training of the shoulder abductor muscles could improve the outcome of extracorporeal shock wave therapy.
DESIGN: Pre-post intervention pilot study with matched control-group.
SETTING: Outpatient, University Hospital.
POPULATION: Twenty-two subjects affected by painful supraspinatus calcific tendinopathy.
METHODS: The study-group was assigned to receive focal extracorporeal shockwave therapy (f-ESWT) plus a supervised eccentric training (SET) of the shoulder abductor muscles. The matched control-group received f-ESWT only. The post-treatment assessment (follow-up t1) was performed nine weeks after the enrollment (t0). We assessed shoulder pain and function by the means of a numeric rating scale (p-NRS) and a DASH scale. As secondary outcome, we measured the isometric strength of the abductor muscles of the affected shoulder using a handheld dynamometer.
RESULTS: At t1, we recorded a significant decrease in pain (p<0.001) and an improvement in upper limb function (p<0.001) in both groups. However, we observed no statistical differences in favour of the study-group, in terms of p-NRS and DASH total score. A mild increase (13% from the baseline) of the maximum isometric abduction strength was noticed in the study- group at t1.
CONCLUSIONS: Our findings did not support the hypothesis that adding a supervised eccentric training of the shoulder abductor muscles could improve the outcome (pain and function) of shock wave therapy.
CLINICAL REHABILITATION IMPACT: Our study confirmed that f-ESWT is effective in reducing shoulder pain and improving function in calcific supraspinatus tendinopathy. Adding a supervised eccentric training, focused on the abductor muscles, was useful to improve maximum isometric abduction strength, but appeared to give no advantage in the short-term outcome of shock wave therapy.