Extracorporeal shock wave therapy for rotator cuff tendinopathy: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

HAN Xuan ^1,2 ,  YUAN Xiangnan ^1,2

1. Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang 110134, P.R.China;
2. The Second Clinical College of China Medical University, Shenyang 110122, P.R.China;

Corresponding author：

YUAN Xiangnan, Email: yuanxn@sj-hospital.org

Keywords：

Extracorporeal shock wave therapy; Rotator cuff tendinopathy; Pain; Shoulder function; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202104149

Video：

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Objective To systematically review the efficacy and safety of extracorporeal shock wave therapy (ESWT) in the treatment of rotator cuff tendinopathy to provide evidence for clinical practice. Methods Databases including CENTRAL, MEDLINE, EMbase, CINAHL plus, PEDro, CNKI, CBM, WanFang Data, and VIP were searched to collect randomized controlled trials (RCTs) of ESWT in the treatment of rotator cuff tendinopathy from inception to January 11^th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 12 RCTs from 11 articles were included, including 529 subjects (273 in the case group and 256 in the control group). Meta-analysis showed that no significant difference between ESWT and placebo in pain improvement (SMD=−1.08, 95% CI −2.45 to 0.29, P=0.12), superior pain improvement in ESWT group than electroacupuncture group (SMD=−7.15, 95%CI −8.50 to −5.80, P<0.000 01), and no significant difference in pain improvement between ESWT as adjuvant therapy and acupuncture alone (SMD=−4.32, 95%CI −11.93 to 3.29, P=0.27). Regarding the Constant–Murley score (CMS) for shoulder joint function, ESWT was associated with an improved CMS compared with placebo (SMD=1.31, 95%CI 0.08 to 2.53, P=0.04). There was no significant difference in the improvement in the CMS between ESWT and other treatments (SMD=0.13, 95%CI −2.07 to 2.53, P=0.91). There was no significant difference in the improvement in the CMS between ESWT as adjuvant therapy and acupuncture alone (SMD=1.68, 95%CI −0.69 to 4.05, P=0.16). Conclusions ESWT may improve shoulder joint function in patients with rotator cuff tendinopathy, and the alleviation of pain in patients with rotator cuff tendinopathy requires further investigation. Due to the limited quality and quantity of included studies, the above conclusions requires further investigation by more high-quality studies.

Citation： HAN Xuan, YUAN Xiangnan. Extracorporeal shock wave therapy for rotator cuff tendinopathy: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(10): 1126-1132. doi: 10.7507/1672-2531.202104149 Copy

