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Meta-Analysis
. 2020 Mar 4;3(3):CD008962.
doi: 10.1002/14651858.CD008962.pub2.

Shock wave therapy for rotator cuff disease with or without calcification

Stephen J Surace  1 , Jessica Deitch  1 , Renea V Johnston  1 , Rachelle Buchbinder  1
Affiliations
Meta-Analysis

Shock wave therapy for rotator cuff disease with or without calcification

Stephen J Surace et al. Cochrane Database Syst Rev. .

Abstract

Background: Shock wave therapy has seen widespread use since the 1990s to treat various musculoskeletal disorders including rotator cuff disease, but evidence of its efficacy remains equivocal.

Objectives: To determine the benefits and harms of shock wave therapy for rotator cuff disease, with or without calcification, and to establish its usefulness in the context of other available treatment options.

Search methods: We searched Ovid MEDLINE, Ovid Embase, CENTRAL, ClinicalTrials.gov and the WHO ICTRP up to November 2019, with no restrictions on language. We reviewed the reference lists of retrieved trials to identify potentially relevant trials.

Selection criteria: We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that used quasi-randomised methods to allocate participants, investigating participants with rotator cuff disease with or without calcific deposits. We included trials of comparisons of extracorporeal or radial shock wave therapy versus any other intervention. Major outcomes were pain relief greater than 30%, mean pain score, function, patient-reported global assessment of treatment success, quality of life, number of participants experiencing adverse events and number of withdrawals due to adverse events.

Data collection and analysis: Two review authors independently selected studies for inclusion, extracted data and assessed the certainty of evidence using GRADE. The primary comparison was shock wave therapy compared to placebo.

Main results: Thirty-two trials (2281 participants) met our inclusion criteria. Most trials (25) included participants with rotator cuff disease and calcific deposits, five trials included participants with rotator cuff disease and no calcific deposits, and two trials included a mixed population of participants with and without calcific deposits. Twelve trials compared shock wave therapy to placebo, 11 trials compared high-dose shock wave therapy (0.2 mJ/mm² to 0.4 mJ/mm² and above) to low-dose shock wave therapy. Single trials compared shock wave therapy to ultrasound-guided glucocorticoid needling, ultrasound-guided hyaluronic acid injection, transcutaneous electric nerve stimulation (TENS), no treatment or exercise; dual session shock wave therapy to single session therapy; and different delivery methods of shock wave therapy. Our main comparison was shock wave therapy versus placebo and results are reported for the 3 month follow up. All trials were susceptible to bias; including selection (74%), performance (62%), detection (62%), and selective reporting (45%) biases. No trial measured participant-reported pain relief of 30%. However, in one trial (74 participants), at 3 months follow up, 14/34 participants reported pain relief of 50% or greater with shock wave therapy compared with 15/40 with placebo (risk ratio (RR) 1.10, 95% confidence interval (CI) 0.62 to 1.94); low-quality evidence (downgraded for bias and imprecision). Mean pain (0 to 10 scale, higher scores indicate more pain) was 3.02 points in the placebo group and 0.78 points better (0.17 better to 1.4 better; clinically important change was 1.5 points) with shock wave therapy (9 trials, 608 participants), moderate-quality evidence (downgraded for bias). Mean function (scale 0 to 100, higher scores indicate better function) was 66 points with placebo and 7.9 points better (1.6 better to 14 better, clinically important difference 10 points) with shock wave therapy (9 trials, 612 participants), moderate-quality evidence (downgraded for bias). Participant-reported success was reported by 58/150 people in shock wave therapy group compared with 35/137 people in placebo group (RR 1.59, 95% CI 0.87 to 2.91; 6 trials, 287 participants), low-quality evidence (downgraded for bias and imprecision). None of the trials measured quality of life. Withdrawal rate or adverse event rates may not differ between extracorporeal shock wave therapy and placebo, but we are uncertain due to the small number of events. There were 11/34 withdrawals in the extracorporeal shock wave therapy group compared with 13/40 withdrawals in the placebo group (RR 0.75, 95% CI 0.43 to 1.31; 7 trials, 581 participants) low-quality evidence (downgraded for bias and imprecision); and 41/156 adverse events with extracorporeal shock wave therapy compared with 10/139 adverse events in the placebo group (RR 3.61, 95% CI 2.00 to 6.52; 5 trials, 295 participants) low-quality evidence (downgraded for bias and imprecision). Subgroup analyses indicated that there were no between-group differences in pain and function outcomes in participants who did or did not have calcific deposits in the rotator cuff.

Authors' conclusions: Based upon the currently available low- to moderate-certainty evidence, there were very few clinically important benefits of shock wave therapy, and uncertainty regarding its safety. Wide clinical diversity and varying treatment protocols means that we do not know whether or not some trials tested subtherapeutic doses, possibly underestimating any potential benefits. Further trials of extracorporeal shock wave therapy for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review. A standard dose and treatment protocol should be decided upon before further research is conducted. Development of a core set of outcomes for trials of rotator cuff disease and other shoulder disorders would also facilitate our ability to synthesise the evidence.

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Conflict of interest statement

RB has authored two randomised controlled trials; one of ESWT for heel pain and one for lateral elbow pain (Buchbinder 2002; Staples 2008), as well as a Cochrane systematic review of ESWT for lateral elbow pain (Buchbinder 2005). RB has received royalties from Wolters Kluwer Health for writing a chapter on plantar fasciitis in UpToDate. She is also the Co‐ordinating Editor of Cochrane Musculoskeletal, but is not involved in editorial decisions regarding this review. She is a recipient of a National Health and Medical Research Council (NHMRC) Cochrane Collaboration Round 7 Funding Program Grant, which supports the activities of Cochrane Musculoskeletal ‐ Australia and Cochrane Australia, but the funders do not participate in the conduct of reviews.

