Via PubMed 5 reviews and 159 RCTs, via Embase 21 reviews and 202 RCTs, via Cinahl 344 reviews/RCTs, and via Pedro 7 reviews and 28 RCTs were found. Finally, no (Cochrane) reviews and 17 additional RCTs (14 via PubMed, 3 via Embase, 0 via Cinahl or Pedro) were included: 16 studied ESWT (10 for calcific and 6 for non-calcific tendinosis) and one studied Radial ShockWave Therapy (RSWT) for calicific tendinosis. RSWT is pneumatically generated with low- or medium-energy shockwaves (Cacchio et al., 2006) PCI 32765 and therefore should have a lower peak-pressure and longer rise-time than ESWT. Further, the focal

point is centred on the tip of the applicator instead of on the target zone, as is done in ESWT. Therefore, it is supposed to be less painful, of less risk and should target the calcification more effectively (Haake et al., 2002). The characteristics of the studies are described in Appendix II. Of the 17 RCTs, 10 were classified as high-quality selleck chemical and 7 as low-quality (Table 2) by using the list of Furlan et al. (2009) The most prevalent methodological flaws were ‘care giver’ (i.e. the one who provides the intervention) not blinded’ (65%), and ‘no intention-to-treat analysis’ (35%). Table 3 and Table 4 show the evidence for effectiveness we found in this study. A high-quality study (Gerdesmeyer

et al., 2003) (n = 96) compared high-ESWT (EFD: 0.32 mJ/mm2) to placebo for calcific supraspinatus tendinosis. At 3, 6, and 12 months follow-up, there were significant between-group differences in favour of the treatment group on pain, the total Constant Score, and on calcific deposit size (mm2). See Appendix II for the exact data. A low-quality study (Hsu et al., 2008) (n = 46) compared high-ESWT BCKDHA (EFD: 0.55 mJ/mm2) to placebo for calcifying shoulder tendinosis. The treatment group showed significant decrease on pain and the Constant score compared to the sham group at 3, 6 and 12 months follow-up. The calcium deposit width

reduction was bigger in the treatment group at 12 months, although no statistical comparisons were made between the groups. In conclusion, there is moderate evidence for effectiveness of ESWT compared with placebo in the short-, mid- and long-term. A low-quality RCT (Loew et al., 1999) (n = 80) studied high-ESWT-1-session versus high-ESWT-2-sessions versus no treatment for calcific shoulder tendinosis. There were no baseline differences on the Constant score; at 3 months follow-up significant higher Constant scores for the ESWT groups (63.7 (14.6) (mean (SD)) (high-ESWT-1-session), 68.5 (13.1) (high-ESWT-2-sessions), 47.8 (11.4) (no treatment)) was found. There is limited evidence for the effectiveness of high-ESWT (1 session and 2 sessions) compared to no treatment in the short-term. One low-quality RCT (Loew et al., 1999) studied effectiveness of high-ESWT-1-session versus high-ESWT-2-sessions.