PMC9645527_01
Case 1-Right supraspinatus insertional tendinopathy. (A) Original image revealing hyperechoic mixed echogenicity within supraspinatus tendon. (B) More homogenous tendon fiber pattern is shown at 8 weeks post shockwave therapy. (C) A normal fiber pattern is shown at 18 months post shockwave therapy. (D) revealed supra measurement at 18 months post shockwave therapy.
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F1
Left supraspinatus fibers near the musculotendinous junction had an irregular fiber pattern, supraspinatus insertional tendinopathy in the right shoulder (Figure 1A). After four treatments with the piezoelectric shockwave, the musculoskeletal ultrasound revealed tendon healing and MTP resolution (Figures 1B, 2B, 3B). The supraspinatus and biceps tendon were measured in cross section (Figure 1D). Musculoskeletal ultrasound of the supraspinatus tendon and supraspinatus and infraspinatus muscles 8 weeks after starting shockwave therapy revealed a normal fiber pattern of the infraspinatus and supraspinatus muscles, normal echogenicity of the supraspinatus tendon, and a decrease in the overall size of the supraspinatus tendon (Figures 1B,C, 2B,C, 3B,C).
Case 1-Right infraspinatus myofascial trigger points (MTPs). (A) Original image revealing irregular muscle fiber pattern with hyperechoic and wavy fibers indicating fiber pattern disruption. (B) A normalizing muscle fiber pattern is shown at 8 weeks post shockwave therapy. (C,D) The normal tendon and muscle fiber patterns are shown at 18 months post shockwave therapy.
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F2
There were also hypoechoic areas and fiber pattern disruption in both the right infraspinatus and left supraspinatus muscles (Figures 2A, 3A). Bilateral infraspinatus and supraspinatus myofascial trigger points were identified using musculoskeletal ultrasound (Figures 2A, 3A, 4A). After four treatments with the piezoelectric shockwave, the musculoskeletal ultrasound revealed tendon healing and MTP resolution (Figures 1B, 2B, 3B). The muscles and tendons were reimaged at 18 weeks post treatment (Figures 2D, 3C). Musculoskeletal ultrasound of the supraspinatus tendon and supraspinatus and infraspinatus muscles 8 weeks after starting shockwave therapy revealed a normal fiber pattern of the infraspinatus and supraspinatus muscles, normal echogenicity of the supraspinatus tendon, and a decrease in the overall size of the supraspinatus tendon (Figures 1B,C, 2B,C, 3B,C).
Case 1-Left supraspinatus MTP. (A) Original image revealing muscle fiber pattern disruption with hypoechoic areas throughout the muscle. (B) The wavy muscle fiber patterns with less hypoechoic areas is shown at 8 weeks post shockwave therapy. (C) The normal tendon and muscle fiber patterns are shown at 18 months post shockwave therapy.
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F3
Recheck musculoskeletal ultrasound of the infraspinatus 8 and 12 weeks after starting shockwave therapy revealed a normal fiber pattern of the infraspinatus and supraspinatus muscles (Figures 3C, 4B,C, 5B,C).
Case 1-left infraspinatus MTP. (A) Original image revealing irregular muscle fiber pattern. (B) A normalizing muscle and tendon fiber pattern is shown at 8 weeks post shockwave therapy. (C) Normal muscle and tendon fiber patterns are shown at 18 Month post shockwave reveals.
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F4
Recheck musculoskeletal ultrasound of the infraspinatus 8 and 12 weeks after starting shockwave therapy revealed a normal fiber pattern of the infraspinatus and supraspinatus muscles (Figures 3C, 4B,C, 5B,C).
PMC9645527_02
Case 2-Left infraspinatus MTP. (A) Original injury revealing hypoechoic areas and irregular muscle fiber patterns. (B) Myofascial trigger points resolution, 1-week post injury after 2nd shockwave therapy reveals normalizing muscle. (C) Follow up, 2 weeks after MTP resolution with normal muscle fiber pattern.
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F5
Recheck musculoskeletal ultrasound of the infraspinatus 8 and 12 weeks after starting shockwave therapy revealed a normal fiber pattern of the infraspinatus and supraspinatus muscles (Figures 3C, 4B,C, 5B,C).
PMC9645527_03
Case 1-Left supraspinatus MTP. (A) Original image revealing muscle fiber pattern disruption with hypoechoic areas throughout the muscle. (B) The wavy muscle fiber patterns with less hypoechoic areas is shown at 8 weeks post shockwave therapy. (C) The normal tendon and muscle fiber patterns are shown at 18 months post shockwave therapy.
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F3
Recheck musculoskeletal ultrasound of the infraspinatus 8 and 12 weeks after starting shockwave therapy revealed a normal fiber pattern of the infraspinatus and supraspinatus muscles (Figures 3C, 4B,C, 5B,C).
Case 1-left infraspinatus MTP. (A) Original image revealing irregular muscle fiber pattern. (B) A normalizing muscle and tendon fiber pattern is shown at 8 weeks post shockwave therapy. (C) Normal muscle and tendon fiber patterns are shown at 18 Month post shockwave reveals.
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F4
Recheck musculoskeletal ultrasound of the infraspinatus 8 and 12 weeks after starting shockwave therapy revealed a normal fiber pattern of the infraspinatus and supraspinatus muscles (Figures 3C, 4B,C, 5B,C).
Case 2-Left infraspinatus MTP. (A) Original injury revealing hypoechoic areas and irregular muscle fiber patterns. (B) Myofascial trigger points resolution, 1-week post injury after 2nd shockwave therapy reveals normalizing muscle. (C) Follow up, 2 weeks after MTP resolution with normal muscle fiber pattern.
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F5
Recheck musculoskeletal ultrasound of the infraspinatus 8 and 12 weeks after starting shockwave therapy revealed a normal fiber pattern of the infraspinatus and supraspinatus muscles (Figures 3C, 4B,C, 5B,C).