JD has been employed by Alfred Health from January 2016 to present as a Hospital Medical Officer (HMO).

RJ is the Managing Editor of Cochrane Musculoskeletal, but is not involved in editorial decisions regarding this review. She is a recipient of an NHMRC (Australia) Cochrane Collaboration Round 7 Funding Program Grant, which supports the Cochrane Musculoskeletal Australian Editorial base, but the funders do not participate in the conduct of this review.

SJS: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 1 Proportion of participants with ≥ 50% improvement in pain.
1.2
1.2. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 2 Mean pain (various scales, lower score indicates less pain).
1.3
1.3. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 3 Mean function (various scales).
1.4
1.4. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 4 Treatment success.
1.5
1.5. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 5 Withdrawals due to adverse events and treatment intolerance.
1.6
1.6. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 6 Total withdrawals.
1.7
1.7. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 7 Proportion of participants with adverse events.
1.8
1.8. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 8 Calcification size (complete resolution).
1.9
1.9. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 9 Calcification size (partial resolution).
1.10
1.10. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 10 Mean or change in mean calcification width (mm).
1.11
1.11. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 11 Subgroup analysis: pain (various scales, lower score indicates less pain).
1.12
1.12. Analysis
Comparison 1 Shock wave therapy (ESWT) versus placebo, Outcome 12 Subgroup: function (various scales, higher score is better function).
2.1
2.1. Analysis
Comparison 2 Shock wave therapy (ESWT) versus no treatment, Outcome 1 Mean function (Constant score 0–100, 100 indicating best).
2.2
2.2. Analysis
Comparison 2 Shock wave therapy (ESWT) versus no treatment, Outcome 2 Treatment success as determined by participant.
2.3
2.3. Analysis
Comparison 2 Shock wave therapy (ESWT) versus no treatment, Outcome 3 Calcification size (complete resolution).
3.1
3.1. Analysis
Comparison 3 Shock wave therapy (ESWT) versus ultrasound‐guided needling with glucocorticoid, Outcome 1 Mean calcification size.
3.2
3.2. Analysis
Comparison 3 Shock wave therapy (ESWT) versus ultrasound‐guided needling with glucocorticoid, Outcome 2 Calcification size (complete resolution).
3.3
3.3. Analysis
Comparison 3 Shock wave therapy (ESWT) versus ultrasound‐guided needling with glucocorticoid, Outcome 3 Calcification size (partial resolution).
4.1
4.1. Analysis
Comparison 4 Radial shock wave therapy (RSWT) versus ultrasound‐guided needling with corticosteroid, Outcome 1 Mean pain (Numerical Rating Scale, 0–10, higher score indicating worse pain)).
4.2
4.2. Analysis
Comparison 4 Radial shock wave therapy (RSWT) versus ultrasound‐guided needling with corticosteroid, Outcome 2 Function (Constant score, 0–100, higher score indicating better function).
4.3
4.3. Analysis
Comparison 4 Radial shock wave therapy (RSWT) versus ultrasound‐guided needling with corticosteroid, Outcome 3 Function (Oxford Score 12–60).
4.4
4.4. Analysis
Comparison 4 Radial shock wave therapy (RSWT) versus ultrasound‐guided needling with corticosteroid, Outcome 4 Treatment success (proportion of participants with no complaints).
4.5
4.5. Analysis
Comparison 4 Radial shock wave therapy (RSWT) versus ultrasound‐guided needling with corticosteroid, Outcome 5 Proportion of participants with adverse events.
4.6
4.6. Analysis
Comparison 4 Radial shock wave therapy (RSWT) versus ultrasound‐guided needling with corticosteroid, Outcome 6 Calcification size (complete resolution).
5.1
5.1. Analysis
Comparison 5 Radial extracorporeal shock wave therapy (rESWT) versus supervised exercises, Outcome 1 Mean pain (9‐point Likert, 9 is most pain).
5.2
5.2. Analysis
Comparison 5 Radial extracorporeal shock wave therapy (rESWT) versus supervised exercises, Outcome 2 Mean function (SPADI 0–100, 100 is best).
5.3
5.3. Analysis
Comparison 5 Radial extracorporeal shock wave therapy (rESWT) versus supervised exercises, Outcome 3 Proportion of participants who withdrew due to adverse events.
5.4
5.4. Analysis
Comparison 5 Radial extracorporeal shock wave therapy (rESWT) versus supervised exercises, Outcome 4 Proportion of participants who experienced adverse events.
5.5
5.5. Analysis
Comparison 5 Radial extracorporeal shock wave therapy (rESWT) versus supervised exercises, Outcome 5 Active range of abduction.
6.1
6.1. Analysis
Comparison 6 Extracorporeal shock wave therapy (ESWT) versus ultrasound‐guided percutaneous lavage, Outcome 1 Pain (VAS 0–10, higher score indicating worse pain).
6.2
6.2. Analysis
Comparison 6 Extracorporeal shock wave therapy (ESWT) versus ultrasound‐guided percutaneous lavage, Outcome 2 Treatment success (pain free).
6.3
6.3. Analysis
Comparison 6 Extracorporeal shock wave therapy (ESWT) versus ultrasound‐guided percutaneous lavage, Outcome 3 Proportion of participants with adverse events.
6.4
6.4. Analysis
Comparison 6 Extracorporeal shock wave therapy (ESWT) versus ultrasound‐guided percutaneous lavage, Outcome 4 Calcification size.
6.5
6.5. Analysis
Comparison 6 Extracorporeal shock wave therapy (ESWT) versus ultrasound‐guided percutaneous lavage, Outcome 5 Calcification size (proportion with complete resolution).
7.1
7.1. Analysis
Comparison 7 Extracorporeal shock wave therapy (ESWT) versus transcutaneous electrical nerve stimulation (TENS), Outcome 1 Change in mean pain from baseline (0–10 VAS, 0 is no pain).
7.2
7.2. Analysis
Comparison 7 Extracorporeal shock wave therapy (ESWT) versus transcutaneous electrical nerve stimulation (TENS), Outcome 2 Mean function (Constant score 0–100, 0 is worst and 100 is best).
7.3
7.3. Analysis
Comparison 7 Extracorporeal shock wave therapy (ESWT) versus transcutaneous electrical nerve stimulation (TENS), Outcome 3 Withdrawals.
