Research & Evidence Center

European Journal of Physical and Rehabilitation Medicine · 2024 · Lippi et al.

Pooled data from randomized trials found extracorporeal shockwave therapy produced meaningful reductions in heel pain for chronic plantar fasciopathy, with a good tolerability profile across the included studies.

Limitations: Included trials varied in energy level, number of sessions, and follow-up duration, and meta-regression identified this heterogeneity as a source of variable effect sizes between studies.

The Journal of Foot and Ankle Surgery · 2020 · Fansa, Talsania, Kennedy, O'Malley

This retrospective chart review of 108 patients (119 heels) treated with unfocused medium-intensity shockwave therapy (OrthoGold 100 device) for plantar fasciitis found pain scores improved significantly (from 6.7 to 2.6 on average) alongside significant gains on validated function subscales, with 81.5% of patients satisfied with the procedure at final follow-up.

Limitations: This is a retrospective chart review without a control group, not a randomized trial — it can show association and patient-reported outcomes but can't rule out improvement from time, other concurrent care, or expectation effects. It was also conducted using the same OrthoGold 100 (SoftWave TRT) device family used at this practice, which is a meaningful strength for relevance but doesn't substitute for independent replication.

Rheumatology International · 2022 · Caner, Güneş, Gökmen, Ataman, Kutlay

This double-blind, sham-controlled trial specifically studied plantar fasciitis in 22 patients with axial spondyloarthritis (an inflammatory arthritis where plantar fascia involvement is a form of enthesitis, not ordinary mechanical plantar fasciitis). Three shockwave sessions one week apart significantly reduced pain and improved pressure-pain thresholds and foot function versus sham, with no adverse events, though plantar fascia thickness on imaging didn't change in either group.

Limitations: Small sample (n=22, 11 per group), and this population — plantar fascia enthesitis specifically in axial spondyloarthritis — is a distinct patient group from typical mechanical plantar fasciitis, so results shouldn't be assumed to generalize to the general plantar fasciitis population without that context.

International Journal of Rheumatology · 2020 · Alpturker, et al.

This single-blind trial of 40 spondyloarthritis patients with plantar fasciitis (enthesitis) compared shockwave therapy to laser therapy; both groups improved significantly on pain, plantar fascia thickness on imaging, and spondyloarthritis-specific disease-activity and function scores, with no significant difference found between the two treatments.

Limitations: No untreated or sham control arm was included (an ethical constraint given both are considered active treatments), only one month of follow-up, and — as with the Caner et al. trial above — this population is plantar fascia enthesitis in spondyloarthritis specifically, not the general mechanical plantar fasciitis population.

Conference presentation (cited in SoftWave/MTS Clinical & PMCF Study Compendium, Sept. 2025) · 2007 · Marx, Thiele

This conference presentation, cited in a SoftWave/MTS manufacturer-compiled clinical and post-market compendium, reports a comparison of focused vs. defocused extracorporeal shockwave therapy for heel spur-associated pain.

Limitations: This is a conference abstract/presentation, not a peer-reviewed journal article — it does not appear in PubMed, Crossref, or Semantic Scholar under this title, and full methodology, sample size, and results are not available in independently indexed form. The source record lists only "an MTS device (unspecified)," not confirmed as the OrthoGold 100 model used at this practice. Treat as preliminary, manufacturer-cited information rather than independently verified evidence.

British Journal of Sports Medicine · 2024 · Rhim, Shin, Kang, Dyrek, Crockett, Galido, Wade, Hollander, Borg-Stein, Sampson, Tenforde

This systematic review of 56 studies (1,874 athletes and physically active individuals) found level-I evidence that shockwave therapy may be effective alone for plantar fasciitis, lateral epicondylitis, and proximal hamstring tendinopathy, and as an adjunct to exercise treatment for medial tibial stress syndrome and osteitis pubis, with generally good tolerability and minimal adverse effects.

Limitations: The review authors note that additional high-quality research is still needed to clarify shockwave therapy's optimal clinical role, dosing, and protocol across these conditions, and evidence quality varied by condition.

Orthopaedic Journal of Sports Medicine · 2020 · Fan et al.

This meta-analysis of randomized and comparative trials found shockwave therapy was associated with improved pain and function scores in chronic Achilles tendinopathy compared with control interventions.

Limitations: Insertional and midportion Achilles tendinopathy were not always analyzed separately across the included studies, and protocol (energy level, session count) varied by trial.

The American Journal of Sports Medicine · 2006 · Furia

This case-control study of 68 patients with chronic insertional Achilles tendinopathy found high-energy shockwave therapy significantly outperformed nonoperative conservative treatment at 12 months, with 83% of the shockwave group achieving a successful result.

Limitations: Non-randomized case-control design (Level of Evidence 3), single surgeon/center. Read alongside the more recent Butler et al. 2024 and Ulusoy et al. 2026 studies cited below, which raise real questions about how well insertional Achilles results hold up beyond 1 year.

Orthopaedic Journal of Sports Medicine · 2024 · Butler, DeClouette, Azam, Walls, Jejelava, Zheng, Jia, Kennedy

This retrospective review of 105 ankles treated with shockwave therapy for chronic Achilles tendinopathy directly compared insertional versus noninsertional (midportion) outcomes, finding insertional cases initially improved by 6 months but then deteriorated by final follow-up (beyond 1 year), with failure rates rising to nearly 60% for insertional disease versus about 29% for noninsertional/midportion disease, which held up better and more durably.

Limitations: Retrospective, non-randomized cohort with no untreated comparison group, so it can't fully separate treatment effect from natural history. We're citing this specifically for its cautionary insertional-vs-midportion comparison — it should not be read as showing shockwave therapy works well for insertional Achilles tendinopathy long-term; the data here show the opposite for that specific location.

Journal of the American Podiatric Medical Association · 2026 · Ulusoy, Yılmaz, Tantekin, Güzel, Kıvrak

As its title states plainly, this comparative study found shockwave therapy provided short-term pain relief and functional improvement for chronic insertional Achilles tendinopathy, similar to conservative physical/medical treatment, but no long-term advantage over conservative treatment at 6 and 12 months — the authors explicitly conclude the findings "do not support ESWT as a routine treatment" for this specific location and suggest the early gains may partly reflect a placebo effect.

Limitations: We're citing this study for exactly what it found — a negative result for shockwave therapy specifically in chronic insertional Achilles tendinopathy — not as supporting evidence. It's a non-randomized comparative study without a sham/placebo arm, from a single center, but its conclusion is consistent with the Butler et al. 2024 study cited alongside it, and both are part of why this page is direct that the evidence for insertional (as opposed to midportion) Achilles tendinopathy is meaningfully weaker.

Journal of Human Kinetics · 2022 · Stania et al.

Pooled results across included trials showed shockwave therapy reduced pain and improved function in patellar tendinopathy (jumper's knee), though the certainty of evidence varied by outcome measured.

Limitations: The authors noted a limited number of high-quality randomized trials specific to patellar tendinopathy compared with the evidence base for plantar fasciitis or lateral epicondylitis.

Annals of Internal Medicine · 2014 · Bannuru, Flavin, Vaysbrot, Harvey, McAlindon

This systematic review found moderate-quality evidence that high-energy extracorporeal shockwave therapy improves pain and function in chronic calcific tendinitis of the shoulder and can be associated with resorption of calcium deposits, compared with placebo.

Limitations: Low-energy shockwave protocols did not show the same benefit in the reviewed trials, and outcomes for non-calcific rotator cuff tendinopathy were evaluated separately from calcific tendinitis.

American Journal of Physical Medicine & Rehabilitation · 2023 · Kamonseki, da Rocha, Mascarenhas, Ocarino, Pogetti

Moderate-certainty evidence in this review indicated that extracorporeal shockwave therapy produced a small improvement in shoulder pain over sham shockwave therapy at short-term follow-up for noncalcific rotator cuff tendinopathy.

Limitations: The authors described the treatment effect as small in magnitude and noted that longer-term outcome data were more limited than short-term data.

Journal of Shoulder and Elbow Surgery · 2008 · Hsu, Wang, Tseng, Fong, Hsu, Jim

In this randomized, sham-controlled trial of 46 patients with calcific tendinitis of the shoulder (33 treated, 13 sham), two courses of extracorporeal shockwave therapy produced good-to-excellent outcomes in the large majority of treated shoulders (87.9%) versus mostly fair-to-poor outcomes in the sham group, along with partial or complete calcium deposit elimination in more than half of treated shoulders.

