Key Takeaway
ESWT significantly reduces pain and improves function in both calcific and non-calcific tendinopathies of the upper and lower limbs compared to placebo.
Summary
This systematic review and meta-analysis evaluated the effectiveness of extracorporeal shockwave therapy (ESWT) for treating tendinopathies across both upper and lower extremities. The review synthesized evidence from randomized controlled trials comparing ESWT to placebo or sham treatments for conditions including lateral epicondylitis, rotator cuff tendinopathy, patellar tendinopathy, Achilles tendinopathy, and plantar fasciitis.
The pooled results demonstrated that ESWT produced statistically significant improvements in both pain reduction and functional outcomes across multiple tendinopathy types. The analysis examined both calcific and non-calcific tendinopathies, finding benefits in both categories. The findings support ESWT as an effective non-invasive treatment option for chronic tendon disorders that have not responded to conventional conservative management.
The review strengthens the evidence base for ESWT as a versatile intervention applicable across different anatomical sites and tendinopathy types, suggesting it should be considered as part of the treatment algorithm for persistent tendon pain in both upper and lower limbs.
Methods
Systematic review and meta-analysis following PRISMA guidelines. Searched PubMed, Cochrane Library, and other databases for RCTs comparing ESWT to placebo/sham in upper and lower limb tendinopathies. Outcomes included pain scores (VAS) and functional measures. Risk of bias was assessed using standardized tools, and data were pooled using random-effects meta-analysis.
Key Results
ESWT demonstrated significant improvements in pain reduction compared to placebo across both upper limb tendinopathies (lateral epicondylitis, rotator cuff, calcific tendinitis) and lower limb tendinopathies (plantar fasciitis, Achilles, patellar). Functional outcomes also showed significant improvement. Both focused and radial shockwave modalities showed effectiveness, with benefits maintained at follow-up periods.
Limitations
Heterogeneity across included studies in terms of ESWT protocols (energy levels, number of sessions, shockwave type). Some included studies had small sample sizes. Variability in outcome measures across studies. Limited long-term follow-up data beyond 6-12 months. Publication bias cannot be fully excluded. Differences in tendinopathy severity and chronicity across study populations.