7.4
7.4. Analysis
Comparison 7 Extracorporeal shock wave therapy (ESWT) versus transcutaneous electrical nerve stimulation (TENS), Outcome 4 Proportion of participants with adverse events.
7.5
7.5. Analysis
Comparison 7 Extracorporeal shock wave therapy (ESWT) versus transcutaneous electrical nerve stimulation (TENS), Outcome 5 Reduction in calcification size (mm).
8.1
8.1. Analysis
Comparison 8 Extracorporeal shock wave therapy (ESWT) high dose versus ESWT low dose, Outcome 1 Mean pain (various scales, lower score indicates less pain).
8.2
8.2. Analysis
Comparison 8 Extracorporeal shock wave therapy (ESWT) high dose versus ESWT low dose, Outcome 2 Mean function (various scales, higher score is better function).
8.3
8.3. Analysis
Comparison 8 Extracorporeal shock wave therapy (ESWT) high dose versus ESWT low dose, Outcome 3 Treatment success as determined by participant.
8.4
8.4. Analysis
Comparison 8 Extracorporeal shock wave therapy (ESWT) high dose versus ESWT low dose, Outcome 4 Withdrawals.
8.5
8.5. Analysis
Comparison 8 Extracorporeal shock wave therapy (ESWT) high dose versus ESWT low dose, Outcome 5 Proportion of participants who experienced adverse events.
8.6
8.6. Analysis
Comparison 8 Extracorporeal shock wave therapy (ESWT) high dose versus ESWT low dose, Outcome 6 Range of movement (University of California at Los Angeles subscore, active flexion measured in degrees).
8.7
8.7. Analysis
Comparison 8 Extracorporeal shock wave therapy (ESWT) high dose versus ESWT low dose, Outcome 7 Resolution of calcification.
8.8
8.8. Analysis
Comparison 8 Extracorporeal shock wave therapy (ESWT) high dose versus ESWT low dose, Outcome 8 Partial resolution of calcification.
8.9
8.9. Analysis
Comparison 8 Extracorporeal shock wave therapy (ESWT) high dose versus ESWT low dose, Outcome 9 Calcification size (mm).
8.10
8.10. Analysis
Comparison 8 Extracorporeal shock wave therapy (ESWT) high dose versus ESWT low dose, Outcome 10 Calcification size (> 80% reduction of calcified surface on anteroposterior view).
9.1
9.1. Analysis
Comparison 9 Extracorporeal shock wave therapy (ESWT) two sessions versus ESWT one session, Outcome 1 Mean function (Constant score, 0–100, 100 is best).
9.2
9.2. Analysis
Comparison 9 Extracorporeal shock wave therapy (ESWT) two sessions versus ESWT one session, Outcome 2 Treatment success as determined by participant.
9.3
9.3. Analysis
Comparison 9 Extracorporeal shock wave therapy (ESWT) two sessions versus ESWT one session, Outcome 3 Resolution of calcification.
10.1
10.1. Analysis
Comparison 10 Extracorporeal shock wave therapy (ESWT) calcification‐focused versus ESWT supraspinatus origin‐focused, Outcome 1 Mean pain (0–10 point NRS, 0 is no pain).
10.2
10.2. Analysis
Comparison 10 Extracorporeal shock wave therapy (ESWT) calcification‐focused versus ESWT supraspinatus origin‐focused, Outcome 2 Mean function (Constant score 0–100, 100 is best).
10.3
10.3. Analysis
Comparison 10 Extracorporeal shock wave therapy (ESWT) calcification‐focused versus ESWT supraspinatus origin‐focused, Outcome 3 Treatment success as determined by participant satisfaction.
10.4
10.4. Analysis
Comparison 10 Extracorporeal shock wave therapy (ESWT) calcification‐focused versus ESWT supraspinatus origin‐focused, Outcome 4 Calcification size (complete resolution).
11.1
11.1. Analysis
Comparison 11 Extracorporeal shock wave therapy (ESWT) image‐guided versus ESWT palpation‐guided, Outcome 1 Mean pain (0–100 VAS, 0 is no pain).
11.2
11.2. Analysis
Comparison 11 Extracorporeal shock wave therapy (ESWT) image‐guided versus ESWT palpation‐guided, Outcome 2 Mean function (Constant score 0–100, 100 is best).
11.3
11.3. Analysis
Comparison 11 Extracorporeal shock wave therapy (ESWT) image‐guided versus ESWT palpation‐guided, Outcome 3 Calcification size (complete resolution).
11.4
11.4. Analysis
Comparison 11 Extracorporeal shock wave therapy (ESWT) image‐guided versus ESWT palpation‐guided, Outcome 4 Calcification size (partial resolution).
12.1
12.1. Analysis
Comparison 12 Extracorporeal shock wave therapy (ESWT) with hyperextended arm position versus ESWT with neutral arm position, Outcome 1 Mean pain (0–15 VAS, 15 is worst pain).
12.2
12.2. Analysis
Comparison 12 Extracorporeal shock wave therapy (ESWT) with hyperextended arm position versus ESWT with neutral arm position, Outcome 2 Mean function (Constant score 0–100, 100 is best).
12.3
12.3. Analysis
Comparison 12 Extracorporeal shock wave therapy (ESWT) with hyperextended arm position versus ESWT with neutral arm position, Outcome 3 Calcification size (> 80% reduction of calcified surface on anteroposterior view).
13.1
13.1. Analysis
Comparison 13 Extracorporeal shock wave therapy (ESWT) and exercise and advice versus exercise and advice, Outcome 1 Mean function (Constant score 0–100, 100 is best).
14.1
14.1. Analysis
Comparison 14 Shock wave therapy (ESWT) versus ultrasound guided hyaluronic acid (HA) injection, Outcome 1 Function.
15.1
15.1. Analysis
Comparison 15 Radial extracorporeal shock wave therapy (rESWT) plus physiotherapy versus physiotherapy, Outcome 1 Mean pain.
15.2
15.2. Analysis
Comparison 15 Radial extracorporeal shock wave therapy (rESWT) plus physiotherapy versus physiotherapy, Outcome 2 Mean function.
15.3
15.3. Analysis
Comparison 15 Radial extracorporeal shock wave therapy (rESWT) plus physiotherapy versus physiotherapy, Outcome 3 Range of movement (ROM) flexion.
15.4
15.4. Analysis
Comparison 15 Radial extracorporeal shock wave therapy (rESWT) plus physiotherapy versus physiotherapy, Outcome 4 ROM extension.
15.5
15.5. Analysis
Comparison 15 Radial extracorporeal shock wave therapy (rESWT) plus physiotherapy versus physiotherapy, Outcome 5 ROM abduction.
15.6
15.6. Analysis
Comparison 15 Radial extracorporeal shock wave therapy (rESWT) plus physiotherapy versus physiotherapy, Outcome 6 ROM external rotation.
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References