Limitations: This is a single, moderately sized trial using a specific ESWT protocol and energy level, and it predates and is separate from the OrthoGold 100 (SoftWave TRT) device used at this practice — it reflects the broader shockwave-for-calcific-tendinitis literature rather than a study of this specific device.

Conference presentation (cited in SoftWave/MTS Clinical & PMCF Study Compendium, Sept. 2025) · 2014 · Serrano, Flores, Criado

This conference presentation, cited in a SoftWave/MTS manufacturer-compiled clinical and post-market compendium, reports a comparison of radial and focal shockwave delivery for calcific tendinosis of the rotator cuff using the OrthoGold 100 device.

Limitations: This is a conference abstract/presentation rather than a peer-reviewed journal article, and it is not independently indexed in PubMed, Crossref, or Semantic Scholar under this title. It supplements, but does not replace, the independently verified peer-reviewed evidence on shockwave therapy for calcific tendinitis of the shoulder cited elsewhere on this site (Bannuru et al. 2014; Hsu et al. 2008).

Orthopaedic Surgery · 2024 · Zhang et al.

This meta-analysis compared shockwave therapy against corticosteroid injection for chronic lateral epicondylitis (tennis elbow) and found shockwave therapy associated with better longer-term outcomes, while corticosteroid injection showed faster short-term relief in some trials.

Limitations: Follow-up periods and outcome measures were inconsistent across the pooled trials, and risk of bias was rated as moderate to high in a number of the included studies.

British Journal of Sports Medicine · 2024 · Rhim, Shin, Kang, Dyrek, Crockett, Galido, Wade, Hollander, Borg-Stein, Sampson, Tenforde

This systematic review of 56 studies (1,874 athletes and physically active individuals) found level-I evidence that shockwave therapy may be effective alone for plantar fasciitis, lateral epicondylitis, and proximal hamstring tendinopathy, and as an adjunct to exercise treatment for medial tibial stress syndrome and osteitis pubis, with generally good tolerability and minimal adverse effects.

Limitations: The review authors note that additional high-quality research is still needed to clarify shockwave therapy's optimal clinical role, dosing, and protocol across these conditions, and evidence quality varied by condition.

JBJS Reviews · 2024 · Rhim, Shin, Beling, et al.

Three weekly sessions of shockwave therapy produced significantly lower pain scores than comparison treatments at 2 to 4 months in greater trochanteric pain syndrome, with focused shockwave outperforming radial shockwave in the pooled analysis.

Limitations: The review authors cautioned that results should be interpreted carefully because of high risk of bias in several included trials and meaningful heterogeneity across study protocols; functional gains at 6 months, while present, did not consistently reach a clinically meaningful threshold.

JBJS Reviews · 2024 · Rhim, Shin, Beling, et al.

Three weekly sessions of shockwave therapy produced significantly lower pain scores than comparison treatments at 2 to 4 months in greater trochanteric pain syndrome, with focused shockwave outperforming radial shockwave in the pooled analysis.

Limitations: The review authors cautioned that results should be interpreted carefully because of high risk of bias in several included trials and meaningful heterogeneity across study protocols; functional gains at 6 months, while present, did not consistently reach a clinically meaningful threshold.

Journal of Shoulder and Elbow Surgery · 2008 · Hsu, Wang, Tseng, Fong, Hsu, Jim

In this randomized, sham-controlled trial of 46 patients with calcific tendinitis of the shoulder (33 treated, 13 sham), two courses of extracorporeal shockwave therapy produced good-to-excellent outcomes in the large majority of treated shoulders (87.9%) versus mostly fair-to-poor outcomes in the sham group, along with partial or complete calcium deposit elimination in more than half of treated shoulders.

Limitations: This is a single, moderately sized trial using a specific ESWT protocol and energy level, and it predates and is separate from the OrthoGold 100 (SoftWave TRT) device used at this practice — it reflects the broader shockwave-for-calcific-tendinitis literature rather than a study of this specific device.

Conference presentation (cited in SoftWave/MTS Clinical & PMCF Study Compendium, Sept. 2025) · 2014 · Serrano, Flores, Criado

This conference presentation, cited in a SoftWave/MTS manufacturer-compiled clinical and post-market compendium, reports a comparison of radial and focal shockwave delivery for calcific tendinosis of the rotator cuff using the OrthoGold 100 device.

Limitations: This is a conference abstract/presentation rather than a peer-reviewed journal article, and it is not independently indexed in PubMed, Crossref, or Semantic Scholar under this title. It supplements, but does not replace, the independently verified peer-reviewed evidence on shockwave therapy for calcific tendinitis of the shoulder cited elsewhere on this site (Bannuru et al. 2014; Hsu et al. 2008).

The Journal of Foot and Ankle Surgery · 2020 · Fansa, Talsania, Kennedy, O'Malley

This retrospective chart review of 108 patients (119 heels) treated with unfocused medium-intensity shockwave therapy (OrthoGold 100 device) for plantar fasciitis found pain scores improved significantly (from 6.7 to 2.6 on average) alongside significant gains on validated function subscales, with 81.5% of patients satisfied with the procedure at final follow-up.

Limitations: This is a retrospective chart review without a control group, not a randomized trial — it can show association and patient-reported outcomes but can't rule out improvement from time, other concurrent care, or expectation effects. It was also conducted using the same OrthoGold 100 (SoftWave TRT) device family used at this practice, which is a meaningful strength for relevance but doesn't substitute for independent replication.

Conference presentation (cited in SoftWave/MTS Clinical & PMCF Study Compendium, Sept. 2025) · 2007 · Marx, Thiele

This conference presentation, cited in a SoftWave/MTS manufacturer-compiled clinical and post-market compendium, reports a comparison of focused vs. defocused extracorporeal shockwave therapy for heel spur-associated pain.

Limitations: This is a conference abstract/presentation, not a peer-reviewed journal article — it does not appear in PubMed, Crossref, or Semantic Scholar under this title, and full methodology, sample size, and results are not available in independently indexed form. The source record lists only "an MTS device (unspecified)," not confirmed as the OrthoGold 100 model used at this practice. Treat as preliminary, manufacturer-cited information rather than independently verified evidence.

Cited in SoftWave/MTS Clinical & PMCF Study Compendium, Sept. 2025 · 2023 · Ngai et al.

This observational/retrospective report, cited in a SoftWave/MTS manufacturer-compiled clinical and post-market compendium, describes focal shockwave therapy (OrthoGold 100 device) used for ankle impingement symptoms in an athletic population.

Limitations: This is an observational/retrospective report rather than a randomized trial, and it is not independently indexed in PubMed, Crossref, or Semantic Scholar under this title. Ankle impingement can be bony or soft-tissue in origin and sometimes requires imaging or surgical evaluation; this record does not establish shockwave therapy as effective for every form of ankle impingement.

Cited in SoftWave/MTS Clinical & PMCF Study Compendium, Sept. 2025 · 2012 · Barillas et al.

This case series, cited in a SoftWave/MTS manufacturer-compiled clinical and post-market compendium, describes shockwave therapy (OrthoGold 100 device) used for carpal tunnel syndrome symptoms.

Limitations: This is a small, uncontrolled case series rather than a controlled trial, and it is not independently indexed in PubMed, Crossref, or Semantic Scholar under this title. Carpal tunnel syndrome is a nerve compression condition, and the independent peer-reviewed evidence base for shockwave therapy specifically for this diagnosis is limited; nerve conduction studies and a hand/nerve-focused medical evaluation remain the standard diagnostic approach.

Cited in SoftWave/MTS Clinical & PMCF Study Compendium, Sept. 2025 · 2023 · Thiele et al.

This record, cited in a SoftWave/MTS manufacturer-compiled clinical and post-market compendium, describes combining shockwave therapy (OrthoGold 100 device) with manual medicine techniques for myofascial pain and trigger points.