1.	van der Heijden GJ. Shoulder disorders: a state-of-the-art review. Baillieres Best Pract Res Clin Rheumatol, 1999, 13(2): 287-309.
2.	Tekavec E, Jöud A, Rittner R, et al. Population-based consultation patterns in patients with shoulder pain diagnoses. BMC Musculoskelet Disord, 2012, 13: 238.
3.	Lewis J, McCreesh K, Roy JS, et al. Rotator cuff tendinopathy: navigating the diagnosis-management conundrum. J Orthop Sports Phys Ther, 2015, 45(11): 923-937.
4.	Jeong JY, Song SY, Yoo JC, et al. Comparison of outcomes with arthroscopic repair of acute-on-chronic within 6 months and chronic rotator cuff tears. J Shoulder Elbow Surg, 2017, 26(4): 648-655.
5.	MacDermid JC, Ramos J, Drosdowech D, et al. The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. J Shoulder Elbow Surg, 2004, 13(6): 593-598.
6.	Soslowsky LJ, Thomopoulos S, Esmail A, et al. Rotator cuff tendinosis in an animal model: role of extrinsic and overuse factors. Ann Biomed Eng, 2002, 30(8): 1057-1063.
7.	Lewis JS. Rotator cuff tendinopathy. Br J Sports Med, 2009, 43(4): 236-241.
8.	Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev, 2003, (1): CD004016.
9.	Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet, 2010, 376(9754): 1751-1767.
10.	Min KS, St Pierre P, Ryan PM, et al. A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroidversus NSAID in patients with shoulder impingement syndrome. J Shoulder Elbow Surg, 2013, 22(5): 595-601.
11.	Pieters L, Lewis J, Kuppens K, et al. An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. J Orthop Sports Phys Ther, 2020, 50(3): 131-141.
12.	Saw A. Extracorporeal shock wave therapy for musculoskeletal pathology--a literature review. Med J Malaysia, 2005, 60(Suppl C): 8-10.
13.	Ioppolo F, Rompe JD, Furia JP, et al. Clinical application of shock wave therapy (SWT) in musculoskeletal disorders. Eur J Phys Rehabil Med, 2014, 50(2): 217-230.
14.	Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther, 2003, 83(8): 713-721.
15.	Cochrane M, Mitchell E, Hollingworth W, et al. Cost-effectiveness of interventions for chronic fatigue syndrome or myalgic encephalomyelitis: a systematic review of economic evaluations. Appl Health Econ Health Policy, 2021: 1-14.
16.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
17.	Frizziero A, Vittadini F, Barazzuol M, et al. Extracorporeal shockwaves therapyversus hyaluronic acid injection for the treatment of painful non-calcific rotator cuff tendinopathies: preliminary results. J Sports Med Phys Fitness, 2017, 57(9): 1162-1168.
18.	Kolk A, Yang KG, Tamminga R, et al. Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial. Bone Joint J, 2013, 95-B(11): 1521-1526.
19.	Li W, Zhang SX, Yang Q, et al. Effect of extracorporeal shock-wave therapy for treating patients with chronic rotator cuff tendonitis. Medicine (Baltimore), 2017, 96(35): e7940.
20.	Galasso O, Amelio E, Riccelli DA, et al. Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial. BMC Musculoskelet Disord, 2012, 13: 86.
21.	Schmitt J, Haake M, Tosch A, et al. Low-energy extracorporeal shock-wave treatment (ESWT) for tendinitis of the supraspinatus. a prospective, randomised study. J Bone Joint Surg Br, 2001, 83(6): 873-876.
22.	Speed CA, Richards C, Nichols D, et al. Extracorporeal shock-wave therapy for tendonitis of the rotator cuff: a double-blind, randomised, controlled trial. J Bone Joint Surg Br, 2002, 84(4): 509-512.
23.	Efe T, Felgentreff M, Heyse TJ, et al. Extracorporeal shock wave therapy for non-calcific supraspinatus tendinitis - 10-year follow-up of a randomized placebo-controlled trial. Biomed Tech (Berl), 2014, 59(5): 431-437.
24.	谷玉静, 林松, 冯晓东. 体外冲击波治疗非钙化性冈上肌肌腱炎疗效观察. 中国骨与关节杂志, 2014, 3(9): 657-660.
25.	王俊华, 徐远红, 王刚, 等. 体外冲击波联合电针治疗冈上肌肌腱炎的临床研究. 中国中医急症, 2012, 21(7): 1050-1051, 1099.
26.	徐远红, 王俊华, 王贤明, 等. 超声能量多普勒微循环指数测定在研究体外冲击波对冈上肌肌腱炎微循环影响中的应用. 中国康复医学杂志, 2012, 27(5): 462-464.
27.	张立俭, 黄静宜, 祁昌杰, 等. 温针灸“肩三针”结合体外冲击波治疗劳损性冈上肌腱炎. 中医学报, 2020, 35(9): 2024-2027.
28.	Kachewar SG, Kulkarni DS. Calcific tendinitis of the rotator cuff: a review. J Clin Diagn Res, 2013, 7(7): 1482-1485.
29.	Bannuru RR, Flavin NE, Vaysbrot E, et al. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review. Ann Intern Med, 2014, 160(8): 542-549.
30.	Arirachakaran A, Boonard M, Yamaphai S, et al. Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs. Eur J Orthop Surg Traumatol, 2017, 27(3): 381-390.
31.	Wu KT, Chou WY, Wang CJ, et al. Efficacy of extracorporeal shockwave therapy on calcified and noncalcified shoulder tendinosis: a propensity score matched analysis. Biomed Res Int, 2019, 2019: 2958251.
32.	Harniman E, Carette S, Kennedy C, et al. Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review. J Hand Ther, 2004, 17(2): 132-151.
33.	Cipollaro L, Sahemey R, Oliva F, et al. Immunohistochemical features of rotator cuff tendinopathy. Br Med Bull, 2019, 130(1): 105-123.
34.	Vrotsou K, Ávila M, Machón M, et al. Constant-murley score: systematic review and standardized evaluation in different shoulder pathologies. Qual Life Res, 2018, 27(9): 2217-2226.
35.	Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, (214): 160-164.
36.	Angst F, Schwyzer HK, Aeschlimann A, et al. Measures of adult shoulder function: disabilities of the arm, shoulder, and hand questionnaire (DASH) and its short version (QuickDASH), shoulder pain and disability index (SPADI), American shoulder and elbow surgeons (ASES) society standardized shoulder assessment form, constant (Murley) score (CS), simple shoulder test (SST), Oxford shoulder score (OSS), shoulder disability questionnaire (SDQ), and Western ontario shoulder instability index (WOSI). Arthritis Care Res (Hoboken), 2011, 63(Suppl 11): S174-S188.
37.	Testa G, Vescio A, Perez S, et al. Extracorporeal shockwave therapy treatment in upper limb diseases: a systematic review. J Clin Med, 2020, 9(2): 453.
38.	Liao CD, Tsauo JY, Chen HC, et al. Efficacy of extracorporeal shock wave therapy for lower-limb tendinopathy: a meta-analysis of randomized controlled trials. Am J Phys Med Rehabil, 2018, 97(9): 605-619.
39.	Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res, 2012, 7: 11.
40.	Speed CA. Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions. J Bone Joint Surg Br, 2004, 86(2): 165-171.

