Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis – A systematic review

Abstract

Extracorporeal shock-wave therapy (ESWT) is suggested as a treatment alternative for calcific and non-calcific rotator cuff tendinosis (RC-tendinosis), which may decrease the need for surgery. In this study we assessed the evidence for effectiveness of ESWT for these disorders. The Cochrane Library, PubMed, Embase, Pedro, and Cinahl were searched for relevant systematic reviews and RCTs. Two reviewers independently extracted data and assessed the methodological quality. Seventeen RCTs (11 calcific, 6 non-calcific) were included. For calcific RC-tendinosis, strong evidence was found for effectiveness in favour of high-ESWT versus low-ESWT in short-term. Moderate evidence was found in favour of high-ESWT versus placebo in short-, mid- and long-term and versus low-ESWT in mid- and long-term. Moreover, high-ESWT was more effective (moderate evidence) with focus on calcific deposit versus focus on tuberculum major in short- and long-term. RSWT was more effective (moderate evidence) than placebo in mid-term. For non-calcific RC-tendinosis, no strong or moderate evidence was found in favour of low-, mid- or high-ESWT versus placebo, each other, or other treatments. This review shows that only high-ESWT is effective for treating calcific RC-tendinosis. No evidence was found for the effectiveness of ESWT to treat non-calcific RC-tendinosis.

High-energy Versus Low-energy Extracorporeal Shock Wave Therapy for Calcifying Tendinitis of the Shoulder: Which is Superior? A Meta-analysis

“…These findings are in line with those of Huisstede et al [13] and Vavken et al [24]. Huisstede et al [13] performed a systematic review on the effectiveness of ESWT on calcific and noncalcific rotator cuff tendinitis and two studies [1,9] were included and presented narratively that compared high-energy ESWT with low-energy ESWT. Vavken et al [24] performed a meta-analysis in which they chose a new, nonevidencebased, cutoff point (0.20 mJ/mm 2 ).…”

Association between the increased thoracic curvature and the prevalence of pain in the shoulder complex on roping practitioners

“…Also, in addition to elevation, movement is associated with rotations that need to occur at both joints for a precise gesture that aims to noose the cattle. In this sense, due to the high amount of repetitive movements with the upper limb in an elevated position, pain is frequently reported in the literature in individuals under these conditions (19)(20)(21)(22) . Similar to the results of the present study changes and symptoms in the shoulder Table 2 complex are also evidenced in baseball (23) , swimming (24)(25)(26) , volleyball (19) players and in other sports, which also use the upper limb above the shoulder joint and shoulder girdle (27) .…”

Clinical Outcome after Ultrasound-Guided Needling in the Treat-ment of Chronic Calcifying Rotator Cuff Tendinopathy

“…The success rates of high-energy ESWT in clinical and radiologic examination have been reported to range between 78% and 91% [28,11,29]. US-guided needling success rates range between 68% and 92% [10,14,18].…”