Limitations: The compendium itself lists this record's publication format as unclear/other rather than a defined study type, and it is not independently indexed in PubMed, Crossref, or Semantic Scholar under this title. A related preclinical (mouse) study on shockwaves for myofascial trigger points has been published in a peer-reviewed journal (Monclús et al., 2023, Pain Practice, DOI 10.1111/papr.13237), but animal findings do not establish human clinical efficacy on their own.

International Journal of Surgery · 2015 · Ramon, Gleitz, Hernandez, Romero

This narrative review proposes a shockwave treatment protocol for myofascial pain syndrome and fibromyalgia, summarizing the authors' clinical reasoning and experience rather than reporting a new controlled trial.

Limitations: This is a review/opinion-style article proposing a treatment protocol, not a randomized controlled trial with its own original outcome data. A 2022 scoping review (cited below) notes this protocol predates current fibromyalgia diagnostic criteria, and that applying it as originally described 'would be too intense' under today's diagnostic understanding of the condition.

Medicina (Kaunas) · 2022 · Paoletta, Moretti, Liguori, Toro, Gimigliano, Iolascon

This scoping review screened the published literature from 2012-2021 on shockwave therapy for myofascial pain syndrome and fibromyalgia. For myofascial pain, it found promising evidence for pain and function improvement across the studies reviewed; for fibromyalgia specifically, the review states plainly that 'no evidence was found' meeting its inclusion criteria.

Limitations: This review's own conclusion for fibromyalgia specifically is that there is currently a lack of qualifying trial evidence — we're citing it for that honest, direct statement about the evidence gap, not as evidence that shockwave therapy works for fibromyalgia. Standardized treatment protocols for both conditions remain undefined in the literature this review examined.

Cited in SoftWave/MTS Clinical & PMCF Study Compendium, Sept. 2025 (E-poster / conference presentation)

This E-poster/conference presentation, cited in a SoftWave/MTS manufacturer-compiled clinical and post-market compendium, describes ultrasound-guided shockwave therapy (OrthoGold 100 device) targeted at specific soft-tissue sources of low back pain, using focused, defocused, and radial shockwave delivery.

Limitations: This is an E-poster/conference presentation, not a peer-reviewed journal article, and the source compendium does not list a publication year, named authors, sample size, or outcome statistics for this record. It is not independently indexed in PubMed, Crossref, or Semantic Scholar under this title. Low back pain has many possible causes, and this record does not establish which specific low back pain diagnoses shockwave therapy may or may not help; some causes of low back pain (nerve compression, fracture, certain spine conditions) are not treated with shockwave therapy at all.

The Journal of Bone and Joint Surgery (American) · 2010 · Furia, Juliano, Wade, Schaden, Mittermayr

This randomized trial compared high-energy extracorporeal shockwave therapy with intramedullary screw fixation (surgery) for nonunion of proximal fifth metatarsal (Jones-type) fractures and found comparable healing outcomes between the two approaches, with shockwave therapy avoiding surgical risks.

Limitations: This trial is specific to one fracture location and pattern (proximal fifth metatarsal nonunion); results should not be generalized to every non-union location or fracture type without individualized evaluation by the treating surgeon.

Injury · 2021 · Mittermayr, Haffner, Feichtinger, Schaden

This review summarizes the mechanobiology behind shockwave-stimulated bone repair and the published clinical evidence for extracorporeal shockwave therapy in delayed union and non-union fractures, concluding that ESWT is a valuable, efficient, and cost-effective intervention with healing rates comparable to surgical revision in appropriate cases.

Limitations: As a review by authors closely associated with shockwave bone-healing research, it should be read alongside independently conducted trials (such as the Furia et al. randomized trial cited alongside it) rather than as a stand-alone, fully independent assessment.

European Journal of Trauma and Emergency Surgery · 2022 · Dahm, Feichtinger, Vallant, Haffner, Schaden, Fialka, Mittermayr

This retrospective study evaluated high-energy shockwave therapy for delayed and non-union fractures of the humerus (upper arm bone), reporting favorable healing outcomes for a substantial proportion of patients treated non-surgically.

Limitations: Retrospective, uncontrolled design without a comparison group, and specific to humeral fractures — outcomes for other bones or fracture patterns may differ.

Foot & Ankle International · 2023 · Ramon, Lucenteforte, Alentorn-Geli, Steinbacher, et al.

This pilot study in soccer players compared shockwave treatment with surgery for proximal fifth metatarsal (Jones-type) stress fractures using the OrthoGold 100 device, evaluating healing and return-to-play outcomes between the two approaches.

Limitations: Described by its own authors as a pilot study — a smaller sample intended to inform future, larger trials rather than to be conclusive on its own — and specific to this one fracture location in athletes.

Journal of Clinical Medicine · 2022 · Mittermayr, Haffner, Eder, Flatscher, Schaden, Slezak, Slezak

This retrospective study of 49 compromised clavicle (collarbone) fractures compared focused shockwave therapy with surgery and found comparable 6-month healing rates between the two approaches (75% vs. 71%), with the shockwave group experiencing no serious complications versus several in the surgery group.

Limitations: Retrospective, non-randomized comparison (not a randomized trial), which carries a risk of selection bias — patients weren't randomly assigned to shockwave therapy versus surgery — and this is a single-center study.

The Journal of Bone and Joint Surgery (American) · 2010 · Furia, Juliano, Wade, Schaden, Mittermayr

This randomized trial compared high-energy extracorporeal shockwave therapy with intramedullary screw fixation (surgery) for nonunion of proximal fifth metatarsal (Jones-type) fractures and found comparable healing outcomes between the two approaches, with shockwave therapy avoiding surgical risks.

Limitations: This trial is specific to one fracture location and pattern (proximal fifth metatarsal nonunion); results should not be generalized to every non-union location or fracture type without individualized evaluation by the treating surgeon.

Foot & Ankle International · 2023 · Ramon, Lucenteforte, Alentorn-Geli, Steinbacher, et al.

This pilot study in soccer players compared shockwave treatment with surgery for proximal fifth metatarsal (Jones-type) stress fractures using the OrthoGold 100 device, evaluating healing and return-to-play outcomes between the two approaches.

Limitations: Described by its own authors as a pilot study — a smaller sample intended to inform future, larger trials rather than to be conclusive on its own — and specific to this one fracture location in athletes.

British Journal of Sports Medicine · 2024 · Rhim, Shin, Kang, Dyrek, Crockett, Galido, Wade, Hollander, Borg-Stein, Sampson, Tenforde

This systematic review of 56 studies (1,874 athletes and physically active individuals) found level-I evidence that shockwave therapy may be effective alone for plantar fasciitis, lateral epicondylitis, and proximal hamstring tendinopathy, and as an adjunct to exercise treatment for medial tibial stress syndrome and osteitis pubis, with generally good tolerability and minimal adverse effects.

Limitations: The review authors note that additional high-quality research is still needed to clarify shockwave therapy's optimal clinical role, dosing, and protocol across these conditions, and evidence quality varied by condition.

Life · 2026 · Santilli, Santoboni, Checchi, et al.

This prospective, single-arm pilot study of 31 soccer players with groin pain syndrome combined focused shockwave therapy with a 16-week structured rehabilitation program and found statistically significant improvements in pain and hip/groin function at 4-month follow-up, with no serious adverse events.

Limitations: The study's own authors describe it as a single-arm pilot study whose design 'precludes causal inference regarding treatment effectiveness' — because every participant received both shockwave therapy and the rehabilitation program together, the results cannot show how much of the improvement came from the shockwave therapy itself versus the rehabilitation alone. The authors explicitly call the findings 'hypothesis-generating' and recommend a randomized trial next.

British Journal of Sports Medicine · 2024 · Rhim, Shin, Kang, Dyrek, Crockett, Galido, Wade, Hollander, Borg-Stein, Sampson, Tenforde

This systematic review of 56 studies (1,874 athletes and physically active individuals) found level-I evidence that shockwave therapy may be effective alone for plantar fasciitis, lateral epicondylitis, and proximal hamstring tendinopathy, and as an adjunct to exercise treatment for medial tibial stress syndrome and osteitis pubis, with generally good tolerability and minimal adverse effects.

Limitations: The review authors note that additional high-quality research is still needed to clarify shockwave therapy's optimal clinical role, dosing, and protocol across these conditions, and evidence quality varied by condition.

