Background: Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach in the management of a number of tendinopathies. Benefit has been shown in calcific tendinitis of the rotator cuff, but evidence for its use in non-calcific disorders is limited.Aims: To perform a double blind randomised controlled trial of moderate dose shock wave therapy in plantar Fasciitis. Methods: Adults with plantar fasciitis for at least 3 months were randomised to receive either active treatment (0.12 mJlmm') or sham therapy, monthly for 3 months. Pain in the day, nocturnal pain and morning start-up pain were assessed at baseline, before each treatment and 1 and 3 months after completion of therapy.Results: Eighty-eight subjects participated and no differences existed between the groups at baseline. At 3 months, 37%0 of the subjects in the ESWT group and 24%) in the sham group showed a positive response (50% improvement from baseline) with respect to pain. Positive responses in night pain occurred in 41% and 31Y0 in the ESWT and sham groups, respectively. Positive responses in start-up pain occurred in 370/0 and 36% in the ESWT and sham groups, respectively. Both groups showed significant improvement over the course of the study, but no statistically significant difference existed between the groups with respect to the changes were seen in any of the outcome measures over the 6-month period.Conclusions: There appears to be no treatment effect of moderate dose ESWT in subjects with plantar fasciitis. Efficacy may be highly dependent upon machine types and treatment protocols. Further research is needed to develop evidence based recommendation for the use ESWT in musculoskeletal complaints.

Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach to the treatment of a number of soft tissue complaints. Whilst benefit has been demonstrated in calcific tendinitis, evidence is lacking for benefit in the management of non-calcific rotator cuff disorders.Aims: To perform a double-blind placebo controlled trial of moderate dose ESWT in chronic lateral epicondylitis. Meth0d.s: Adults with lateral epicondylitis were randomised to receive either active treatment (1 500 pulses ESWT at 0.12 mJ/ mm2) or sham therapy, monthly for three months. All were assessed before each treatment and one month after completion of therapy. Outcome measures consisted of visual analogue scores for pain in the day and at night.Results: Seventy-five subjects participated and there were no significant differences between the two groups at baseline. The mean duration of symptoms was 15.9 and 12 months in the ESWT and sham groups, respectively. Both groups showed significant improvements from two months. No significant difference existed between the groups with respect to the degrees of change in pain scores over the study period. In the ESWT group the mean (SD, range) pain score was 73.4 (14.5, 38-99) at baseline and 47.9 (31.4, 3-100) at three months. In the sham group the mean (SD, range) pain score was 67.2 (21.7, 12-100) at baseline and 51.5 (32.5, 3-100) at three months.At three months, 50% improvement from baseline was noted in 35% of the ESWT group and 34% of the sham group with respect to pain.Conclusions: There appears to be a significant placebo effect of moderate dose ESWT in subjects with lateral epicondylitis but there is no evidence of added benefit of treatment when compared to sham therapy.

We have performed a double-blind placebo-controlled trial of moderate doses of extracorporeal shock-wave therapy (ESWT) for non-calcific tendonitis of the rotator cuff. Adults (74) with chronic tendonitis of the rotator cuff were randomised to receive either active (1500 pulses ESWT at 0.12 mJ/mm2) or sham treatment, monthly for three months. All were assessed before each treatment, and at one and three months after the completion of treatment. The outcome was measured with regard to pain in the shoulder, including a visual analogue score for night pain, and a disability index. There were no significant differences between the two groups before treatment. The mean duration of symptoms in both groups was 23.3 months. Both showed significant and sustained improvements from two months onwards. There was no significant difference between them with respect to change in the Shoulder Pain and Disability Index (SPADI) scores or night pain over the six-month period. A mean (+/-SD; range) change in SPADI of 16.1 +/- 27.2 (0 to 82) in the treatment group and 24.3 +/- 24.8 (-11 to 83) in the sham group was noted at three months. At six months the mean changes were 28.4 +/- 25.9 (-24 to 69) and 30.4 +/- 31.2 (-12 to 88), respectively. Similar results were noted for night pain. We conclude that there is a significant and sustained placebo effect after moderate doses of ESWT in patients with non-calcific tendonitis of the rotator cuff, but there is no evidence of added benefit when compared with sham treatment.

W e have performed a double-blind placebo-controlled trial of moderate doses of extracorporeal shock-wave therapy (ESWT) for non-calcific tendonitis of the rotator cuff. Adults (74) with chronic tendonitis of the rotator cuff were randomised to receive either active (1500 pulses ESWT at 0.12 mJ/mm 2 ) or sham treatment, monthly for three months. All were assessed before each treatment, and at one and three months after the completion of treatment. The outcome was measured with regard to pain in the shoulder, including a visual analogue score for night pain, and a disability index. There were no significant differences between the two groups before treatment. The mean duration of symptoms in both groups was 23.3 months. Both showed significant and sustained improvements from two months onwards. There was no significant difference between them with respect to change in the Shoulder Pain and Disability Index (SPADI) scores or night pain over the six-month period. A mean (±SD; range) change in SPADI of 16.1 ± 27.2 (0 to 82) in the treatment group and 24.3 ± 24.8 (-11 to 83) in the sham group was noted at three months. At six months the mean changes were 28.4 ± 25.9 (-24 to 69) and 30.4 ± 31.2 (-12 to 88), respectively. Similar results were noted for night pain.We conclude that there is a significant and sustained placebo effect after moderate doses of ESWT in patients with non-calcific tendonitis of the rotator cuff, but there is no evidence of added benefit when compared with sham treatment. Extracorporeal shock-wave therapy (ESWT) by singlepressure pulses of microsecond duration can be guided by ultrasound to focus on a specific site. Having revolutionised the treatment of urolithiasis, ESWT has more recently been used in the treatment of a number of musculoskeletal conditions, including tendinopathies and enthesopathies, at doses of 10% to 20% of those used in lithotripsy for renal calculi.1-5 The theoretical benefits are the stimulation of tissue healing and the breakdown of calcification. [4][5][6][7] In spite of the increasing popularity of this method of treatment, there has been no randomised, controlled trial of its use in specific musculoskeletal conditions. Benefit from ESWT has been demonstrated in calcific tendonitis of the rotator cuff. 4 We present our findings of a double-blind, randomised, controlled trial in non-calcific tendonitis of the rotator cuff. Patients and MethodsWe recruited adult patients with a clinical diagnosis of tendonitis of the rotator cuff. Informed consent was obtained. The patients were more than 18 years of age and had had pain in the shoulder for at least three months with clinical signs of a unilateral tendonitis of the rotator cuff. These included a painful arc and/or an impingement sign and pain, without weakness on resisted testing of one or more musculotendinous units of the rotator cuff. Exclusion criteria were demonstrable shoulder pathology including glenohumeral or acromioclavicular arthritis, instability, polyarthritis, neck pain, a local dermatological condition, n...

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