In a lengthy letter, a female reader describes her problems with both shoulders, which have been intensifying over the past year. So far, she has undergone physiotherapy, regularly uses ice to reduce pain, and has been on analgesic medication therapy for months.
Overall, her condition has improved, and she now experiences fewer symptoms.
Her questions are related to further therapy, exercises, and the possibility of using shockwave therapy to “break” and eliminate her symptoms in the long term.
Calcifications have three phases – formation, resting, and reabsorption. The most painful are the first and last phases, while the middle phase is characterized by reduced or absent pain. The entire process from start to its natural end can take years, and many of its aspects are not fully understood. In this regard, shockwave therapy, which we first introduced into regular practice in Croatia, has its advantages and limitations.
Namely, shoulder calcifications are increasingly viewed today as a consequence rather than a direct cause. It seems that disorders in shoulder function, primarily in scapular mobility and the function of muscles around it, significantly contribute to the formation of calcifications and the development of pain in the same area. Some eminent European experts claim that only by improving scapular function can we reduce the need for shoulder surgery due to calcifications, and thus the need for shockwave therapy, which is uncomfortable, with consequent pain being a regular part of the therapeutic procedure. Statistics recently presented by Dr. Van der List (an orthopedic specialist in shoulder from the Netherlands) indicate that the number of such surgeries in his clinic has decreased from about ten per month to only a few annually, by shifting the focus from calcifications to the scapula.
In this sense, assessing scapular mobility and the condition of its muscles is a fundamental procedure in painful shoulders, especially with calcifications. Shockwave therapy is only implemented after addressing identified deficiencies, or concurrently with them. Such an approach has ultimately shown much better results than shockwave therapy alone.