British Journal of Sports Medicine · 2024 · Rhim, Shin, Kang, Dyrek, Crockett, Galido, Wade, Hollander, Borg-Stein, Sampson, Tenforde

This systematic review of 56 studies (1,874 athletes and physically active individuals) found level-I evidence that shockwave therapy may be effective alone for plantar fasciitis, lateral epicondylitis, and proximal hamstring tendinopathy, and as an adjunct to exercise treatment for medial tibial stress syndrome and osteitis pubis, with generally good tolerability and minimal adverse effects.

Limitations: The review authors note that additional high-quality research is still needed to clarify shockwave therapy's optimal clinical role, dosing, and protocol across these conditions, and evidence quality varied by condition.

Cited in SoftWave/MTS Clinical & PMCF Study Compendium, Sept. 2025 · 2023 · Ngai et al.

This observational/retrospective report, cited in a SoftWave/MTS manufacturer-compiled clinical and post-market compendium, describes focal shockwave therapy (OrthoGold 100 device) used for focal knee cartilage defects in athletes.

Limitations: This is an observational/retrospective report rather than a randomized trial, and it is not independently indexed in PubMed, Crossref, or Semantic Scholar under this title. Cartilage defects are structural joint injuries with very limited independent healing capacity; this record does not establish shockwave therapy as an alternative to proper imaging-based staging and, when appropriate, surgical cartilage restoration.

Orthopaedic Journal of Sports Medicine · 2022 · Zhang, Wang, Liu, Zhang, Guo, Huang

This meta-analysis of 20 randomized trials found shockwave therapy added to routine treatment produced significant short-term pain reduction and immediate improvement in shoulder function for frozen shoulder (adhesive capsulitis), compared with routine treatment alone.

Limitations: Long-term pain outcomes and external rotation range-of-motion gains showed high statistical heterogeneity across the pooled trials, meaning those particular findings are less consistent and harder to generalize than the short-term pain and function results.

Saudi Medical Journal · 2025 · Sharahili, Alzahrani

This single-blind randomized trial of 30 patients found radial shockwave therapy combined with a structured physical therapy program produced significantly greater pain reduction, less disability, and better active and passive range of motion at 12 weeks than physical therapy with sham shockwave.

Limitations: Small sample (15 patients per group), single-center, and only 12 weeks of follow-up — longer-term durability of the additional benefit isn't yet established.

Clinical Journal of Sport Medicine · 2017 · Furia, Rompe, Maffulli, Cacchio, Schmitz

This non-randomized case-control study of 48 patients with chronic distal (elbow) biceps tendinopathy found radial shockwave therapy associated with significantly lower pain scores and better function at 12 months than a comparison group, with no significant treatment-related complications.

Limitations: This is a non-randomized, case-control comparative study (Level of Evidence 3), not a randomized controlled trial, and is specific to the distal (elbow) biceps tendon — it does not address proximal (shoulder-area) biceps tendon pain, which has a separate, much thinner evidence base (see the case report cited alongside it).

Turkish Journal of Sports Medicine · 2024 · Şahbat, Çat, Yağcı, Topkar

This case report describes a 28-year-old athlete with calcific tendinitis of the proximal (shoulder-area, long head) biceps tendon who was treated with four monthly sessions of radial shockwave therapy, with pain dropping from 9/10 to 0/10 and shoulder function score improving substantially, sustained at 1-year follow-up.

Limitations: This is a single-patient case report — the weakest form of clinical evidence — and is not independently indexed in PubMed/MEDLINE, so cross-verification is thinner than for our PubMed-indexed citations. It also describes a specific subtype (calcific tendinitis of the long head), not proximal biceps tendinopathy generally, and cannot establish how often this approach works or for whom.

Archives of Orthopaedic and Trauma Surgery · 2019 · Quadlbauer, Pezzei, Beer, Jurkowitsch, Keuchel, Schlintner, Schaden, Hausner, Leixnering

This retrospective study of 42 patients with scaphoid waist nonunion, treated surgically with bone grafting and screw or plate fixation, found the group that also received intraoperative shockwave therapy had a somewhat higher union rate (81% vs. 75%) and significantly better pain and functional scores than the group without shockwave therapy.

Limitations: Retrospective, non-randomized comparison with small and uneven subgroup sizes, and a long mean follow-up (about 52 months) that introduces some recall and attrition uncertainty. This is surgical-adjunct evidence from a single research group, not a stand-alone treatment.

Archives of Orthopaedic and Trauma Surgery · 2023 · Quadlbauer, Pezzei, Jurkowitsch, Beer, Moser, Rosenauer, Salminger, Hausner, Leixnering

This retrospective study of 32 patients with scaphoid waist nonunion, all of whom received intraoperative shockwave therapy alongside either double-screw or plate fixation, found high overall union rates (91%) with no significant differences in range of motion, pain, or grip strength between the two fixation methods.

Limitations: Every patient in this study received shockwave therapy — there was no shockwave-free comparison group in this particular study, so it can't by itself show how much shockwave therapy added (the companion 2019 study above addresses that comparison). Small, single-center, retrospective sample.

Shiraz E-Medical Journal · 2021 · Haghighat, Vahdatpour, Ataei

This small, sham-controlled randomized trial of 26 patients with De Quervain's tenosynovitis (all also given a thumb splint and an anti-inflammatory medication) found real shockwave therapy produced significantly greater improvement in pain and disability scores than sham shockwave, with grip strength improving similarly in both groups.

Limitations: Very small sample (13 per group), and because both groups also received a splint and medication, the trial can't fully isolate the shockwave-specific effect from those co-treatments.

Turkish Journal of Physical Medicine and Rehabilitation · 2024 · Karakuzu Güngör, Güngör

This randomized trial of 60 patients compared shockwave therapy with high-intensity laser therapy for De Quervain's tenosynovitis and found both groups improved significantly in pain, function, and grip strength over 3 months, with no significant difference between the two treatments on most measures (laser therapy had a modest edge on one specific pain-threshold measure).

Limitations: There was no sham/no-treatment control group, so natural recovery over time can't be ruled out, and follow-up was limited to 3 months.

Journal of Hand Surgery (European Volume) · 2016 · Yildirim, Gultekin, Yildirim, Karahan, Tok

This randomized trial of 40 patients directly compared shockwave therapy with corticosteroid injection for trigger finger and found no significant difference in cure rate, pain, or functional status between the two treatments at 6-month follow-up.

Limitations: Small sample size (40 patients) from a single center; a larger trial would give more confidence in how reliably the two treatments compare.

Frontiers in Physiology · 2026 · Zhang, Luo, Chen, Zhang, Chen

This meta-analysis pooling 12 randomized trials (760 patients) found shockwave therapy produced significantly better pain relief and wrist/hand functional scores than various comparison treatments for trigger finger, and rated overall clinical efficacy significantly in favor of shockwave therapy, though improvement on one specific disability questionnaire (QuickDASH) didn't reach statistical significance.

Limitations: The review authors themselves note the underlying trials need to be more rigorous and adequately powered before this can be considered definitive; this is a very recently published review and not yet independently cited or replicated elsewhere.

Archives of Health Science and Research · 2025 · Tezen, Ata, Yılmaz, Uzun, Yaşar

This pilot study of 22 patients with Dupuytren's contracture compared radial and focused shockwave therapy (both alongside a home tendon-gliding exercise program) and found both approaches significantly reduced pain and improved function; radial shockwave produced significantly greater pain reduction, while focused shockwave produced significantly greater reduction in nodule size. Neither approach significantly improved grip strength.

Limitations: Very small sample (22 patients), no sham or no-treatment control group, and only a 3-week treatment period — placebo and natural-history effects can't be ruled out. A published critique/response exchange exists in the same journal about this study's methodology, which we were not able to fully review.

Advanced Biomedical Research · 2022 · Taheri, Salek, Mousavi, Maghroori

This uncontrolled study of 20 patients with Dupuytren's contracture found pain, disability, and finger contraction angle continued to improve significantly through 14 weeks of follow-up after 6 weekly shockwave therapy sessions.

Limitations: No control group — without a comparison group, natural fluctuation or placebo response can't be ruled out — and a small sample (20 patients) with follow-up limited to 14 weeks, so durability beyond that point isn't established.

