What type of study is this?

This is a Meta-Analysis study (also classified as: Systematic Review).

What question did this study set out to answer?

To compare the efficacy and safety of radial and focused shockwave therapy in treating tendinopathy.

February 8, 2026Open Access

Efficacy of radial and focused shockwave therapy for tendinopathy: a systematic review and meta-analysis

Key Points

To compare the efficacy and safety of radial and focused shockwave therapy in treating tendinopathy.
Conducted a systematic review and meta-analysis of randomized controlled trials
Analyzed pain intensity, physical function, muscle strength, and adverse effects
Calculated risk ratios and mean differences with confidence intervals
Assessed risk of bias with the Cochrane tool
Evaluated evidence quality with the GRADE approach.
Nine articles met inclusion criteria with 530 patients included
No clear superiority observed for radial or focused shockwave therapy for pain or functional outcomes
Moderate-quality evidence showed radial shockwave therapy improved wrist extensor strength in tennis elbow compared to focused shockwave therapy.

Abstract

Tendinopathy is a common musculoskeletal condition that impairs body function and quality of life. Extracorporeal shockwave therapy is a widely used non-invasive treatment method. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of radial shockwave therapy (RSWT) and focused shockwave therapy (FSWT) in the treatment of upper and lower limb tendinopathies, based on randomized controlled trials (RCTs) assessing pain intensity, physical function, muscle strength, and adverse effects. The review protocol was registered in the PROSPERO database under the registration number CRD420251011209. A comprehensive search of PubMed, EBSCOhost, Ovid MEDLINE, and Embase was conducted to identify RCTs. Databases were searched from their inception until the last update—26 March 2025 for PubMed, EBSCOhost and Ovid MEDLINE, and 27 March 2025 for Embase. Review methods: Risk ratios and mean differences (MD) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I 2 statistic. The risk of bias and methodological quality of the included studies were evaluated using the Cochrane Risk of Bias tool and the Physiotherapy Evidence Database scale. The overall quality of the body of evidence was assessed using the GRADE approach. Of the 102 records identified, 9 articles met the inclusion criteria, comprising a total of 530 patients with upper or lower limb tendinopathy. No clear superiority of RSWT or FSWT was observed for pain or functional outcomes, owing to low or very low certainty of evidence. Moderate-quality evidence indicated that RSWT significantly improved wrist extensor strength in patients with tennis elbow compared to FSWT (MD: 1.81; 95% CI 0.97 to 2.64; p < 0.001; I 2 = 0%), while grip strength did not differ significantly between the modalities (MD: 0.57; 95% CI −1.68 to 2.82; p = 0.62; I 2 = 0%). Both treatments were similarly safe, but conclusions are limited by low-quality evidence.

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