Radial Extracorporeal Shock Wave Therapy Versus Multimodal Physical Therapy in Non-Traumatic (Degenerative) Rotator Cuff Tendinopathy with Partial Supraspinatus Tear: A Randomized Controlled Trial

TL;DR

A study found that radial extracorporeal shock wave therapy (rESWT) was more effective than physical therapy for treating shoulder tendon issues, providing faster pain relief and better recovery.

Contribution

This is the first randomized controlled trial comparing rESWT and multimodal physical therapy for non-traumatic rotator cuff tendinopathy with partial supraspinatus tear.

Findings

rESWT resulted in greater and faster improvement in shoulder function and pain reduction compared to physical therapy.

rESWT led to better patient satisfaction and improved range of motion in shoulder abduction, flexion, and external rotation.

Ultrasound imaging showed rESWT reduced tendon thickness and increased acromiohumeral distance, indicating tendon remodeling.

Abstract

Background/Objectives: Non-traumatic (degenerative) rotator cuff tendinopathy with partial supraspinatus tear (NT-RCTT) is a common source of shoulder pain and disability. Comparative evidence between radial extracorporeal shock wave therapy (rESWT) and multimodal physical therapy modalities (PTMs) remains scarce. Methods: In this single-center randomized controlled trial, 60 adults with MRI-confirmed NT-RCTT were assigned (1:1) to rESWT (one session weekly for six weeks; 2000 impulses per session, 2 bar air pressure, positive energy flux density 0.08 mJ/mm2; 8 impulses per second) or a multimodal PTM program (interferential current, shortwave diathermy and magnetothermal therapy; five sessions weekly for six weeks). All participants performed standardized home exercises. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) total score; secondary outcomes included pain (visual analog scale, VAS), satisfaction, range of motion (ROM), supraspinatus tendon (ST) thickness and acromiohumeral distance (AHD). Assessments were conducted at baseline, and at week 6 (W6) and week 12 (W12) post-baseline. Results: Both interventions significantly improved all outcomes, but rESWT produced greater and faster effects. Mean ASES total scores increased by 31 ± 5 points with rESWT versus 26 ± 6 with PTMs (p < 0.05). VAS pain decreased from 5.2 ± 0.7 to 1.0 ± 0.7 with rESWT and from 5.2 ± 0.8 to 1.7 ± 0.8 with PTMs (p < 0.01). rESWT achieved higher satisfaction and larger gains in abduction, flexion and external rotation. Ultrasound showed reduced ST thickness and increased AHD after rESWT but not after PTMs. No serious adverse events occurred. Conclusions: rESWT yielded superior pain relief, functional recovery and tendon remodeling compared with a multimodal PTM program, with markedly lower treatment time and excellent tolerability.

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