International Journal of Surgery · 2020 · Avendaño-Coy, Comino-Suárez, Grande-Muñoz, Avendaño-López, Gómez-Soriano

This meta-analysis pooling 14 randomized trials (782 participants, 877 knees) found shockwave therapy reduced pain and improved function scores in knee osteoarthritis, with medium energy-density protocols outperforming low- or high-energy protocols, and only minor side effects reported.

Limitations: The review authors emphasize the evidence is strongest for short-term outcomes; a published commentary raising methodological questions about this review also exists in the literature and is worth reading alongside it.

Clinical Rehabilitation · 2019 · Liao, Tsauo, Liou, Chen, Huang

This meta-regression pooling 50 randomized trials (4,844 patients) found shockwave therapy associated with significantly better treatment success, pain reduction, and functional improvement for knee osteoarthritis, and identified a dose-response relationship where higher energy dose and longer follow-up predicted greater effect.

Limitations: Meta-regression analysis carries some risk of residual confounding, and the pooled trials used meaningfully different shockwave protocols (energy level, session count, device type), which the authors themselves highlight as a source of variability.

Biomedicines · 2022 · Liao, Huang, Chen, Liou, Lin, Huang

This network meta-analysis pooling 69 randomized trials (nearly 6,000 participants) compared shockwave therapy, alone and combined with other non-injection treatments, against numerous other conservative options for knee osteoarthritis, finding medium-energy focused shockwave therapy combined with physical therapy among the more effective approaches for pain and function.

Limitations: Network meta-analysis relies on indirect statistical comparisons across trials that didn't all test each other head-to-head, which carries more inherent uncertainty than a direct comparison, and the pooled shockwave protocols varied meaningfully by energy level and device.

Journal of Back and Musculoskeletal Rehabilitation · 2016 · Weckström, Söderström

This small randomized trial of 24 runners with iliotibial band syndrome (both groups also doing exercise rehab) compared radial shockwave therapy with manual therapy and found no statistically significant difference in pain reduction between the two at either 4 or 8 weeks — both groups improved.

Limitations: Very small, unevenly split sample (24 runners total), no true sham/placebo control, and the manual-therapy group's own within-group improvement didn't reach statistical significance at either timepoint, which weakens confidence in the comparison.

Journal of Clinical Medicine · 2024 · Niculăeș, Hernandez-Lucas, Ioja, Lucaci

This pilot study of 64 patients with patellofemoral pain syndrome compared a roughly 3-week program of shockwave therapy plus targeted physical therapy exercises against a comparison group receiving conventional electrotherapy, ultrasound, and laser therapy plus physical therapy, finding significantly greater pain reduction and improved joint mobility in the shockwave group.

Limitations: Described by its own design as a pilot/exploratory study with a short roughly 3-week intervention window; randomization method and blinding were not clearly reported, and the authors call for further research before drawing broader conclusions.

Life · 2026 · Culebras Almeida, Schwitzguebel

This case report describes a professional soccer player with an isolated peroneus longus tendon tear treated with focused shockwave therapy, progressive physical therapy, and custom orthotics, resulting in substantial pain and function improvement, MRI evidence of tendon healing, and return to full competition at 12 weeks, sustained at 18-month follow-up.

Limitations: This is a single-patient case report — the weakest form of clinical evidence that exists. It shows the approach was plausible and safe in one specific, favorable case (a young professional athlete with an isolated tear), not that it's an established or reliable treatment for peroneal tendon problems generally. Published case reports also carry inherent publication bias toward successful outcomes.

Journal of the American Podiatric Medical Association · 2009 · Fridman, Cain, Weil

This randomized, placebo-controlled, double-blind trial of 68 patients with Morton's neuroma (interdigital neuroma) found the shockwave therapy group had significantly better outcomes than the placebo group at 12 months, with 83% of treated patients achieving a successful result.

Limitations: Has case-control-like design elements limiting it to Level of Evidence 3 rather than a top-tier RCT; single-center study; the authors also noted that using local anesthesia during treatment reduced how effective shockwave therapy was, an important procedural detail.

Journal of the American Podiatric Medical Association · 2016 · Seok, Kim, Lee, Park

This placebo-controlled randomized trial of 26 patients with Morton's neuroma found the shockwave therapy group had significantly better pain and function scores than the sham group at 1 and 4 weeks.

Limitations: Very small sample (26 completers) and short 4-week follow-up. Notably, on a separate patient-satisfaction measure, only 57% of the treated group was satisfied, with no significant difference from the sham group on that specific measure — the objective pain/function improvement didn't fully translate to a clear satisfaction advantage.

Journal of Foot and Ankle Research · 2019 · Matthews, Hurn, Harding, Henry, Ware

This independent systematic review of non-surgical treatments for Morton's neuroma identified only a single randomized trial evaluating shockwave therapy against a control, and found that trial showed a non-significant effect on pain — the review found corticosteroid injection and manual mobilization had stronger supporting evidence overall.

Limitations: We're citing this review specifically for its honest, more cautious read on the shockwave evidence for this condition — it's based on just one RCT for shockwave therapy specifically, and the review itself concludes no single non-surgical treatment for Morton's neuroma currently qualifies as a clear gold standard, calling for more high-quality trials across the board.

Annals of Rehabilitation Medicine · 2021 · Al-Amir Mohamed, Kamal, Gaber, Aneis

This randomized trial of 60 participants with upper-trapezius myofascial trigger points found shockwave therapy, a manual technique, and the two combined all improved pain, with the combined shockwave-plus-manual-technique group showing the greatest reduction in pain and disability.

Limitations: The study population was young, healthy university students (ages 18-24) rather than a typical clinic population with chronic pain and other health conditions, which limits how directly the results generalize; follow-up was a relatively short 4 weeks.

Journal of Back and Musculoskeletal Rehabilitation · 2019 · Manafnezhad, Salahzadeh, Salimi, Ghaderi, Ghojazadeh

This randomized trial of 70 patients with non-specific neck pain and upper-trapezius trigger points compared shockwave therapy with dry needling and found both significantly reduced pain and disability and increased pressure-pain thresholds, with no significant difference between the two treatments.

Limitations: No untreated control group, so the results can't fully rule out improvement from natural history alone; single-center study.

Clinical Rehabilitation · 2021 · Rahbar, Samandarian, Salekzamani, Khamnian, Dolatkhah

This single-blind randomized trial of 72 patients with neck and upper-back myofascial pain compared shockwave therapy against standard care (ultrasound, hot pack, and stretching) and a stretching-only control, finding shockwave therapy produced significantly greater pain reduction than standard care at 4 weeks, though not a significant advantage on disability scores specifically.

Limitations: Modest sample size split across three groups, short 4-week follow-up, and single-blind rather than double-blind design.

British Medical Bulletin · 2025 · Crupnik, Silveti, Wajnstein, Rolon, Wuerfel, Stiller, Morral, Furia, Maffulli, Schmitz

This sham-controlled, patient/assessor-blinded randomized trial of 36 semi-professional athletes with ultrasound-confirmed acute hamstring muscle injury found radial shockwave therapy added to a rehab program sped up return to sport (25.4 vs. 28.3 days) and, unlike the sham+rehab group, avoided a persistent strength deficit compared with the uninjured leg.

Limitations: A small sample (n=36) — the authors themselves state 62–82 participants would be needed for definitive statistical power — diagnosis was made by ultrasound rather than MRI, the absolute time benefit was modest (about 3 days), and re-injury rates were equal between groups at 6 months.

World Journal of Clinical Cases · 2020 · Jung, Kim, Yang, Lee, Park

This case report describes a 65-year-old man with an MRI-confirmed medial gastrocnemius muscle rupture and a large intramuscular hematoma (a "tennis leg"-type injury) whose pain dropped immediately after shockwave therapy and whose swelling and pain had fully resolved by 3 months.

Limitations: A single case with no control group — the injury also occurred from a fall in an older non-athlete rather than the classic athletic tennis-leg presentation, and there's no long-term return-to-sport data.

Medical Journal of the Islamic Republic of Iran · 2023 · Majidi, Saeb, Alaei, Khateri, Ezzati Amini, Nikoo

This open-label trial randomized 60 patients with pes anserine bursitis to three weekly shockwave sessions or a single ultrasound-guided corticosteroid injection and found shockwave therapy produced greater pain reduction and much larger quality-of-life gains, while the corticosteroid injection produced a greater reduction in bursal thickness on imaging.

