Extracorporeal shockwaves therapy versus hyaluronic acid injection for the treatment of painful non-calcific rotator cuff tendinopathies: preliminary results

J Sports Med Phys Fitness. 2017 Sep;57(9):1162-1168. doi: 10.23736/S0022-4707.16.06408-2. Epub 2016 Apr 12.


Background: Rotator cuff tendinopathy is the most common cause of painful shoulder. The treatment is mainly conservative and several therapeutic approaches have been proposed, including NSAIDs, physiotherapy, injections and physical therapies. The aim of the current study was to compare the clinical effectiveness of low molecular weight hyaluronic acid (LMW-HA) injection versus low-energy extracorporeal shock-wave therapy (ESWT) until 3 months of follow-up for the management of painful non-calcific rotator cuff tendinopathies, evaluating also the trend over time between the groups.

Methods: A total of 34 patients affected by painful rotator cuff tendinopathy were randomly divided into 2 groups of 17 individuals. The first group (group A; mean age 58.2 years) underwent 3 injections of LMW-HA (Hyalgan®, 500-730 kDa), while in the second group (group B; mean age 58.5 years) the treatment protocol consisted of 4 sessions of low-energy ESWT. Pain level and function were assessed with the DASH and Constant-Murley questionnaires. Parameters were evaluated at baseline (V0), at the end of the treatment (V1) and after 3 months of follow-up (V2).

Results: Patients of both groups achieved statistically significant improve in pain and function (P<0.0001). Clinical outcome shows a different trend in time between group A and group B for DASH and Constant-Murley questionnaires.

Conclusions: LMW-HA and low-energy ESWT are effective and safe in patients suffering from non-calcific rotator cuff tendinopathy until 3 months of follow-up. Intra-articular injections of LMW-HA provide prompt clinical improvement compared to ESWT, which results in more gradual improvement over time.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Female
  • High-Energy Shock Waves / therapeutic use*
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Male
  • Middle Aged
  • Pain Measurement
  • Pilot Projects
  • Rotator Cuff / physiology*
  • Shoulder Pain / therapy
  • Single-Blind Method
  • Tendinopathy / therapy*
  • Time Factors
  • Treatment Outcome


  • Hyaluronic Acid