References to studies included in this review

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    1. Melegati G, Tornese D, Bandi M. Effective of extracorporeal shock wave therapy associated with kinesitherapy in the treatment of subacromial impingement: a randomised, controlled study [Efficacia della terapia con onde d'urto extracorporee associata a chinesiterapia nel trattamento della sindrome da conflitto subacromiale: studio randomizzato controllato]. Journal of Sports Traumatology and Related Research 2000;22(2):58‐64.
Pan 2003 {published data only}
    1. Pan PJ, Chou CL, Chiou HJ, Ma HL, Lee HC, Chan RC. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study. Archives of Physical Medicine and Rehabilitation 2003;84:988‐93. - PubMed
Perlick 2003 {published data only}
    1. Perlick L, Luring C, Bathis H, Perlick C, Kraft C, Diedrich O. Efficacy of extracorporal shock‐wave treatment for calcific tendinitis of the shoulder: experimental and clinical results. Journal of Orthopaedic Science 2003;8:777‐83. - PubMed
Peters 2004 {published data only}
    1. Peters J, Luboldt W, Schwarz W, Jacobi V, Herzog C, Vogl TJ. Extracorporeal shock wave therapy in calcific tendinitis of the shoulder. Skeletal Radiology 2004;33:712‐8. - PubMed
    1. Peters J, Volkmar J, Thalhamer A, Vogl TJ. Extracorporeal shock wave lithotripsy in tendinitis calcarea of the shoulder: randomized comparison of different energy flux densities. Radiology 2001;221:560.
Pleiner 2004 {published data only}
    1. Pleiner J, Crevenna R, Langenberger H, Keilani M, Nuhr M, Kainberger F, et al. Extracorporeal shockwave treatment is effective in calcific tendonitis of the shoulder. A randomized controlled trial. Wiener Klinische Wochenschrift 2004;116(15‐16):536‐41. - PubMed
Rompe 1998 {published data only}
    1. Rompe JD, Buerer R, Hopf C, Eysel P. Shoulder function after extracorporal shock wave therapy for calcific tendinitis. Journal of Shoulder and Elbow Surgery 1998;7(5):505‐9. - PubMed
Sabeti 2007 {published data only}
    1. Sabeti M, Dorotka R, Goll A, Gruber M, Schatz KD. A comparison of two different treatments with navigated extracorporeal shock‐wave therapy for calcifying tendinitis – a randomized controlled trial. Wiener Klinische Wochenschrift 2007;119(3‐4):124‐8. - PubMed
Sabeti‐Aschraf 2005 {published data only}
    1. Sabeti‐Aschraf M, Dorotka R, Goll A, Trieb K. Extracorporeal shock wave therapy in the treatment of calcific tendinitis of the rotator cuff. American Journal of Sports Medicine 2005;33(9):1365‐8. - PubMed
Schmitt 2001 {published data only}
    1. Schmitt J, Haake M, Tosch A, Hildebrand R, Deike B, Griss P. Low‐energy extracorporeal shock‐wave treatment (ESWT) for tendinitis of the supraspinatus. A prospective, randomised study. Journal of Bone and Joint Surgery. British Volume 2001;83‐B(6):873‐6. - PubMed
    1. Schmitt J, Tosch A, Hunerkopf M, Haake M. Extracorporeal shockwave therapy (ESWT) as therapeutic option in supraspinatus tendon syndrome? One year results of a placebo controlled study [Die extrakorporale Stosswellentherapie (ESWT) als therapeutische Option beim Supraspinatussehnensyndrom? Ein‐Jahres‐Ergebnisse einer placebokontrollierten Studie]. Orthopade 2002;31:652‐7. - PubMed
Schofer 2009 {published data only}
    1. Schofer MD, Hinrichs F, Peterlein CD, Arendt M, Schmitt J. High‐ vs low‐energy extracorporeal shock wave therapy of rotator cuff tendinopathy: a prospective, randomised, controlled study. Acta Orthopaedica Belgica 2009;75(4):452‐8. - PubMed
Speed 2002 {published data only}
    1. Speed CA, Richards C, Nichols D, Burnet S, Wies JT, Huphreys H, et al. Extracorporeal shock‐wave therapy for tendinitis of the rotator cuff: a double‐blind, randomised, controlled trial. Journal of Bone and Joint Surgery. British Volume 2002;84‐B(4):509‐12. - PubMed
Tornese 2011 {published data only}
    1. Tornese D, Mattei E, Bandi M, Zerbi A, Quaglia A, Melegati G. Arm position during extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: a randomized study. Clinical Rehabilitation 2011;25(8):731‐9. - PubMed

