Extracorporeal shockwaves therapy versus corticosteroid injection for the treatment of non-calcific rotator cuff tendinopathies: a randomized trial

Background: Rotator cuff tendinopathy is the most common cause of painful shoulder. There is evidence supporting the use of extracorporeal shock wave therapy (ESWT) in the rotator cuff calcific tendinopathy, but evidence supporting its use in non-calcifying tendinopathy is lacking. The current study aimed to compare the clinical effectiveness of corticosteroid injections versus ESWT until 3 mo of follow-up for the management of painful non-calcific rotator cuff tendinopathies. Methods: A total of 33 patients affected by painful rotator cuff tendinopathy were randomly divided into 2 groups of 16 and 17 cases. The first group received corticosteroid injection under ultrasound guidance and the second group received three sessions of shockwave within 3 consecutive weeks consisted of 2000 pulse energy, 5 Hz frequency, and pressure of 4 bar using a radial shock wave device. Two outcome measures of VAS and Quick-DASH were obtained to evaluate patients before treatment, and 2 and 12 wk after treatment. Discussion: Regarding both VAS and the score of the Quick-DASH questionnaire, no statistically significant difference was observed between these 2 therapeutic interventions (ultrasound-guided corticosteroid injection and shockwave). Both interventions reduced the patient’s pain to the same extent (P-value=0.955 for VAS, and P-value=0.865 for Quick DASH questionnaire score). Moreover, within-group changes showed that both groups’ improvements were significant in the time intervals of 1 to 2 and 1 to 3. Conclusions: Corticosteroid injection and radial shockwave, both can be effective to the same extent in reducing pain and improving function in non-calcific shoulder tendinopathy. Level of Evidence: Level I.