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Efficacy of shockwave therapy on calcific tendonitis of the shoulder

This is a great article about interesting research from the Canadian Medical Association on shock-wave therapy effectiveness for some shoulder tendinitis. Is shock-wave therapy effective for some shoulder tendinitis?12

Clinical question

Is extracorporeal shock-wave therapy effective for chronic shoulder tendinitis?3

Bottom line

High-energy extracorporeal shock-wave therapy (ESWT) is effective in improving function and decreasing pain in patients with shoulder tendinitis with calcifications; its effectiveness is not as clear in patients with noncalcific tendinitis. Low-energy ESWT is not as effective. The quality of the research is low; most studies did not mask patients (ie, the patients did not undergo sham treatment), which may have increased the placebo effect of the noisy but painless ESWT magic wand. (LOE = 1a-)

Study design: Meta-analysis (randomized controlled trials)
Funding: Self-funded or unfunded
Allocation: N/A
Setting: Various (meta-analysis)


Effective treatment of rotator cuff tendinitis is hard to find: The common modalities, treatments, and therapies are not particularly effective. Given its effectiveness for other inflammatory soft-tissue problems, ESWT has been studied to decrease pain and improve function for shoulder conditions. The authors of this study searched 4 databases, including the Cochrane Central Register, for randomized controlled trials of ESWT in the treatment of calcific or noncalcific tendinitis. They also searched review articles and manuscripts and did not limit their search by language. Three reviewers determined inclusion eligibility, extracted data, and evaluated study quality, which on average was low. They identified 28 studies including a total of 1745 patients with symptoms lasting from 3 months to 12 months. Only 6 studies were double-blind trials. Also, the studies used different methods of ESWT. In 7 studies of calcific tendinitis, high-energy ESWT improved pain, function, and resolved calcification more than placebo. Low-energy ESWT improved function to a lesser extent, but did not consistently improve pain scores. Results were mixed with both types of ESWT in patients with noncalcific tendinitis.

  1. Canadian Medical Association
  3. Bannuru RR, Flavin NE, Vaysbrot E, Harvey W, McAlindon T. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder. A systematic review. Ann Intern Med 2014;160:542-549.