Twenty-eight RCTs (1,745 participants) were included: 20 trials compared different ESWT energy levels with placebo and eight compared ESWT with other treatments. Twenty-one trials investigated calcific tendinitis. Study quality was generally low.
Calcific tendinitis ESWT versus placebo (seven trials): ESWT reduced shoulder pain or improved function significantly compared with placebo. High-energy ESWT was significantly better than placebo for both outcomes; results for low-energy ESWT were only statistically significant for function.
Calcific tendinitis high- versus low-energy ESWT (eight trials): High-energy ESWT was superior to low-energy in most trials for function but not for pain. High-energy ESWT seemed to be more efficient than low-energy for reducing calcification.
Calcific tendinitis ESWT versus other treatments: Single trials suggested that ESWT was as effective as exercise or radiation therapy and more effective than transcutaneous electrical nerve stimulation. Other results were reported.
Non-calcific tendinitis trials: One of three trials that compared low-energy ESWT with placebo found a significant improvement with ESWT and two found no difference in pain and functional outcomes. One RCT compared high-and low-energy ESWT and found no difference in outcomes.
Adverse events: Patients who received high-energy ESWT reported more adverse events than those who received low-energy ESWT or placebo. No serious adverse events occurred in any of the trials.