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Extracorporeal Shock Wave Therapy in the Treatment of Chronic Tendinopathies

Dr. Sems is Consultant Surgeon, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN. Dr. Dimeff is Medical Director of Sports Medicine, Department of Orthopaedic Surgery, and Vice Chairman, Department of Family Medicine, Cleveland Clinic, Cleveland, OH. Dr. Iannotti is Professor and Chairman, Department of Orthopaedic Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Sems, Dr. Dimeff, and Dr. Iannotti.

Reprint requests: Dr. Iannotti, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.

Many clinical trials have evaluated the use of extracorporeal shock wave therapy for treating patients with chronic tendinosis of the supraspinatus, lateral epicondylitis, and plantar fasciitis. Although extracorporeal shock wave therapy has been reported to be effective in some trials, in others it was no more effective than placebo. The multiple variables associated with this therapy, such as the amount of energy delivered, the method of focusing the shock waves, frequency and timing of delivery, and whether or not anesthetics are used, makes comparing clinical trials difficult. Calcific tendinosis of the supraspinatus and plantar fasciitis have been successfully managed with extracorporeal shock wave therapy when nonsurgical management has failed. Results have been mixed in the management of lateral epicondylitis, however, and this therapy has not been effective in managing noncalcific tendinosis of the supraspinatus. Extracorporeal shock wave therapy has consistently been more effective with patient feedback, which enables directing the shock waves to the most painful area (clinical focusing), rather than with anatomic or image-guided focusing, which are used to direct the shock wave to an anatomic landmark or structure.

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