Limitations: Open-label with no blinding, and an unequal treatment "dose" (three shockwave visits versus one injection) that confounds a fair comparison; follow-up was short to moderate in length.

Advances in Orthopedics · 2023 · Gouda, Abbas, Abdel-Aziz, Shoaeir, Ahmed, Moshrif, Mosallam, Kamal

As its title states, this three-arm trial of 180 patients with pes anserine bursitis compared corticosteroid injection, platelet-rich plasma, and shockwave therapy, and found corticosteroid injection was more effective than either of the other two for pain reduction and function at both 1 and 8 weeks — shockwave therapy was the weakest-performing arm in this particular trial.

Limitations: We're citing this study for exactly what it found — corticosteroid injection outperformed shockwave therapy head-to-head in this trial, not the reverse. Follow-up was short (8 weeks) and outcome-assessor blinding wasn't clearly reported.

BMJ Case Reports · 2017 · Thompson, Malliaropoulos, Padhiar

This case report describes a 52-year-old recreational tennis player with a year of forefoot pain and MRI/CT-confirmed avascular necrosis of a sesamoid bone whose pain fully resolved, with a return to tennis and no recurrence at 1-year follow-up, after 8 sessions of radial shockwave therapy.

Limitations: A single case with no control group — the underlying pathology here was osteonecrosis specifically, not the more common inflammatory sesamoiditis presentation, so this shouldn't be generalized as proof shockwave therapy works for sesamoiditis broadly.

Bulletin of Faculty of Physical Therapy · 2025 · Aldardour, Al-Qudimat, Etoom, et al.

This meta-analysis pooling 4 randomized trials found shockwave therapy produced statistically significant improvements in pain and shoulder function versus comparator treatments at 2–3 months, though no significant difference was seen immediately after treatment or at 1-year follow-up.

Limitations: Only 4 RCTs were pooled, the benefit appeared to be time-window-dependent (present at 2–3 months, not sustained at 1 year), and comparator interventions varied across the included trials.

Acta Orthopaedica et Traumatologica Turcica · 2018 · Çirci, Çağlar Okur, Aksu, Mumcuoğlu, Tuzuner, Çağlar

This uncontrolled case series of 30 patients receiving weekly shockwave therapy for 3 weeks for subacromial impingement found significant improvement in shoulder pain and function scores at 12 weeks, regardless of the patient's underlying acromion shape.

Limitations: No control or placebo group, no blinding, a short follow-up window, and a small single-center sample.

Neurology Asia · 2018 · Shen, Wu, Chu, Li, Chen, Wu

This small prospective pilot study of 7 patients (10 elbows) with cubital tunnel syndrome (ulnar nerve compression at the elbow) found three weekly sessions of radial shockwave therapy significantly improved pain and hand/arm function scores over 12 weeks, with no adverse effects reported.

Limitations: An extremely small sample (n=7) with no control or sham group and no blinding — this is explicitly a pilot study, and the authors themselves call for larger randomized trials before drawing firm conclusions. This is a separate matter from case reports of ESWT causing ulnar nerve injury when misapplied elsewhere on the arm — those describe a complication, not evidence for this specific use.

International Journal of Advanced Research · 2025 · Alibrahim, Abdrabalrasol, Almusabbeh, Algafly

This case report describes a 36-year-old surgeon with a degenerative TFCC (triangular fibrocartilage complex) tear in the wrist, refractory to conservative treatment, who achieved complete resolution of pain and full functional restoration — including a return to unrestricted surgical practice — after 4 weekly sessions of focused shockwave therapy.

Limitations: A single case report — this cannot establish efficacy or be generalized to other patients, there was no control group, and positive-outcome case reports like this one are more likely to be published than unsuccessful ones (publication bias).

International Journal of Surgery · 2025 · Tan, Tang, Chai, Ma, Cao, Lin, Zhu, Xiao, Wen, Li

This systematic review pooling 9 studies (716 patients) found shockwave therapy significantly improved hip function scores and reduced pain in early-stage osteonecrosis of the femoral head and helped bone marrow edema symptoms, though imaging showed only a non-statistically-significant trend toward reduced necrotic area, and the therapy did not substantially change disease staging.

Limitations: The included studies were heterogeneous in design and dosing, the imaging outcome specifically was not statistically significant, and the review authors call for more rigorous trials.

Journal of Clinical Orthopaedics and Trauma · 2023 · Abbas, Khan, Veqar

This systematic review of 13 studies found high-energy shockwave protocols were most beneficial for pain and function in osteonecrosis of the femoral head, particularly in earlier disease stages.

Limitations: Considerable variation in study designs, dosing protocols, and energy levels across the included studies limited how firm the dose-response conclusions could be — the authors explicitly note this evidence is not definitive.

Ultrasound in Medicine & Biology · 2011 · D'Agostino, Romeo, Amelio, Sansone

This prospective clinical study of 22 patients with Kienböck's disease (avascular necrosis of a small wrist bone, the lunate) found shockwave therapy had a positive effect on wrist pain and functional impairment and may delay the need for surgery.

Limitations: No comparison or sham group and a small sample (n=22) — the authors themselves call for further investigation. A 2025 hand-surgery systematic review found this remains essentially the only dedicated study for this specific condition, calling the overall evidence base thin.

International Journal of Surgery · 2015 · Thiele, Thiele, Gerdesmeyer

This case series of 40 patients (29 knees, 11 ankles) with osteochondritis dissecans found resting pain resolved in every patient after a single high-energy shockwave session, swelling dropped substantially, and MRI at 1 year showed complete recovery in 40% and partial defect regression in another 30%.

Limitations: No control group — no Level-1 evidence exists for any osteochondritis dissecans treatment — about 10% of patients showed no improvement at all, knee outcomes were better than ankle outcomes, and there's no follow-up data beyond 12 months.

Musculoskeletal Surgery · 2009 · Moretti, Notarnicola, Moretti, Giordano, Patella

This case report describes a 14-year-old volleyball player with bilateral knee osteochondritis dissecans who was slated for surgery but instead achieved complete healing with shockwave therapy; the authors suggest it as a pre-surgical conservative option.

Limitations: A single case with no control group — this can't be generalized to predict outcomes for other patients.

Journal of Back and Musculoskeletal Rehabilitation · 2017 · Moon, Seok, Kim, Lee, Yeo

This sham-controlled randomized trial of 30 patients with sacroiliac joint pain found active shockwave therapy produced significantly lower pain scores at 4 weeks compared with both baseline and the sham group, which showed no significant improvement.

Limitations: A small sample (n=30), a short-term follow-up window of only 4 weeks, and a single-center design.

Journal of Orthopaedic Surgery and Research · 2024

This prospective trial of 90 postpartum patients with sacroiliac joint dysfunction, randomized to focused shockwave therapy, manual therapy, or a combination, found shockwave therapy produced better disability scores than manual therapy at 1 week, the two were similarly effective by 2 weeks, and combination therapy had the highest overall cure rate (73.3%), with no adverse events.

Limitations: We could not independently confirm the complete author list beyond the journal, DOI, and findings themselves (all verified directly on the publisher's page), so the author byline is omitted here pending further confirmation. The trial also had a small sample, was single-center, and had a short (2-month) follow-up.

European Journal of Orthopaedic Surgery & Traumatology · 2017 · Marwan, Dahrab, Esmaeel, Ibrahim, Al-Failakawi

This case series of 23 patients with coccydynia (tailbone pain) found median pain scores dropped from 7.0 to 2.0 at 6 months, and moderate-to-severe disability fell from 70.6% of patients to 5.9%, with no severe cases remaining.

Limitations: No control group, a single-institution design, and a 26.1% dropout rate among non-responders, which may make the apparent success rate look better than it truly was.

Annals of Medicine and Surgery · 2023 · Lota, Malliaropoulos, Bikos, Lohrer

This prospective case series of 14 patients with coccydynia treated with a pain-adapted radial shockwave protocol found a mean pain reduction of 78% immediately after treatment, 89% at 3 months, and 96% at 12 months, with no dropouts, adverse events, or recurrence.

Limitations: No control or sham group, a small sample, and a single-arm design.

International Journal of Surgery · 2025 · Nedelka, et al.

