[Extracorporeal shock wave therapy (ESWT) and radial extracorporeal shock wave therapy (rESWT) in chronic musculoskeletal pain].

BACKGROUND: The use of shock wave therapy (ESWT) and radial pressure-wave therapy (rESWT) is controversial in chronic musculoskeletal pain. The aim of this literature review is to assess the effect of these therapies in rotator cuff syndrome with and without calcium deposits, lateral epicondylitis and planar fasciitis.

MATERIAL AND METHODS: Medical databases were systematically searched for randomized controlled trials. 54 were identified; 49 of these assessed the effect ESWT and five assessed the effect rESWT. 27 studies were of high of medium quality and form the basis for the assessment of effect.

RESULTS: Treatment with ESWT only had a positive effect in chronic rotator cuff syndrome with calcium deposits and was not effective in the absence of calcium deposits and chronic lateral epicondylitis. The effect in chronic plantar fasciitis was variable. Only a few randomized controlled trials assess the effect of rESWT, but the results indicate that there is an effect on chronic rotator cuff syndrome with calcium deposits and chronic lateral epicondylitis. The theoretical rationale for treatment with shock waves and radial pressure waves is uncertain. No studies compare the two therapies.

INTERPRETATION: Treatment with ESWT or rESWT is only likely to be effective in patients with chronic rotator cuff syndrome and calcium deposits. rESWT may be attempted for chronic lateral epicondylitis. For other diagnoses the treatment effect is either absent or uncertain.