References to studies excluded from this review

Adamietz 2003 {published data only}
    1. Adamietz B. Comment on the article by Gross MW, et al. The effectiveness of radiation treatment in comparison with extracorporeal shockwave therapy (ESWT) in supraspinatus tendon syndrome. (Strahlenther Onkol 2002;178:314‐20. No.6). Strahlentherapie und Onkologie 2003;179(2):129‐30; author reply 131‐2. - PubMed
Ali 2016 {published data only}
    1. Ali SA, Lasheen YR, Kamel RM, Genaidy AF. Efficacy of shockwave therapy in treatment of myofascial trigger points of rotator cuff muscle dysfunction. International Journal of PharmTech Research 2016;9(6):115‐26.
Astore 2003 {published data only}
    1. Astore F. Extracorporeal shock‐wave therapy for tendonitis of the rotator cuff. Journal of Bone and Joint Surgery. British Volume 2003;85(5):774; author reply 774. - PubMed
Avancini‐Dobrovic 2011 {published data only}
    1. Avancini‐Dobrovic V, Frlan‐Vrgoc L, Stamenkovic D, Pavlovic I, Vrbanic TSL. Radial extracorporeal shock wave therapy in the treatment of shoulder calcific tendinitis. Collegium Antropologicum 2011;35 Suppl 2:221‐5. - PubMed
Barnsley 2001 {published data only}
    1. Barnsley L, Martin J. New therapy for musculoskeletal conditions? Extracorporeal shockwave treatment. Medicine Today 2001;2:117‐8.
Boxberg 1996 {published data only}
    1. Boxberg W, Perlick L, Giebel G. Shockwave treatment of therapy refractory soft tissue pain. Chirurg 1996;67(11):1174‐8. - PubMed
Bringmann 2001 {published data only}
    1. Bringmann W. Chronic shoulder pain. Krankengymnastik 2001;53(2):244‐9.
Buch 1999 {published data only}
    1. Buch M, Klat J, Trager D, Siebert W. Prospective comparison of shock wave therapy and needling in calcareous tendinitis of the shoulder. Journal of Bone and Joint Surgery. British Volume 1999;81 Suppl 2:190.
Buselli 2010 {published data only}
    1. Buselli P, Coco V, Notarnicola A, Messina S, Saggini R, Tafuri S, et al. Shock waves in the treatment of post‐traumatic myositis ossificans. Ultrasound in Medicine & Biology 2010;36(3):397‐409. - PubMed
Bytomski 2006 {published data only}
    1. Bytomski JR, Black D. Conservative treatment of rotator cuff injuries. Journal of Surgical Orthopaedic Advances 2006;15(3):126‐31. - PubMed
Charrin 2001 {published data only}
    1. Charrin JE, Noel ER. Shockwave therapy under ultrasonographic guidance in rotator cuff calcific tendinitis. Joint, Bone, Spine 2001;68(3):241‐4. - PubMed
Cheing 2003 {published data only}
    1. Cheing GL, Chang H. Extracorporeal shock wave therapy. Journal of Orthopaedic and Sports Physical Therapy 2003;33(6):337‐43. - PubMed
Chow 2007 {published data only}
    1. Chow IH, Cheing GL. Comparison of different energy densities of extracorporeal shock wave therapy (ESWT) for the management of chronic heel pain. Clinical Rehabilitation 2007;21(2):131‐41. - PubMed
Cosentino 2004 {published data only}
    1. Cosentino R, Selvi E, Stefano R, Frati E, Manca S, Hammoud M, et al. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder. Clinical Rheumatology 2004;23(5):475‐7. - PubMed
Costa 2002 {published data only}
    1. Costa M, Donell S, Schmitt J, Haake M. Low‐energy extracorporeal shock‐wave treatment (ESWT) for tendinitis of the supraspinatus (multiple letters). Journal of Bone and Joint Surgery. British Volume 2002;84(4):619‐20. - PubMed
Cyteval 2003 {published data only}
    1. Cyteval C, Baron‐Sarrabere MP, Jorgensen C, Cottin A, Benis J, Sany J, et al. MRI study before and after extracorporal shock wave therapy in calcifying tendinitis of the shoulder. Journal de Radiologie 2003;84(6):681‐4. - PubMed
Friedberg 2010 {published data only}
    1. Friedberg MW. Supervised exercise superior to radial extracorporeal shockwave treatment for subacromial pain syndrome. JCOM 2010;17(2):58‐9.
Garcia Marti 2004 {published data only}
    1. Garcia Marti S. Usefulness of extracorporeal shock waves in musculoskeletal disorders (Structured abstract). Health Technology Assessment Database 2004; Vol. 4.
Hayes 2005 {published data only}
    1. Hayes Inc. Extracorporeal shock wave therapy for tendonitis of the rotator cuff (Structured abstract). Health Technology Assessment Database 2005; Vol. 4.
Jakobeit 2002 {published data only}
    1. Jakobeit C, Winiarski B, Jakobeit S, Welp L, Spelsberg G. Ultrasound‐guided, high‐energy extracorporeal shock‐wave treatment of symptomatic calcareous tendinopathy of the shoulder. ANZ Journal of Surgery 2002;72(7):496‐500. - PubMed
Kim 2012 {published data only}