1. van der Heijden GJ. Shoulder disorders: a state-of-the-art review. Baillieres Best Pract Res Clin Rheumatol, 1999, 13(2): 287-309.
2. Tekavec E, Jöud A, Rittner R, et al. Population-based consultation patterns in patients with shoulder pain diagnoses. BMC Musculoskelet Disord, 2012, 13: 238.
3. Lewis J, McCreesh K, Roy JS, et al. Rotator cuff tendinopathy: navigating the diagnosis-management conundrum. J Orthop Sports Phys Ther, 2015, 45(11): 923-937.
4. Jeong JY, Song SY, Yoo JC, et al. Comparison of outcomes with arthroscopic repair of acute-on-chronic within 6 months and chronic rotator cuff tears. J Shoulder Elbow Surg, 2017, 26(4): 648-655.
5. MacDermid JC, Ramos J, Drosdowech D, et al. The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. J Shoulder Elbow Surg, 2004, 13(6): 593-598.
6. Soslowsky LJ, Thomopoulos S, Esmail A, et al. Rotator cuff tendinosis in an animal model: role of extrinsic and overuse factors. Ann Biomed Eng, 2002, 30(8): 1057-1063.
7. Lewis JS. Rotator cuff tendinopathy. Br J Sports Med, 2009, 43(4): 236-241.
8. Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev, 2003, (1): CD004016.
9. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet, 2010, 376(9754): 1751-1767.
10. Min KS, St Pierre P, Ryan PM, et al. A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroidversus NSAID in patients with shoulder impingement syndrome. J Shoulder Elbow Surg, 2013, 22(5): 595-601.
11. Pieters L, Lewis J, Kuppens K, et al. An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. J Orthop Sports Phys Ther, 2020, 50(3): 131-141.
12. Saw A. Extracorporeal shock wave therapy for musculoskeletal pathology--a literature review. Med J Malaysia, 2005, 60(Suppl C): 8-10.
13. Ioppolo F, Rompe JD, Furia JP, et al. Clinical application of shock wave therapy (SWT) in musculoskeletal disorders. Eur J Phys Rehabil Med, 2014, 50(2): 217-230.
14. Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther, 2003, 83(8): 713-721.
15. Cochrane M, Mitchell E, Hollingworth W, et al. Cost-effectiveness of interventions for chronic fatigue syndrome or myalgic encephalomyelitis: a systematic review of economic evaluations. Appl Health Econ Health Policy, 2021: 1-14.
16. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
17. Frizziero A, Vittadini F, Barazzuol M, et al. Extracorporeal shockwaves therapyversus hyaluronic acid injection for the treatment of painful non-calcific rotator cuff tendinopathies: preliminary results. J Sports Med Phys Fitness, 2017, 57(9): 1162-1168.
18. Kolk A, Yang KG, Tamminga R, et al. Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial. Bone Joint J, 2013, 95-B(11): 1521-1526.
19. Li W, Zhang SX, Yang Q, et al. Effect of extracorporeal shock-wave therapy for treating patients with chronic rotator cuff tendonitis. Medicine (Baltimore), 2017, 96(35): e7940.
20. Galasso O, Amelio E, Riccelli DA, et al. Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial. BMC Musculoskelet Disord, 2012, 13: 86.
21. Schmitt J, Haake M, Tosch A, et al. Low-energy extracorporeal shock-wave treatment (ESWT) for tendinitis of the supraspinatus. a prospective, randomised study. J Bone Joint Surg Br, 2001, 83(6): 873-876.
