SHOCKIS / CLINICAL APPLICATION
Shoulder Tendinopathy
Rotator cuff tendinopathy is a common musculoskeletal disorder and a leading cause of shoulder pain and functional limitation.
Disease Overview
Rotator cuff tendinopathy is a common musculoskeletal disorder and a leading cause of shoulder pain and functional limitation. The rotator cuff consists of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles, whose tendons converge on the humerus. Rotator cuff conditions account for more than half of all shoulder disorders. Terms such as subacromial pain syndrome and subacromial impingement syndrome are also considered to fall under the diagnostic spectrum of rotator cuff tendinopathy. The condition may present with or without calcification.
Clinical Features
Rotator cuff tendinopathy typically manifests as shoulder pain that worsens with overhead activities, reaching movements, or lying on the affected side, accompanied by weakness and functional limitation. The pain may be localized to the lateral shoulder or radiate down the upper arm.
Professional Evaluation
The diagnosis is primarily based on medical history and physical examination. Current clinical practice guidelines advise against routine use of diagnostic imaging such as MRI for initial diagnosis, as this may lead to additional costs, treatment delays, and potential over-medicalization.
Conservative Management
Clinical practice guidelines recommend exercise therapy as the foundation of non-surgical management for rotator cuff tendinopathy. Exercises should include progressive resistance training and motor control training, individualized according to pain tolerance and patient goals. Manual therapy may be used to provide short-term pain relief.
ESWT: Potential Mechanisms and Limitations of Evidence
Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive treatment that uses a device to deliver shock waves through the skin to the affected area. The evidence base differs between non-calcific and calcific rotator cuff tendinopathy.
For non-calcific rotator cuff tendinopathy, the 2025 clinical practice guideline by Desmeules et al. recommends that clinicians should not use or recommend ESWT to reduce pain and dysfunction.
For calcific rotator cuff tendinopathy, the same guideline states that clinicians may consider using or recommending ESWT to reduce pain and dysfunction.
In the UK, the National Institute for Health and Care Excellence (NICE) concluded that the safety evidence for ESWT for calcific tendinopathy of the shoulder shows no major short-term safety concerns, but the efficacy evidence is insufficient. NICE recommends that this procedure be used only within a research setting. This NICE recommendation is not entirely consistent with the 2025 Desmeules et al. guideline that "ESWT may be considered for calcific rotator cuff tendinopathy". These two recommendations originate from different evidence frameworks and should be considered separately.
Contact with SHOCKIS
Clinicians and procurement professionals evaluating shock wave therapy systems for rotator cuff tendinopathy should consider device-specific characteristics and the applicable regulatory status in their respective regions. The evidence summarized above reflects the broader ESWT literature and does not constitute validation of any specific SHOCKIS product for any particular indication. If you wish to discuss how SHOCKIS can support your clinical or procurement needs, our team is welcome to hear from you.
Clinical Workflow Checklist
- 01CLINICAL ASSESSMENT
Review patient history, symptoms, and contraindications.
- 02TARGET AREA IDENTIFICATION
Identify the treatment area through clinical examination and appropriate imaging when needed.
- 03TREATMENT SETUP
Select treatment parameters according to clinical assessment, device instructions, and patient tolerance.
- 04SHOCKWAVE APPLICATION
Apply coupling gel and deliver treatment while monitoring patient response.
- 05POST-TREATMENT CARE
Clean the treatment area and applicator, and provide appropriate aftercare guidance.
Safety Information
The information below describes conditions and reactions generally associated with extracorporeal shock wave therapy. It does not replace the instructions for use of the specific SHOCKIS device. Clinicians must verify applicability against the current device labeling and their own clinical judgment.
Contraindications & Precautions
Shock wave therapy should not be applied, or should be applied only with particular caution, in the following situations:
- Known hemorrhagic disorders or coagulation dysfunction
- Thrombosis in or adjacent to the intended treatment area
- Severe cognitive impairment or psychiatric illness
- Implanted pacemakers or other active electronic implants
- Tumors located in the treatment area
- Pregnancy, particularly the lower abdominal region
- Ruptured or severely injured tendons and fasciae, as well as regions containing the brain, spinal cord, large blood vessels, or major nerve trunks
- Regions containing abdominal organs, especially lung tissue
- Bone defects exceeding 2 cm
- Joint fluid leakage
- Growing pains in pediatric patients
Any other condition deemed unsuitable by the treating physician.
Potential Adverse Reactions
The following reactions may occur at or near the treatment site:
- Local hematoma, ecchymosis, or petechiae
- Temporary intensification of pain shortly after treatment
- Local numbness, needle-like sensation, or hypoesthesia
- High-energy extracorporeal shock wave therapy may cause local nerve or vascular injury
These reactions are generally transient and typically resolve within approximately one week without special treatment.
References
- [1] Desmeules F, Roy JS, Lafrance S, et al. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. J Orthop Sports Phys Ther. 2025;55(4):235-274. DOI: 10.2519/jospt.2025.13182.
- [2] Xue X, Song Q, Yang X, et al. Effect of extracorporeal shockwave therapy for rotator cuff tendinopathy: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024;25(1):357. DOI: 10.1186/s12891-024-07445-7. PMID: 38704572.
- [3] Moggio L, Marotta N, de Sire A, et al. Efficacy of Conservative Approaches on Pain Relief and Function in Patients With Rotator Cuff Calcific Tendinopathy: Which Is the Best Option? A Systematic Review and Network Meta-Analysis. Orthop Surg. 2025;17(11):3048-3066. DOI: 10.1111/os.70175. PMID: 41002287.
- [4] National Institute for Health and Care Excellence. Extracorporeal shockwave therapy for calcific tendinopathy in the shoulder. HealthTech guidance 645. Published 09 November 2022.