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Extracorporeal shock-wave therapy can improve tendinitis of the shoulder

Bannuru RR, Flavin NE, Vaysbrot E, et al. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review. Ann Intern Med. 2014;160:542-9.

Review question

In people with tendinitis of the shoulder, does extracorporeal shock-wave therapy reduce pain and improve function?


Rotator cuff tendinitis (or shoulder tendinitis) is an inflammation of the tissues that connect the muscles and bones in the shoulder. It is one of the most common causes of shoulder pain. There are 2 types of tendinitis: Calcific tendinitis has calcium deposits in the tendons whereas noncalcific tendinitis does not.

Treatments for shoulder tendinitis include rest, medications to reduce pain or inflammation, physiotherapy, or sometimes surgery. Extracorporeal shock-wave therapy is an alternative treatment. It uses sound shock-waves to treat soft-tissue (e.g., tendon) injuries. It is delivered through the skin for 10 to 30 minutes per session, usually in an office setting.

How the review was done

The researchers did a systematic review, searching for published articles up to November 2013. They found 28 randomized controlled trials with 1745 people (average age 51 years). The key features of the trials were:

  • people had calcific or noncalcific tendinitis of the shoulder; and
  • high-energy or low-energy shock-wave therapy was compared with placebo or other treatments, or high-energy shock-wave therapy was compared with low-energy shock-wave therapy.

What the researchers found

The quality of the studies was generally low.

People with calcific tendinitis

High-energy shock-wave therapy reduced pain and improved function compared with placebo.

Low-energy shock-wave therapy improved function but not pain compared with placebo.

High-energy shock-wave therapy improved function more than low-energy shock-wave therapy. High-energy and low-energy shock-wave therapy did not differ for pain.

People with noncalcific tendinitis

Low-energy shock-wave therapy improved function in only 1 of 3 trials and did not reduce pain compared with placebo.



In people with rotator cuff (shoulder) tendinitis with calcium deposits, high-energy shock-wave therapy reduces pain and improves function.

Extracorporeal shock-wave therapy for tendinitis of the shoulder

Type of shoulder tendinitis


Effect on pain, function, and calcification

Calcific tendinitis

High-energy shock-wave therapy vs placebo

Reduced pain in 2 trials and improved function in 4 trials.


Low-energy shock-wave therapy vs placebo

Improved function in 2 trials, but evidence was inconclusive for pain.


High-energy vs low-energy shock-wave therapy

High-energy shock-wave therapy improved function more than low-energy shock-wave therapy in 8 trials. 5 trials showed no difference in pain.

Noncalcific tendinitis

Low-energy shock-wave therapy vs placebo

Improved function in 1 trial. 2 trials showed no effect on pain or function.


Related Topics


A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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