Raveendhara R. Bannuru, MD; Nina E. Flavin, MD; Elizaveta Vaysbrot, MD, MS; William Harvey, MD, MSc; Timothy McAlindon, MD, MPH
Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1982.
Corresponding Author: Raveendhara R. Bannuru, MD, Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Bannuru, Flavin, Vaysbrot, Harvey, and McAlindon: Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA 02111.
Author Contributions: Conception and design: R.R. Bannuru, N.E. Flavin, E. Vaysbrot, T. McAlindon.
Analysis and interpretation of the data: R.R. Bannuru, N.E. Flavin, W. Harvey, T. McAlindon.
Drafting of the article: R.R. Bannuru, N.E. Flavin, E. Vaysbrot, W. Harvey, T. McAlindon.
Critical revision for important intellectual content: R.R. Bannuru, N.E. Flavin, E. Vaysbrot, W. Harvey, T. McAlindon.
Final approval of the article: R.R. Bannuru, N.E. Flavin, E. Vaysbrot, W. Harvey, T. McAlindon.
Provision of study materials or patients: R.R. Bannuru, N.E. Flavin, E. Vaysbrot, E. Vaysbrot, T. McAlindon.
Statistical expertise: R.R. Bannuru.
Administrative, technical, or logistic support: R.R. Bannuru, E. Vaysbrot.
Collection and assembly of data: R.R. Bannuru, N.E. Flavin, E. Vaysbrot.
Bannuru RR, Flavin NE, Vaysbrot E, Harvey W, McAlindon T. High-Energy Extracorporeal Shock-Wave Therapy for Treating Chronic Calcific Tendinitis of the Shoulder: A Systematic Review. Ann Intern Med. 2014;160:542-549. doi: 10.7326/M13-1982
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Published: Ann Intern Med. 2014;160(8):542-549.
Calcific and noncalcific tendinitis of the shoulder can be unresponsive to conventional therapies. Extracorporeal shock-wave therapy (ESWT) has been suggested as an alternative treatment.
To assess the efficacy of ESWT in patients with calcific and noncalcific tendinitis.
MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Google Scholar were searched up to 1 November 2013.
Randomized, controlled trials (RCTs) comparing high-energy versus low-energy ESWT or placebo for treatment of calcific or noncalcific tendinitis of the shoulder. Outcome measures included pain (visual analogue scale score), functional assessment (Constant–Murley score), and resolution of calcifications.
Three independent reviewers abstracted data and determined eligibility and quality by consensus.
Twenty-eight RCTs met the inclusion criteria. Studies were heterogeneous. Twenty RCTs compared ESWT energy levels and placebo and consistently showed that high-energy ESWT was significantly better than placebo in decreasing pain and improving function and resorption of calcifications in calcific tendinitis. No significant difference was found between ESWT and placebo in treatment of noncalcific tendinitis.
The number of RCTs was small, and the studies were heterogeneous.
High-energy ESWT is effective for improving pain and shoulder function in chronic calcific shoulder tendinitis and can result in complete resolution of calcifications. This therapy may be underutilized for a condition that can be difficult to manage.
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