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

Ann Intern Med. 2014 Apr 15;160(8):542-9. doi: 10.7326/M13-1982.


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.

Primary funding source: None.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Calcinosis / physiopathology
  • Calcinosis / therapy*
  • High-Energy Shock Waves / adverse effects
  • High-Energy Shock Waves / therapeutic use*
  • Humans
  • Range of Motion, Articular
  • Rotator Cuff* / physiopathology
  • Shoulder Pain / therapy
  • Tendinopathy / physiopathology
  • Tendinopathy / therapy*
  • Treatment Outcome