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Effectiveness of Shockwave Therapy for Calcific Tendonitis

You may be like millions of people who suffer from shoulder pain related to something referred to as “calcific tendonitis”. But you may not know exactly what calcific tendonitis is, or which treatments you should consider. Well, calcific tendonitis is a disorder characterized by the calcification of soft tissues (such as tendons and synovium) in the shoulder [1]. Whether due to overuse or other biological changes in the body, the cells in the shoulder start to create little deposits of bone-like calcium in what should be soft tissues in the shoulder. As the soft tissues become burdened with the accumulation of these calcium deposits, the patient experiences pain and loss of function or mobility. Calcific tendonitis can also cause muscle spasms, inflammation, adhesive capsulitis, and rotator cuff tears [1].

The management of calcific tendonitis typically starts with the use of NSAIDs, physical therapy, massage, and steroid injections [1]. However, these treatments aren’t successful in as many as one out of every four patients [1]. That’s where ESWT can come into play. ESWT has shown great promise in the treatment of chronic calcific tendonitis. In fact, ESWT has been shown to decrease pain [2-23] and improve function [2-12,14-23] in long-term sufferers of calcific-tendonitis-related pain. ESWT has even generated “a reduction in pain and functional improvement with a significant clinical change” after only one week of treatment [7]. And the benefits are often enduring, with clinical studies demonstrating significant improvements in pain that lasted up to 12 months [12,13,17], and success rates of up to 92% even 12 months after treatment [13]. Perhaps the most important finding is that ESWT can decrease the size of calcium deposits [5,9,11,15,17,18, 21-23], and in some cases completely eliminate the bonelike calcium deposits in the soft tissues of the joint [3,5,9,11,12,18,21-23]. Although the mechanisms of action are unknown, ESWT is thought to increase the production of both new blood vessels and new lymphatic vessels [24].


1. Sansone V, Maiorano E, Galluzzo A, Pascale V. Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment. Orthop Res Rev. 2018 Oct 3;10:63-72.

2. Albert JD, Meadeb J, Guggenbuhl P, et al. High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial. J Bone Joint Surg Br. 2007 Mar;89(3):335-41.

4. Carlisi E, Lisi C, Dall'angelo A, et al. Focused extracorporeal shock wave therapy combined with supervised eccentric training for supraspinatus calcific tendinopathy. Eur J Phys Rehabil Med. 2018 Feb;54(1):41-47.

5. Cosentino R, De Stefano R, Selvi E, et al. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study. Ann Rheum Dis. 2003 Mar;62(3):248-50.

6. Daecke W, Kusnierczak D, Loew M. Long-term effects of extracorporeal shockwave therapy in chronic calcific tendinitis of the shoulder. J Shoulder Elbow Surg. 2002 Sep- Oct;11(5):476-80.

7. Frassanito P, Cavalieri C, Maestri R, Felicetti G. Effectiveness of Extracorporeal Shock Wave Therapy and kinesio taping in calcific tendinopathy of the shoulder: a randomized controlled trial. Eur J Phys Rehabil Med. 2018 Jun;54(3):333-340.

9. Hsu CJ, Wang DY, Tseng KF, et al. Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. J Shoulder Elbow Surg. 2008 Jan-Feb;17(1):55-9.

11. Loew M, Jurgowski W, Mau HC, Thomsen M. Treatment of calcifying tendinitis of rotator cuff by extracorporeal shock waves: a preliminary report. J Shoulder Elbow Surg. 1995 Mar-Apr;4(2):101-6.

12. Magosch P, Lichtenberg S, Habermeyer P. Radial shock wave therapy in calcifying tendinitis of the rotator cuff--a prospective study. Z Orthop Ihre Grenzgeb. 2003 Nov- Dec;141(6):629-36.

13. Malliaropoulos N, Thompson D, Meke M, et al. Individualised radial extracorporeal shock wave therapy (rESWT) for symptomatic calcific shoulder tendinopathy: a retrospective clinical study. BMC Musculoskelet Disord. 2017 Dec 6;18(1):513.

14. Mangone G, Veliaj A, Postiglione M, et al. Radial extracorporeal shock-wave therapy in rotator cuff calcific tendinosis. Clin Cases Miner Bone Metab. 2010 May;7(2): 91-6.

15. Pan PJ, Chou CL, Chiou HJ, et al. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study. Arch Phys Med Rehabil. 2003 Jul;84(7):988-93.

16. Park C, Lee S, Yi CW, Lee K. The effects of extracorporeal shock wave therapy on frozen shoulder patients' pain and functions. J Phys Ther Sci. 2015 Dec;27(12):3659-61.

18. Rompe JD, Bürger R, Hopf C, Eysel P. Shoulder function after extracorporal shock wave therapy for calcific tendinitis. J Shoulder Elbow Surg. 1998 Sep-Oct;7(5):505-9.

19. Sabeti-Aschraf M, Dorotka R, Goll A, Trieb K. Extracorporeal shock wave therapy in the treatment of calcific tendinitis of the rotator cuff. Am J Sports Med. 2005 Sep;33(9): 1365-8.

20. Vahdatpour B, Taheri P, Zade AZ, Moradian S. Efficacy of extracorporeal shockwave therapy in frozen shoulder. Int J Prev Med. 2014 Jul;5(7):875-81.

21. Wang CJ, Yang KD, Wang FS, Chen HH, Wang JW. Shock wave therapy for calcific tendinitis of the shoulder: a prospective clinical study with two-year follow-up. Am J Sports Med. 2003 May-Jun;31(3):425-30.

22. Wang CJ, Ko JY, Chen HS. Treatment of calcifying tendinitis of the shoulder with shock wave therapy. Clin Orthop Relat Res. 2001 Jun;(387):83-9.

23. Notarnicola A, Moretti L, Maccagnano G, et al. Tendonitis of the rotator cuff treated with extracorporeal shock wave therapy: radiographic monitoring to identify prognostic factors for disintegration. J Biol Regul Homeost Agents. 2016 Oct-Dec;30(4):1195-1202.

24. BrañEs J, Contreras HR, Cabello P, et al. Shoulder Rotator Cuff Responses to Extracorporeal Shockwave Therapy: Morphological and Immunohistochemical Analysis. Shoulder & Elbow, vol. 4, 3: pp. 163-168.

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