Effectiveness of Extracorporeal Shockwave Therapy Versus Conventional Physiotherapy in Rotator Cuff Tendinitis

Abstract

Background: Rotator cuff tendinitis is a prevalent cause of shoulder pain and functional limitation across both younger and older adults. Although several physiotherapeutic and medical interventions are utilised, clinical outcomes are often variable, and symptom recurrence is common. In recent years, extracorporeal shockwave therapy has gained attention as a non-invasive treatment option; however, evidence regarding its efficacy remains inconclusive. Objective: To compare the effectiveness of shockwave therapy with conventional physiotherapy in patients with rotator cuff tendinitis. Methodology: A single-blinded, randomized controlled trial was conducted at a tertiary care center in Lahore, Pakistan. Among 102 assessed patients, 77 participants with rotator cuff tendinitis were randomized to receive either focused extracorporeal shockwave therapy (n=39) once weekly or conventional physiotherapy (n=38) twice weekly for six weeks following standardized treatment protocols. Pain intensity and shoulder function were evaluated using the visual analogue scale and the Constant-Murley score at baseline, 6 weeks, and 12 weeks of follow-up. Statistical analysis was performed using SPSS version 25, with significance set at p<0.05. Results: The shockwave group demonstrated significantly greater improvements than the conventional physiotherapy group. At the 12-week follow-up, the shockwave group had a lower mean VAS score (2.3±1.0 vs. 3.8±1.3; p<0.001) and a higher mean Constant-Murley score  (84.1±7.2 vs. 70.0±8.9; p<0.001). The between-group difference in Constant-Murley score increased from 7.8 points at 6 weeks to 14.1 points at 12 weeks. A significantly higher proportion of patients in the shockwave group achieved a clinically important improvement (≥10-point increase in Constant-Murley score) at 12 weeks (94.9% vs. 60.5%; p<0.001). Conclusion: Focused extracorporeal shockwave therapy is significantly more effective than conventional physiotherapy for improving pain and shoulder function in patients with rotator cuff tendinitis, with benefits that are not only superior but also progressive over time.