Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Jul;29(3):e2106.
doi: 10.1002/pri.2106.

The effectiveness of extracorporeal shock wave therapy for rotator cuff calcific tendinopathy. A systematic review with meta-analysis

Fabrizio Brindisino  1 , Sharon Marruganti  2 , Domenico Lorusso  3 , Claudia Cavaggion  4 , Diego Ristori  5
Affiliations
Meta-Analysis

The effectiveness of extracorporeal shock wave therapy for rotator cuff calcific tendinopathy. A systematic review with meta-analysis

Fabrizio Brindisino et al. Physiother Res Int. 2024 Jul.

Abstract

Purpose: To investigate if Extracorporeal Shock Wave therapy (ESWT) is effective in reducing pain and disability, in improving function, quality of life and complete resorption rate of calcification in patients with Rotator Cuff Calcific Tendinopathy. To investigate which modality of ESWT brings the greatest clinical improvements between High (HE)-SWT and Low Energy (LE)-SWT and between Focal (F)-SWT and Radial (R)-SWT.

Methods: MEDLINE, EMBASE, CENTRAL Database, and PEDro databases until February 2024 were searched. Study registers were further investigated. The Risk of Bias (RoB) was assessed with the Revised Cochrane RoB Tool (RoB 2). The certainty of evidence was rated with GRADE.

Results: Twenty-one randomized controlled trials were included. None was judged as overall low RoB. Comparing ESWT and Ultrasound Guided Needling Procedures (USGNP), the pooled results reported a significant difference favoring USGNP in pain at <24 and <48 weeks (MD = 1.17, p = 0.004, I2 = 59%; MD = 1.31, p = 0.004, I2 = 42%, respectively). Comparing ESWT and sham-ESWT, the pooled results reported a clinically significant difference favoring ESWT in pain and function at 24 weeks (MD = -5.72, p < 0.00001, I2 = 0%; Standardized Mean Difference = 2.94, p = 0.02 I2 = 98%, respectively). Comparing HE-SWT and LE-SWT, HE-SWT was statistically and clinically superior in pain and function at <24 weeks (MD = -1.83, p = 0.03, I2 = 87%; MD = 14.60, p = 0.002, I2 = 77%, respectively) and showed a significantly higher complete resorption rate of calcification at 12 weeks (Risk Ratio = 2.53, p = 0.001, I2 = 0%). F-SWT and R-SWT appear equally effective in reducing pain, improving disability and resorption rate. The certainty of evidence was rated as very low through GRADE approach.

Conclusion: USGNP was statistically superior to ESWT in pain reduction at <24 and <48 weeks. ESWT was clinically better to sham-ESWT in pain reduction and function improvement at 24 weeks. HE-SWT was clinically more effective than LE-SWT in reducing pain, improving function at <24 weeks, and resolving calcific deposits at 12 weeks, while no differences between F-SWT and R-SWT were reported.

Keywords: extracorporeal shock wave therapy; rotator cuff calcific tendinopathy.

PubMed Disclaimer

References

REFERENCES

    1. Abo Al‐Khair, M. A., El Khouly, R. M., Khodair, S. A., Al Sattar Elsergany, M. A., Hussein, M. I., & Eldin Mowafy, M. E. (2021). Focused, radial and combined shock wave therapy in treatment of calcific shoulder tendinopathy. The Physician and Sportsmedicine, 49(4), 480–487. https://doi.org/10.1080/00913847.2020.1856633
    1. Albert, J. D., Meadeb, J., Guggenbuhl, P., Marin, F., Benkalfate, T., Thomazeau, H., & Chalès, G. (2007). High‐energy extracorporeal shock‐wave therapy for calcifying tendinitis of the rotator cuff: A randomised trial. The Journal of Bone & Joint Surgery British, 89(3), 335–341. https://doi.org/10.1302/0301‐620x.89b3.18249
    1. Andrade, C. (2020). Mean difference, standardized mean difference (SMD), and their use in meta‐analysis: As Simple as it gets. The Journal of Clinical Psychiatry, 81(5). https://doi.org/10.4088/JCP.20f13681
    1. Arirachakaran, A., Boonard, M., Yamaphai, S., Prommahachai, A., Kesprayura, S., & Kongtharvonskul, J. (2017). Extracorporeal shock wave therapy, ultrasound‐guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: A network meta‐analysis of RCTs. European Journal of Orthopaedic Surgery and Traumatology, 27(3), 381–390. https://doi.org/10.1007/s00590‐016‐1839‐y
    1. Auersperg, V., Gerdesmeyer, L., Thiele, S., Knobloch, K., Hausdorf, J., Ringeisen, M., Schaden, W., & Müller‐Ehrenberg, H. (2019). DIGEST guidelines for extracorporeal shock wave therapy. The International Society for Medical Shockwave Treatment, 3–19.

LinkOut - more resources