Is Shockwave Therapy Gold Standard Treatment for Calcific Tendinopathy?

Focused shockwave therapy is regarded as the gold standard treatment for calcific tendinopathy due to its high effectiveness in breaking down calcium deposits, relieving pain, and restoring tendon function, all through a non-invasive approach with minimal risks.

Mechanism and Clinical Impact

Focused shockwave therapy uses high-energy acoustic waves to penetrate deep into the tendon, generating microtrauma that directly fragments calcific deposits. This action enhances local blood flow, stimulates the influx of growth factors, and encourages cellular regeneration in the affected tissue. The net effect is accelerated resorption of calcium deposits and improved tissue healing, which translates to better shoulder mobility and reduced pain, often within a few sessions.

Supporting Evidence

Multiple systematic reviews and clinical trials have demonstrated that focused shockwave therapy for calcific tendinopathy leads to significant improvements in pain scores, functional capacity, and reduction in the size of calcific deposits compared to placebo or other conservative treatments (such as physiotherapy or corticosteroid injection). Success rates for pain relief and function restoration approach 90% in some studies, with high-energy focused shockwave found to be especially effective. Focused therapy is also preferable to radial shockwave because it can target deeper tissues and precisely address calcific foci.

Comparison to Other Treatments

Compared to surgery, focused shockwave therapy is non-invasive, involves no downtime, and carries far fewer risks. While corticosteroid injections might offer quick pain relief, they lack the long-term effectiveness and regenerative capacity provided by shockwave therapy and carry potential risks with repeated use. Surgery is now typically reserved for refractory cases where shockwave therapy is unsuccessful or not possible.

Clinical Recommendations

Professional guidelines and systematic reviews recommend focused shockwave therapy as a first-line treatment for calcific tendinopathy, especially of the shoulder (such as supraspinatus tendinopathy), due to its robust evidence base for pain relief, functional improvement, and calcific deposit dissolution.

In summary, focused shockwave therapy’s precise targeting, ability to fragment and resorb calcium deposits, stimulation of tendon healing mechanisms, high patient tolerability, and strong clinical evidence base together establish it as the gold standard for calcific tendinopathy