22. Speed CA, Richards C, Nichols D, et al. Extracorporeal shock-wave therapy for tendonitis of the rotator cuff: a double-blind, randomised, controlled trial. J Bone Joint Surg Br, 2002, 84(4): 509-512.
23. Efe T, Felgentreff M, Heyse TJ, et al. Extracorporeal shock wave therapy for non-calcific supraspinatus tendinitis - 10-year follow-up of a randomized placebo-controlled trial. Biomed Tech (Berl), 2014, 59(5): 431-437.
24. 谷玉静, 林松, 冯晓东. 体外冲击波治疗非钙化性冈上肌肌腱炎疗效观察. 中国骨与关节杂志, 2014, 3(9): 657-660.
25. 王俊华, 徐远红, 王刚, 等. 体外冲击波联合电针治疗冈上肌肌腱炎的临床研究. 中国中医急症, 2012, 21(7): 1050-1051, 1099.
26. 徐远红, 王俊华, 王贤明, 等. 超声能量多普勒微循环指数测定在研究体外冲击波对冈上肌肌腱炎微循环影响中的应用. 中国康复医学杂志, 2012, 27(5): 462-464.
27. 张立俭, 黄静宜, 祁昌杰, 等. 温针灸“肩三针”结合体外冲击波治疗劳损性冈上肌腱炎. 中医学报, 2020, 35(9): 2024-2027.
28. Kachewar SG, Kulkarni DS. Calcific tendinitis of the rotator cuff: a review. J Clin Diagn Res, 2013, 7(7): 1482-1485.
29. Bannuru RR, Flavin NE, Vaysbrot E, et al. High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review. Ann Intern Med, 2014, 160(8): 542-549.
30. Arirachakaran A, Boonard M, Yamaphai S, et al. Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs. Eur J Orthop Surg Traumatol, 2017, 27(3): 381-390.
31. Wu KT, Chou WY, Wang CJ, et al. Efficacy of extracorporeal shockwave therapy on calcified and noncalcified shoulder tendinosis: a propensity score matched analysis. Biomed Res Int, 2019, 2019: 2958251.
32. Harniman E, Carette S, Kennedy C, et al. Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review. J Hand Ther, 2004, 17(2): 132-151.
33. Cipollaro L, Sahemey R, Oliva F, et al. Immunohistochemical features of rotator cuff tendinopathy. Br Med Bull, 2019, 130(1): 105-123.
34. Vrotsou K, Ávila M, Machón M, et al. Constant-murley score: systematic review and standardized evaluation in different shoulder pathologies. Qual Life Res, 2018, 27(9): 2217-2226.
35. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, (214): 160-164.
36. Angst F, Schwyzer HK, Aeschlimann A, et al. Measures of adult shoulder function: disabilities of the arm, shoulder, and hand questionnaire (DASH) and its short version (QuickDASH), shoulder pain and disability index (SPADI), American shoulder and elbow surgeons (ASES) society standardized shoulder assessment form, constant (Murley) score (CS), simple shoulder test (SST), Oxford shoulder score (OSS), shoulder disability questionnaire (SDQ), and Western ontario shoulder instability index (WOSI). Arthritis Care Res (Hoboken), 2011, 63(Suppl 11): S174-S188.
37. Testa G, Vescio A, Perez S, et al. Extracorporeal shockwave therapy treatment in upper limb diseases: a systematic review. J Clin Med, 2020, 9(2): 453.
38. Liao CD, Tsauo JY, Chen HC, et al. Efficacy of extracorporeal shock wave therapy for lower-limb tendinopathy: a meta-analysis of randomized controlled trials. Am J Phys Med Rehabil, 2018, 97(9): 605-619.
39. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res, 2012, 7: 11.
40. Speed CA. Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions. J Bone Joint Surg Br, 2004, 86(2): 165-171.

Chinese Journal of Evidence-Based Medicine

Extracorporeal shock wave therapy for rotator cuff tendinopathy: a meta-analysis

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