This sham-controlled randomized trial of 128 patients with facet-joint-mediated low back pain (confirmed by diagnostic medial branch block) found the shockwave group had a 64% reduction in pain at 12 months versus minimal improvement in the sham group, with disability scores improving 42% versus 12% and MRI showing bone marrow edema resolution in the majority of treated patients.

Limitations: We were able to confirm the journal, DOI, and PMID directly, but accessed the specific findings through a professional rehabilitation-review digest of the trial rather than the primary paywalled abstract itself, and could not independently confirm the complete author list beyond the first author — we recommend verifying the primary source directly before treating this as definitive. If accurate, it's otherwise the strongest-designed trial found across this entire research round (a large sham-controlled RCT with imaging plus validated outcome measures).

Journal of Personalized Medicine · 2023 · Şah

This double-blind, randomized, sham-controlled trial of 148 patients with hip osteoarthritis found both focused and radial shockwave therapy significantly reduced pain and improved function scores compared with baseline through 8 weeks, with focused shockwave outperforming radial on both measures.

Limitations: A short follow-up window (8 weeks total, with no long-term data), a mixed-gender group without more detailed subgroup analysis, and diagnosis made by X-ray alone rather than advanced imaging.

Cureus · 2024 · Kudo

This single-case experimental study of a man in his 70s with piriformis syndrome found statistically significant improvements in pain, muscle hardness, and sciatic nerve cross-sectional area after radial shockwave therapy, sustained through follow-up.

Limitations: A single-patient exploratory design — the authors themselves state it "cannot establish causal relationships or predict effectiveness across populations."

Aktuelle Rheumatologie · 2021 · Çiftçi, Gezginaslan

This single-blind randomized trial of 67 patients with costochondritis (chest-wall cartilage pain) compared shockwave therapy against a therapeutic steroid injection and found the shockwave group showed significantly better improvement in pain and pressure-pain threshold than the steroid-injection group.

Limitations: A small sample, no untreated control group, only 1 month of follow-up, and a single-center scope — this also appears to be the only dedicated study on shockwave therapy for costochondritis in the literature, so the evidence base is thin even though this one trial is well-designed.

Frontiers in Rehabilitation Sciences · 2026 · Chen, Luo, Zhang, Zhang, Chen, Hu

This meta-analysis pooling 18 randomized trials (1,150 patients) found shockwave therapy produced a significant reduction in jaw pain and a significant improvement in maximal mouth opening (exceeding the threshold considered clinically meaningful), though no significant improvement was seen on a composite jaw-dysfunction index.

Limitations: Very high statistical heterogeneity across studies, a predominance of single-center studies from one country, unclear allocation-concealment reporting, and insufficient long-term follow-up — the authors say results "need to be interpreted with caution."

Journal of Back and Musculoskeletal Rehabilitation · 2025 · Zhang, Jiang, Gao, Zhou, Zhang

This pilot randomized trial of 60 patients with muscle-related TMJ disorder found shockwave therapy plus medication produced significantly better pain scores, maximal mouth opening, and jaw-friction measures than ultrashort-wave therapy plus medication.

Limitations: The authors explicitly state their findings "should be interpreted with caution" due to the small sample size and lack of prospective trial registration.

Turkish Journal of Physical Medicine and Rehabilitation · 2024 · Xia, Zhao, Lin, Yu, Wang, Fan, Yuan, Zhang

This randomized trial of 42 patients with cervicogenic headache linked to neck muscle trigger points found both shockwave therapy and manual therapy produced significant improvement in pain, neck disability, and muscle stiffness, with no significant difference between the two approaches.

Limitations: A small sample, only 4 weeks of follow-up, and no true sham or untreated control group (for ethical reasons), so it can't rule out that some of the improvement reflects natural history rather than either treatment specifically.

Journal of Medical Case Reports · 2023 · Takekawa, Chino, Yamada, Watanabe, Abo, Sengoku

This case report describes a man with a 20-year history of refractory chronic tension-type headache whose pain dropped substantially over 11 weeks using a multimodal treatment plan that included shockwave therapy to the neck and shoulder muscles alongside injections and medication.

Limitations: A single case, and the multimodal nature of the treatment (shockwave plus injections plus medication together) makes it impossible to isolate shockwave therapy's own contribution to the improvement.

Cureus · 2024 · Mifsud

This systematic review of 12 studies found shockwave therapy alone showed functional and aesthetic outcomes comparable to intralesional steroid injection for keloid scars, and combining shockwave with steroid outperformed steroid alone; the review authors describe it as a "promising" non-invasive option while calling for more research to standardize protocols.

Limitations: The included studies were heterogeneous in protocol and device used, and this is review-level evidence rather than a single large primary trial.

Wound Repair and Regeneration · 2018 · Wang, Ko, Chou, Cheng, Kuo

This randomized comparative trial of 39 patients with keloid scars, comparing shockwave therapy against intralesional steroid injection, found no significant difference in functional or cosmetic outcome between the two — both improved scar discoloration, flattening, softness, and elasticity — while tissue analysis showed shockwave produced a greater reduction in the collagen types associated with scar tissue.

Limitations: A small sample, a single-center design, and a short 6-week treatment/observation window relative to how long keloids actually take to develop and mature, with no long-term recurrence data reported.

BMC Research Notes · 2012 · Knobloch, Vogt

This small pilot case series of 6 patients with plantar fibromatosis (Ledderhose disease, a nodular thickening of the plantar fascia related to Dupuytren's contracture) found pain scores fell substantially by 14 days and continued improving to 3 months, with nodule softening noted in every patient and no adverse effects.

Limitations: An extremely small sample (n=6), no control group, a short follow-up window of only 3 months, and no data on whether symptoms recurred later.

Life · 2024 · Fulceri, Ryskalin, Morucci, Busoni, Soldani, Gesi

This case report describes a 48-year-old man with bilateral plantar fibromatosis whose pain dropped from 6/10 to 0/10 by 2 months after shockwave therapy, with ultrasound showing improved nodule tissue uniformity, though the nodules themselves didn't shrink in size.

Limitations: A single case report — this cannot establish generalizable efficacy and had no comparison group. Together with the small case series above, the evidence for this specific condition tops out at the case-series/case-report level — there are no controlled trials — so this should be considered preliminary rather than established.

Medical Sciences · 2025 · Ruiz-Muñoz, Rueda-Zapata, Martinez-Barrios, Nováková, Lopezosa-Reca, Gonzalez-Sanchez, Fernandez-Torres, Galan-Mercant

This meta-analysis pooling 8 randomized trials (672 patients) found chronic diabetic foot ulcers treated with shockwave therapy as an adjunct to standard care had significantly higher complete-healing rates than standard wound care alone, with low variability across the included studies.

Limitations: The included trials varied in shockwave protocol and dose and in what "standard care" comparator they used, and the authors are careful to frame shockwave therapy as an adjunctive approach, not a replacement for standard wound care.

Cochrane Database of Systematic Reviews · 2018 · Cooper, Bachoo

This Cochrane systematic review searched for randomized trials of shockwave therapy for venous leg ulcers and found zero that met its inclusion criteria at the time, concluding no determination of efficacy could be made from the evidence then available.

Limitations: We're citing this specifically as an honest evidence gap, not a positive finding — it should never be read as supportive evidence for shockwave therapy in venous leg ulcers. The two randomized trials below were published after this Cochrane search and offer more recent primary evidence, which the Cochrane review predates.

International Journal of Medical Sciences · 2018 · Dolibog, Dolibog, Franek, Brzezińska-Wcisło, Arasiewicz, Wróbel, Chmielewska, Ziaja, Błaszczak

This randomized pilot trial of 57 patients with venous leg ulcers, comparing radial shockwave, focused shockwave, and standard wound care, found ulcer surface area decreased substantially more with either type of shockwave therapy than with standard care alone at 8 weeks, with complete healing in about a quarter to a third of shockwave-treated patients versus fewer in the standard-care group.

Limitations: A small pilot sample with 7 dropouts and a single-center design.

Journal of Clinical Medicine · 2024 · Dolibog, Dolibog, Bergler-Czop, Grzegorczyn, Chmielewska

This single-center randomized trial of 69 patients with venous leg ulcers compared intermittent pneumatic compression, radial shockwave, focused shockwave, and standard care, and found all four approaches produced significant improvement, but standard compression therapy significantly outperformed both shockwave modalities and standard care alone at 4 weeks.