    1. Kim JY, Lee JS, Park CW. Extracorporeal shock wave therapy is not useful after arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy 2012;20(12):2567‐72. - PubMed
Krasny 2005 {published data only}
    1. Krasny C, Enenkel M, Aigner N, Wlk M, Landsiedl F. Ultrasound‐guided needling combined with shock‐wave therapy for the treatment of calcifying tendonitis of the shoulder. Journal of Bone and Joint Surgery. British Volume 2005;87(4):501‐7. - PubMed
Labek 1999 {published data only}
    1. Labek G, Auersperg V, Boehler N. Treatment of tendinosis calcarea and impingement by extracorporal shock wave therapy (ESWT). Journal of Bone and Joint Surgery. British Volume 1999;81‐B Supp 2:190.
Lee 2011 {published data only}
    1. Lee SY, Cheng B, Grimmer‐Somers K. The midterm effectiveness of extracorporeal shockwave therapy in the management of chronic calcific shoulder tendinitis. Journal of Shoulder and Elbow Surgery 2011;20(5):845‐54. - PubMed
Lippincott 2010 {published data only}
    1. Lippincott W, Lippincott W. Supervised exercise may be better than ESWT in treating shoulder pain. Lippincott's Bone and Joint Newsletter 2010;16(1):8.
Liu 2012 {published data only}
    1. Liu S, Zhai L, Shi Z, Jing R, Zhao B, Xing G. Radial extracorporeal pressure pulse therapy for the primary long bicipital tenosynovitis a prospective randomized controlled study. Ultrasound in Medicine & Biology 2012;38(5):727‐35. - PubMed
Loew 1995 {published data only}
    1. Loew M, Jurgowski W, Mau HC, Thomsen M. Treatment of calcifying tendinitis of rotator cuff by extracorporeal shock waves: a preliminary report. Journal of Shoulder and Elbow Surgery 1995;4(2):101‐6. - PubMed
Lorbach 2008 {published data only}
    1. Lorbach O, Kusma M, Pape D, Kohn D, Dienst M. Influence of deposit stage and failed ESWT on the surgical results of arthroscopic treatment of calcifying tendonitis of the shoulder. Knee Surgery, Sports Traumatology, Arthroscopy 2008;16(5):516‐21. - PubMed
Magosch 2003 {published data only}
    1. Magosch P, Lichtenberg S, Habermeyer P. Radial shock wave therapy in calcifying tendinitis of the rotator cuff – a prospective study. Zeitschrift fur Orthopadie und Ihre Grenzgebiete 2003;141(6):629‐36. - PubMed
Maier 2000 {published data only}
    1. Maier M, Stabler A, Lienemann A, Kohler S, Feitenhansl A, Durr HR, et al. Shockwave application in calcifying tendinitis of the shoulder – prediction of outcome by imaging. Archives of Orthopaedic and Trauma Surgery 2000;120(9):493‐8. - PubMed
Mangone 2010 {published data only}
    1. Mangone G, Veliaj A, Postiglione M, Viliani T, Pasquetti P. Radial extracorporeal shock‐wave therapy in rotator cuff calcific tendinosis. Clinical Cases in Mineral & Bone Metabolism 2010;7(2):91‐6. - PMC - PubMed
Manske 2004 {published data only}
    1. Manske RC, Reiman MP, Stovak ML. Nonoperative and operative management of snapping scapula. American Journal of Sports Medicine 2004;32(6):1554‐65. - PubMed
Meier 2000 {published data only}
    1. Meier M, Duerr HR, Koehler S, Staupendahl D, Pfahler M, Refior HJ. Analgetic effect of extracorporeal shockwaves used for tendinosis calcarea, epicondylitis humeri radialis and plantar fasciitis [Analgetische wirkung nieder‐energetischer extrakorporaler stosswellen bei tendinosis calcarea, epikondylitis humeri radialis und plantarfasziitis]. Zeitschrift fur Orthopadie und Unfallchirurgie 2000;138:34‐8. - PubMed
Moretti 2005 {published data only}
    1. Moretti B, Garofalo R, Genco S, Patella V, Mouhsine E. Medium‐energy shock wave therapy in the treatment of rotator cuff calcifying tendinitis. Knee Surgery, Sports Traumatology, Arthroscopy 2005;13(5):405‐10. - PubMed
Mundy 2004 {published data only}
    1. Mundy L, Merlin T, Hodgkinson B. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff. Horizon Scanning Prioritising Summary – Volume 3 (Structured abstract). Health Technology Assessment Database 2004; Vol. 4.
Njawaya 2018 {published and unpublished data}
    1. Njawaya MM, Moses B, Martens D, Orchard JJ, Driscoll T, Negrine J, et al. Ultrasound guidance does not improve the results of shock wave for plantar fasciitis or calcific achilles tendinopathy: a randomized control trial. Clinical Journal of Sport Medicine 2018;28(1):21‐7. - PubMed
Noel 1999 {published data only}
    1. Noel E, Charrin J. Extracorporeal shock wave therapy in calcific tendinitis of the shoulder. Revue du Rhumatisme 1999;66(12):691‐3. - PubMed
Notarnicola 2011 {published data only}
