Clinician Article

High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review.

  • Bannuru RR
  • Flavin NE
  • Vaysbrot E
  • Harvey W
  • McAlindon T
Ann Intern Med. 2014 Apr 15;160(8):542-9. doi: 10.7326/M13-1982. (Review)
PMID: 24733195
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  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Physical Medicine and Rehabilitation
    Relevance - 6/7
    Newsworthiness - 5/7
  • Rheumatology
    Relevance - 6/7
    Newsworthiness - 4/7
  • Surgery - Orthopaedics
    Relevance - 5/7
    Newsworthiness - 5/7


BACKGROUND: Calcific and noncalcific tendinitis of the shoulder can be unresponsive to conventional therapies. Extracorporeal shock-wave therapy (ESWT) has been suggested as an alternative treatment.

PURPOSE: To assess the efficacy of ESWT in patients with calcific and noncalcific tendinitis.

DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Google Scholar were searched up to 1 November 2013.

STUDY SELECTION: Randomized, controlled trials (RCTs) comparing high-energy versus low-energy ESWT or placebo for treatment of calcific or noncalcific tendinitis of the shoulder. Outcome measures included pain (visual analogue scale score), functional assessment (Constant-Murley score), and resolution of calcifications.

DATA EXTRACTION: Three independent reviewers abstracted data and determined eligibility and quality by consensus.

DATA SYNTHESIS: Twenty-eight RCTs met the inclusion criteria. Studies were heterogeneous. Twenty RCTs compared ESWT energy levels and placebo and consistently showed that high-energy ESWT was significantly better than placebo in decreasing pain and improving function and resorption of calcifications in calcific tendinitis. No significant difference was found between ESWT and placebo in treatment of noncalcific tendinitis.

LIMITATION: The number of RCTs was small, and the studies were heterogeneous.

CONCLUSION: High-energy ESWT is effective for improving pain and shoulder function in chronic calcific shoulder tendinitis and can result in complete resolution of calcifications. This therapy may be underutilized for a condition that can be difficult to manage.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

The authors of this systematic review found consistent evidence that the studied intervention improves a patient-oriented outcome when used to treat a reasonably common condition.

General Internal Medicine-Primary Care(US)

This is a useful review of the literature on a therapeutic topic that may not be widely appreciated. The evidence-based data available suggest that ESWT may well be useful for troubling calcific shoulder tendonitis. The review suggests that much better study is needed to be sure, as the current literature has many shortcomings. It is also not clear whether the usefulness of this therapy pertains to rotator cuff or bicipital tendonitis.


Given the nature of the studies included, I'm not sure I find the evidence compelling or wholly credible.

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