title: Efficacy of transcutaneous electrical nerve stimulation for rotator cuff tendinopathy: a systematic review.
abstract: OBJECTIVE
  To perform a systematic review on the efficacy of transcutaneous electrical nerve stimulation (TENS) for the treatment of rotator cuff tendinopathy in adults.
  
  
  METHODS
  A literature search was conducted in four databases (CINAHL, Embase, PubMed and PeDRO) for randomised controlled trials published from date of inception until April 2015, comparing the efficacy of TENS for the treatment of rotator cuff tendinopathy with placebo or any other intervention. Risk of bias was evaluated using the Cochrane risk of bias tool. Results were summarised qualitatively.
  
  
  RESULTS
  Six studies were included in this review. The mean methodological score was 49% (standard deviation 16%), indicating an overall high risk of bias. One placebo-controlled trial reported that a single TENS session provided immediate pain reduction for patients with rotator cuff tendinopathy, but did not follow the participants in the short, medium or long term. Two trials that compared ultrasound therapy with TENS reported discrepancy and contradictory results in terms of pain reduction and shoulder range of motion. Corticosteroid injections were found to be superior to TENS for pain reduction in the short term, but the differences were not clinically important. Other studies included in this review concluded that TENS was not superior to heat or pulsed radiofrequency.
  
  
  CONCLUSIONS
  Due to the limited number of studies and the overall high risk of bias of the studies included in this review, no conclusions can be drawn on the efficacy of TENS for the treatment of rotator cuff tendinopathy. More methodologically sound studies are needed to document the efficacy of TENS. Until then, clinicians should prefer other evidence-based rehabilitation interventions proven to be efficacious to treat patients with rotator cuff tendinopathy.
authors.affiliation: Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada; School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada. Electronic address: f.desmeules@umontreal.ca.
authors.forename: F
authors.initials: F
authors.lastname: Desmeules
authors.affiliation: Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Boudreault
authors.affiliation: Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada.
authors.forename: J S
authors.initials: JS
authors.lastname: Roy
authors.affiliation: Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Axe Santé des populations et pratiques optimales en santé, Centre de recherche FRQS du Centre hospitalier universitaire de Québec, Quebec City, Quebec, Canada.
authors.forename: C E
authors.initials: CE
authors.lastname: Dionne
authors.affiliation: Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Laval University Hospital (CHU) Research Center, Quebec City, Quebec, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Frémont
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
authors.forename: J C
authors.initials: JC
authors.lastname: MacDermid
mesh_terms: D006801:Humans; D061208:Pulsed Radiofrequency Treatment / Q000379:methods; D016059:Range of Motion, Articular; D000070636:Rotator Cuff Injuries / Q000534:rehabilitation*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*
keywords: Rotator cuff; Shoulder impingement syndrome; Systematic review; Tendinopathy; Transcutaneous electrical nerve stimulation