Current Concepts in Pathogenesis and Conservative Management of Supraspinous Tendinopathies Using Shockwave Therapy—A Narrative Review of the Literature

The supraspinatus has been well studied in recent years, since the rotator cuff muscle is most commonly damaged, affecting the quality of life for patients with tendinopathy. Despite this tiny but crucial muscle being well-described, there is still much left to learn and discover, especially because chronic supraspinatus tendinopathy is a common pain syndrome that causes functional and labor disabilities in the population. The present narrative review, including systematic elements from biomechanical and clinical studies, highlights the role of conservative treatment using shockwave therapy. Objectives: We set out to perform a complex analysis of the literature on this topic to identify possible pathophysiological mechanisms that can be used to establish proper therapeutic management, focused specifically on conservative treatment using shockwave therapy. Methods: We researched the medical literature, including clinical studies that met the criteria of being published after 2014. In this review, we described the mechanisms and histological changes in tendinopathy to illustrate the biological effects of shockwave therapy and performed a literature review on its therapeutic effects. Conclusions: The multifaced pathophysiology of supraspinous tendinopathies compromised the healing responses. Recent findings highlight the value of a thorough diagnostic and treatment strategy, with shockwave therapy (ESWT) as a conservative treatment option. According to available data, shockwave therapy has demonstrated significant improvement in function, improving participants’ discomfort, quality of life, and pain relief. It can also be combined with isometric exercise. Given the substantial risk of bias and heterogeneity, our findings should be interpreted cautiously. The need for more research to optimize parameters and provide standardized clinical guidelines is highlighted by the variety of treatment procedures. Improving outcomes in patients with supraspinous tendinopathies will require a better comprehension of the pathology, and individualized treatment needs to be further investigated.