title: High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review.
abstract: 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.
  
  
  OBJECTIVE
  To assess the efficacy of ESWT in patients with calcific and noncalcific tendinitis.
  
  
  METHODS
  MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Google Scholar were searched up to 1 November 2013.
  
  
  METHODS
  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.
  
  
  METHODS
  Three independent reviewers abstracted data and determined eligibility and quality by consensus.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The number of RCTs was small, and the studies were heterogeneous.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  None.
authors.forename: Raveendhara R
authors.initials: RR
authors.lastname: Bannuru
authors.forename: Nina E
authors.initials: NE
authors.lastname: Flavin
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Vaysbrot
authors.forename: William
authors.initials: W
authors.lastname: Harvey
authors.forename: Timothy
authors.initials: T
authors.lastname: McAlindon
mesh_terms: D002114:Calcinosis / Q000503:physiopathology / Q000628:therapy*; D019220:High-Energy Shock Waves / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000503:physiopathology; D020069:Shoulder Pain / Q000628:therapy; D052256:Tendinopathy / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome