Tratamento por ondas de choque na tendinopatia do manguito rotador não calcificada: revisão sistemática com meta-análise

Abstract

Introduction: Rotator cuff tendinopathy is a musculoskeletal disorder with a prevalence of 6.9% to 26% in adults. Pathophysiology of tendinopathy is complex, starting with a short-term acute inflammatory stage which gradually becomes a degenerative condition. Pain is the most common symptom of this disease and can be relieved with the use of analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injection, physical therapy and surgery. Despite this variety of therapeutic approaches, some cases do not seem to respond to these treatments, increasing the search for alternative therapies for the management of symptoms caused by tendinopathy. Objective: Therefore, the aim of the present study was to investigate the efficacy of extracorporeal and radial shock wave therapy on pain and function in patients with non-calcified rotator cuff tendinopathy. Methods: A comprehensive search was carried out in five electronic databases, MEDLINE via Ovid, CINAHL via EBSCO and SPORTDiscus via EBSCO and EMBASE. Population-based studies that reported the prevalence of rotator cuff tendinopathy were considered eligible. The studies retrieved by the search strategy were evaluated by two independent reviewers (G.M.R. and L.S.P.), following the inclusion criteria, extracted the data and assessed the bias of the included studies, using the PEDro scale. Results: Ten studies of moderate to high evidence were considered eligible for this review. The analysis of 5 studies that compared shockwave therapy with placebo at 6, 12 and 24 weeks was performed. There was no significant improvement in pain at 6 weeks (DM: -0.110; 95% CI -0.638 to 0.417; P = 0.681; I2 = 0.000), 12 weeks (DM: -0305; 95% CI -0.650 to 0.039; P = 0.082; I2 = 13.401) and 24 weeks ((DM: -9587; 95% CI -20.908 to 1.734; P = 0.097; I2 = 0.000). Likewise, no difference was found for function in the 6-week periods (DM: 9.135; 95% CI -14.485 to 32.755; P = 0.448; I2 = 74.240), 12 weeks (groups (DM: 0.223; 95% CI -0.219 to 0.664; P = 0.323; I2 = 44.509) and 24 weeks (DM: 0.320; 95% CI -0.079 to 0.720; P = 0.116; I2 = 0.000). The narrative description of the other 5 studies that compared shockwave therapy with other therapies was performed. Conclusion: Based on existing clinical evidence, extracorporeal and radial shockwave therapy is not effective in relieving pain and function of the shoulder joint in individuals with rotator cuff tendinopathy in the periods of 6, 12 and 24 weeks.