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High-Energy Extracorporeal Shock-Wave Therapy for Treating Chronic Calcific Tendinitis of the Shoulder: A Systematic ReviewHigh-Energy Extracorporeal Shock-Wave Therapy for Shoulder Tendinitis

Raveendhara R. Bannuru, MD; Nina E. Flavin, MD; Elizaveta Vaysbrot, MD, MS; William Harvey, MD, MSc; and Timothy McAlindon, MD, MPH
[+] Article and Author Information

From the Center for Treatment Comparison and Integrative Analysis, Tufts Medical Center; Tufts University School of Medicine; Sackler School of Graduate Biomedical Sciences, and Tufts University, Boston, Massachusetts.

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, rbannuru@tuftsmedicalcenter.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.


Ann Intern Med. 2014;160(8):542-549. doi:10.7326/M13-1982
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Background: 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.

Purpose: To assess the efficacy of ESWT in patients with calcific and noncalcific tendinitis.

Data Sources: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Google Scholar were searched up to 1 November 2013.

Study Selection: 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.

Data Extraction: Three independent reviewers abstracted data and determined eligibility and quality by consensus.

Data Synthesis: 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.

Limitation: The number of RCTs was small, and the studies were heterogeneous.

Conclusion: 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.

Primary Funding Source: None.

Figures

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Appendix Figure.

Summary of evidence search and selection.

ESWT = extracorporeal shock-wave therapy.

* 38 articles describing 34 studies. † 7 articles describing 6 studies. ‡ 31 articles describing 28 studies.

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Figure 1.

Effect sizes for pain and function in trials comparing ESWT with placebo.

ESWT = extracorporeal shock-wave therapy.

* The Hedges g value is the standardized mean difference corrected for small sample sizes.

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Figure 2.

Effect sizes for pain and function in trials comparing high-energy ESWT with low-energy ESWT.

ESWT = extracorporeal shock-wave therapy.

* The Hedges g value is the standardized mean difference corrected for small sample sizes.

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