    1. Notarnicola A, Moretti L, Tafuri S, Forcignano M, Pesce V, Moretti B. Reduced local perfusion after shock wave treatment of rotator cuff tendinopathy. World Federation for Ultrasound in Medicine & Biology 2011;37(3):417‐25. - PubMed
Pigozzi 2000 {published data only}
    1. Pigozzi F, Giombini A, Casciello G, Salvo V, Santori N, Mariani PP. The application of shock‐waves therapy in the treatment of resistant chronic painful shoulder: a clinical experience. Journal of Sports Medicine and Physical Fitness 2000;40(4):356‐61. - PubMed
Polimeni 2003 {published data only}
    1. Polimeni V, Panuccio A, Furfari P, Crupi D, Barreca G, Forgione C, et al. Preliminary study on the efficacy of various rehabilitation therapies for shoulder pain. European Journal of Physical and Rehabilitation Medicine 2003;39(1):59‐63.
Rebuzzi 2008 {published data only}
    1. Rebuzzi E, Coletti N, Schiavetti S, Giusto F. Arthroscopy surgery versus shock wave therapy for chronic calcifying tendinitis of the shoulder. Journal of Orthopaedics and Traumatology 2008;9:179‐85. - PMC - PubMed
Rees 2009 {published data only}
    1. Rees J, Maffulli N, Cook J. Management of tendinopathy. American Journal of Sports Medicine 2009;37(9):1855‐67. - PubMed
Rompe 1995 {published data only}
    1. Rompe JD, Rumler F, Hopf C, Nafe B, Heine J. Extracorporal shock wave therapy for calcifying tendinitis of the shoulder. Clinical Orthopaedics and Related Research 1995;321:196‐201. - PubMed
Rompe 2000 {published data only}
    1. Rompe JD, Zollner J, Nafe B, Freitag C. Significance of the elimination of deposits in patients treated for calcifying tendinitis of the shoulder. Orthopadische Klinik der Johannes‐Gutenberg‐Universitat Mainz 2000;138:335‐9.
Rompe 2001 {published data only}
    1. Rompe JD, Zoellner J, Nafe B. Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder. Clinical Orthopaedics and Related Research 2001;387:72‐82. - PubMed
Rompe 2003 {published data only}
    1. Rompe JD. Letters to the editor. American Journal of Sports Medicine 2003;31(6):1049‐51. - PubMed
Sabeti‐Aschraf 2004 {published data only}
    1. Sabeti‐Aschraf M, Dorotka R, Schatz KD, Schubert S, Ebenbichler G, Trieb K. Complication of extracorporal shockwave therapy in the treatment of calcifying tendinitis of the shoulder. Physikalische Medzin Rehabilitationsmedizin Kurotmedizin 2004;14:291‐4.
Saggini 2010 {published data only}
    1. Saggini R, Cavezza T, Pancrazio L, Pisciella V, Saladino G, Zuccaro MC, et al. Treatment of lesions of the rotator cuff. Journal of Biological Regulators and Homeostatic Agents 2010;24(4):453‐9. - PubMed
Sarrat 2004 {published data only}
    1. Sarrat P, Cohen M, Carrasset S, Godde J, Franceschi JP, Aswad R. Focused lithotripsy in the treatment of tendinosis calcarea of the shoulder: results at 2 months and one year. Journal de Radiologie 2004;85:1721‐5. - PubMed
Seil 2006 {published data only}
    1. Seil R, Wilmes P, Nuhrenborger C. Extracorporeal shock wave therapy for tendinopathies. Expert Review of Medical Devices 2006;3(4):463‐70. - PubMed
Sistermann 1998 {published data only}
    1. Sistermann R, Katthagen BD. Complications, side effects and contraindications using middle and high energetic extracorporeal shock waves in orthopaedics. Zeitschrift fur Orthopadie und Ihre Grenzgebiete 1998;136:175‐81. - PubMed
Speed 2005 {published data only}
    1. Speed C. Shoulder pain. Clinical Evidence 2005;14:1543‐60. - PubMed
Spindler 1998 {published data only}
    1. Spindler A, Berman A, Lucero E, Braier M. Extracorporeal shock wave treatment for chronic calcific tendinitis of the shoulder. Journal of Rheumatology 1998;25:1161‐3. - PubMed
Steinacker 2001 {published data only}
    1. Steinacker T, Steuer M. Use of extracorporal shockwave therapy in sport orthopaedics. Sportverletzung Sportschaden 2001;15:45‐9. - PubMed
Thigpen 2010 {published data only}
    1. Thigpen C. Radial extracorporeal shockwave treatment or supervised exercises for subacromial pain syndrome?. Clinical Journal of Sport Medicine 2010;20:225‐6. - PubMed
Wang 2001 {published data only}
    1. Wang C, Ko J, Chen H. Treatment of calcifying tendinitis of the shoulder with shock wave therapy. Clinical Orthopaedics and Related Research 2001;387:83‐9. - PubMed
Wang 2003 {published data only}
    1. Wang C, Yang KD, Wang F, Chen H, Wang J. Shock wave therapy for calcific tendinitis of the shoulder. American Journal of Sports Medicine 2003;31(3):425‐30. - PubMed
Wiley 2002 {published data only}
    1. Wiley P. Low‐energy extracorporeal shock‐wave treatment for tendinitis of the supraspinatus. Clinical Journal of Sports Medicine 2002;12(4):262‐4. - PubMed

