A Narrative Review of Extracorporeal Shock Wave Therapy for Rotator Cuff Tendinopathy: Clinical Effectiveness, Treatment Parameters, and Safety

Rotator cuff tendinopathy is a common cause of shoulder pain and functional limitation.Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment option for rotator cuff tendinopathy, although its effects appear to differ between calcific and non-calcific presentations.A narrative literature search was conducted using PubMed (National Institutes of Health (NIH), Bethesda, Maryland, USA) and Google Scholar (Google LLC, Mountain View, California, USA) to identify studies evaluating the clinical effectiveness, treatment parameters, safety, and therapeutic positioning of ESWT in rotator cuff tendinopathy.Current evidence suggests that ESWT may improve pain and functional outcomes, with more supportive evidence in calcific than non-calcific rotator cuff tendinopathy.In calcific disease, ESWT may promote fragmentation and resorption of calcific deposits, although radiological improvement does not necessarily correspond to clinical improvement.Evidence in non-calcific rotator cuff tendinopathy remains heterogeneous, with variable effects across studies and follow-up periods.Differences in ESWT modality, treatment parameters, patient characteristics, and outcome measures may contribute to this heterogeneity.Overall, the available evidence supports a more established role for ESWT in calcific rotator cuff tendinopathy, whereas its effectiveness in non-calcific disease remains less certain.Further research using standardized treatment protocols, including clearly defined modality, energy flux density, number of pulses, treatment frequency, and number and interval of sessions, is needed to better define the clinical role of ESWT in rotator cuff tendinopathy.