IGeL: shock waves for shoulder pain

Calcium deposits in the shoulder are painful. Orthopedic surgeons often recommend shock wave therapy. Is that a wise investment? What speaks for and against, what costs are incurred

Does it make sense or not? Experts recommend a combination of physiotherapy, needle puncture and ESWT

© W & B / Michelle Günther

What is being done there?

The so-called extracorporeal focused shock wave therapy (ESWT) works with short, violent pressure pulses. Sound waves smash the calcium deposits on the tendons of the shoulder muscles and accelerate their removal.

The ESWT is used, among other things, for the calcified shoulder, the tennis elbow or a heel spur. The statutory health insurance companies only cover the costs for the treatment of the heel, as the effect has been scientifically proven.

Per

  • An American meta-analysis from Tufts Medical Center in Boston shows that ESWT improves arm mobility and relieves pain when lifting and sleeping. "You can help quickly, for a long time and with relatively little effort," explains Dr. Thomas Czerlitzki from the Orthopedic Center Kurfürstendamm in Berlin.
  • If shock wave therapy works, it can prevent surgery. In addition, it has few side effects and there are hardly any complications.

Contra

  • "In most cases the calcium deposits dissolve on their own," says Dr. Dirk Böhm, specialist in orthopedics with a focus on shoulder surgery in Würzburg. This can take months or years to happen, but lime dissolving treatment is usually not necessary. However, when the calcium residues are broken down, painful inflammation of the bursa often occurs.
  • There is no guarantee of success for the expensive therapy. And there are alternative treatments that health insurance companies pay for, such as anti-inflammatory painkillers or injections, physiotherapy and cold therapy, and ultrasound applications. Deposits are only removed in a minimally invasive manner in an emergency.
  • The therapy is not suitable for everyone. ESWT must not be used in pregnant women, patients with cardiac pacemakers or blood clotting disorders as well as cancer patients.

costs

  • Focused ESWT with short, intense and targeted shock waves: 86 to 198 euros per session.
  • Radial ESWT: 15 to 34 euros per session. The pressure waves are weaker and more extensive. The method is used more for tension.
  • To alleviate the symptoms, patients should expect three to five treatments of 15 to 20 minutes at intervals of two weeks.

Conclusion

The experts of the IGeL-Monitor rate the benefits and the study situation as unclear. Böhm sees it differently: "ESWT is only a very good treatment option if the lime does not dissolve on its own, before attempting an arthroscopic operation."

Many orthopedic surgeons such as Thomas Czerlitzki combine focused ESWT with physiotherapy and needle puncture under ultrasound control. The lime is rinsed out of the tissue and cortisone is injected into it afterwards.