References to studies awaiting assessment

Berner 2004 {published data only}
    1. Berner IC, Dudker J. Extracorporeal shock wave therapy for soft tissue rheumatisms: usefulness. [Les ondes de choc extracorporelles en pathologie abarticulaire: quelle utilite?]. Medecine et Hygiene 2004;62:549‐53.
Diehl 2011 {published data only}
    1. Diehl P, Gerdesmeyer L, Gollwitzer H, Sauer W, Tischer T. Calcific tendinitis of the shoulder [Die kalkschulter – tendinosis calcarea]. Der Orthopade 2011;40:733‐46. - PubMed
Gross 2002 {published data only}
    1. Gross MW, Sattler A, Haake M, Schmitt J, Hildebrandt R, Müller HH, et al. The value of radiotherapy in comparison with extracorporeal shockwave therapy for supraspinatus tendinitis [Die wertigkeit der strahlenbehandlung im vergleich zur extrakorporalen stoßwellentherapie (ESWT) beim supraspinatussehnensyndrom]. Strahlentherapie und Onkologie 2002;178:314‐20. - PubMed
Loew 1995 {published data only}
    1. Loew M, Jurgowski W, Thomsen M. Calcareous tendinitis of the shoulder – first experiences with a treatment by extracorporeal shock wave application (ESWA) [Die wirkung extrakorporaler atosswellen auf die tendinosis calcarea der schulter]. Urologe 1995;34:49‐53. - PubMed
Mao 2003 {published data only}
    1. Mao YR, Huang DF, Ding JX, Xu GQ, Xu YL, Zhao M. Analysis of extracorporeal shock wave therapy in immediate treatment of musculoskeletal disorders. Chinese Journal of Clinical Rehabilitation 2003;7:3216‐7.
Paternostro‐Sluga 2004 {published data only}
    1. Paternostro‐Sluga T, Zoch C. Conservative treatment and rehabilitation of shoulder problems [Konservative therapie und rehabilitation von schulterbeschwerden]. Radiologe 2004;44:597‐603. - PubMed
Rompe 1997a {published data only}
    1. Rompe JD, Kullmer K, Vogel J, Eckardt A, Wahlmann U, Eysel P, et al. Extracorporeal shock‐wave therapy. Experimental basis, clinical application [Extrakorporale stoßwellentherapie. Experimentelle grundlagen, klinischer einsatz]. Orthopade 1997;26:215‐28. - PubMed
Rompe 1997b {published data only}
    1. Rompe JD. Extracorporeal shockwave therapy in orthopedics. Positive results in tennis elbow and tendinosis calcarea of the shoulder [Extrakorporale stosswellentherapie in der orthopadie. Positive ergebnisse beim tennisellenbogen und der tendinosis calcarea der schulter]. Fortschritte der Medizin 1997;115:29‐33. - PubMed
Seil 1999 {published data only}
    1. Seil R, Rupp S, Hammer DS, Ensslin S, Gebhardt T, Kohn D. Extracorporeal shockwave therapy in tendionosis calcarea of the rotator cuff: comparison of different treatment protocols [Extrakorporale stosswellentherapie bei der tendionosis calcarea der rotatorenmanschette: vergleich verschiedener behandlungsprotokolle]. Zeitschrift fur Orthopadie und Ihre Grenzgebiete 1999;137:310‐5. - PubMed

References to ongoing studies

ChiCTR1900022932 {published data only}
    1. ChiCTR1900022932. http://www.chictr.org.cn/showproj.aspx?proj=38621.
NCT02677103 {published data only}
    1. NCT02677103. https://clinicaltrials.gov/show/NCT02677103.
NCT03779919 {published data only}
    1. NCT03779919. clinicaltrials.gov/ct2/show/NCT03779919 (first received 19 December 2018).
NTR7093 {published data only}
    1. NTR7093. https://www.trialregister.nl/trial/5527.
PACTR201910650013453 {published data only}
    1. PACTR201910650013453. http://apps.who.int/trialsearch/Trial2.aspx?TrialID=PACTR201910650013453 (first received 16 September 2019).

Additional references

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Ioppolo 2013
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References to other published versions of this review

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