Limitations: We're citing this study for exactly what it found — in this trial, standard compression-based therapy beat shockwave therapy for healing venous leg ulcers, not the other way around — with small per-arm sample sizes (15–20 patients each). Read alongside the Cochrane review above and the earlier Dolibog 2018 pilot trial, the honest picture is that shockwave therapy can outperform doing nothing/basic care, but standard compression therapy remains the better-established first-line treatment for venous leg ulcers.

Frontiers in Rehabilitation Sciences · 2026 · Gustafsson, Ryman Augustsson

This case report describes a 64-year-old woman with bilateral thumb CMC joint osteoarthritis whose hand function score improved substantially and whose grip strength increased in both hands after three weekly sessions of focused shockwave therapy, with improvements sustained at 52 weeks.

Limitations: A single case with no control group — this can't be generalized to predict outcomes for other patients.

Journal of Orthopedic Research and Therapy · 2021 · Visconti, Torres, Cuko, Di Pardo, Gosetti, Bonomi, Romeo

This case series of 66 patients with thumb osteoarthritis, using a specific proprietary shockwave device, found average pain scores dropped significantly after treatment, with no adverse events reported.

Limitations: No control or comparator group, and this used a specific proprietary device ("diamagnetic shock wave") rather than standard shockwave therapy. It was also published in a journal that is not among the widely-indexed, high-rigor venues we typically prioritize — we're citing it with that caveat clearly disclosed rather than presenting it with the same confidence as our more rigorously indexed sources.

Biomedical Journal of Scientific & Technical Research · 2021 · Ibarbia Carreras, Planas Montalvo, Marrero Riverón

This case series of 26 patients with hallux rigidus (big toe joint arthritis) found the large majority went from significant pain and poor foot-function scores to little or no pain and good-to-excellent function after shockwave therapy, particularly in earlier-stage disease. (The same underlying data also appears in a separate regional journal, Panorama Cuba y Salud, 2020 — we treat this as one dataset, not two independent confirmations.)

Limitations: No control group, no blinding, and only short-term follow-up (immediate to 3 months) — this is real but modest-quality evidence.

Annals of Rehabilitation Medicine · 2025 · Rashad, Abousenna, Elsamman, Rehab

This randomized trial of 60 patients with MRI-confirmed post-laminectomy epidural fibrosis and radicular pain compared radial shockwave therapy plus physical therapy against physical therapy alone, and found the shockwave group had significantly greater pain reduction, better low back range of motion, and improvement on objective nerve-conduction testing that correlated with the pain relief.

Limitations: No blinding of providers and no sham/placebo control group, no post-treatment imaging to confirm whether the fibrosis itself changed, and the study population was restricted to ages 30–50 with BMI under 30, which limits how broadly the results generalize. This trial is specific to post-surgical epidural fibrosis and should not be read as evidence for general disc-related sciatica.

Clinical Rehabilitation · 2010 · Larking, Duport, Clinton, Hardy, Andrews

This double-blind, randomized cross-over trial of 9 chronic pressure ulcers in 8 patients found that all of the static, non-healing ulcers began improving 6-8 weeks after starting shockwave therapy, regardless of whether patients received the real treatment or the placebo treatment first.

Limitations: A very small sample (9 ulcers), and the cross-over design carries some risk of a carryover effect between treatment phases despite a washout period between them.

Advances in Wound Care · 2023 · Dymarek, Kuberka, Rosińczuk, Walewicz, Taradaj, Sopel

This single-blind, sham-controlled trial of 40 patients with pressure ulcers found a single session of radial shockwave therapy produced a significant immediate reduction in wound area and significant improvement in wound-bed quality scores compared with sham treatment, while the sham group's wounds regressed slightly.

Limitations: This measured only immediate post-treatment effects from a single session, with no longer-term follow-up reported — the authors themselves describe the overall evidence for shockwave therapy's utility and safety in pressure ulcers as limited.

Medicine (Baltimore) · 2020 · Duan, Li, Liu, Zhang, Liu, Dong, Li

This case report describes an older adult with a severe stage IV sacral pressure ulcer who achieved complete wound healing over about 14 weeks using shockwave therapy alongside alginate wound dressing, debridement, and rehabilitation.

Limitations: A single case with multiple concurrent interventions (dressing, debridement, rehabilitation), which makes it impossible to isolate shockwave therapy's independent contribution to healing.

American Journal of Translational Research · 2020 · Kang, Yu, Ma

This case report describes a heel pressure ulcer in a patient with spinal cord injury that achieved complete healing after about 3 months of radial shockwave therapy at a gradually increasing dose.

Limitations: A single case with no control group — this can't be generalized to predict outcomes for other patients or wound locations.

Rheumatology International · 2011 · Tinazzi, Amelio, Marangoni, et al.

This pilot study of 30 patients with systemic sclerosis (scleroderma) found skin thickness scores and patient-reported skin wellness both improved after shockwave therapy, with local blood vessel/circulation measures also improving by 60-90 days, though skin thickness measured by instrument and blood markers did not change despite the clinical improvement.

Limitations: A pilot design with no control group and a small, single-center sample.

Tohoku Journal of Experimental Medicine · 2016 · Saito, Ishii, Kamogawa, et al.

This single-arm pilot trial of 9 patients with systemic sclerosis-related fingertip ulcers found the number and size of ulcers decreased significantly, pain scores improved, and quality of life improved over 20 weeks of shockwave therapy, with no adverse events.

Limitations: No placebo control group — the authors themselves note this made it difficult to fully distinguish the treatment's effect from ulcers that might have healed on their own, and ulcers recurred in some patients after treatment stopped.

Skin Research and Technology · 2024 · Naranjo García, López Andrino

This prospective, non-controlled study of 20 women with pattern hair loss found statistically significant increases in total hair count, hair thickness, and follicular unit density after a series of shockwave sessions, with most patients perceiving improved hair volume at 3 months and no adverse effects.

Limitations: No control or comparator group and a single-center design — the authors themselves call for randomized controlled trials to confirm the finding before it can be considered established.

Journal of Clinical Medicine · 2020 · Joo, Lee, Cho, Seo

This double-blind, sham-controlled randomized trial of 48 patients with hypertrophic hand burn scars found shockwave therapy significantly improved pain, scar thickness, and scar blood-vessel density, along with improvement on two specific hand-function tasks (turning cards and picking up small objects), compared with sham treatment.

Limitations: No significant improvement was found in grip strength, scar pigmentation, or scar pliability specifically, a small sample, and a short follow-up period.

Journal of Clinical Medicine · 2023 · Weninger, Thallinger, Chytilek, Hanel, Steffel, Karimi, Feichtinger

This randomized trial of 65 patients recovering from hamstring-tendon ACL reconstruction found that adding shockwave therapy to standard rehab significantly shortened time to return to running (about 10.5 vs. 18.5 weeks) and to pivoting sports (about 28 vs. 43 weeks), with better graft signal intensity on 12-month MRI compared to the control group.

Limitations: No placebo or sham-treatment arm was included, so a portion of the benefit could reflect factors beyond the shockwave treatment itself. See the companion 2025 meta-analysis below for a more mixed pooled result across multiple studies.

World Journal of Orthopedics · 2025 · Salimi, Keshtkar, Mosalamiaghili, Lowe, Ahmad, Sharafatvaziri

This meta-analysis pooled 6 studies (5 RCTs plus 1 non-randomized study) of shockwave therapy after ACL reconstruction and found the overall effect on Lysholm, IKDC, VAS pain, and knee laxity (KT-1000) scores was not statistically significant, although a subgroup analysis using focused (rather than radial) shockwave did show a significant Lysholm-score benefit.

Limitations: High heterogeneity between pooled studies (I² 74-98%) and evidence suggestive of publication bias. We're citing this specifically alongside the Weninger et al. RCT above because it tells a genuinely different, more mixed story — one striking positive trial doesn't mean the pooled evidence is settled.

Journal of Orthopaedic Surgery · 2017 · Acar, Karaarslan, Karakasli

This randomized trial of 43 patients with scapulothoracic bursitis (the cause of snapping scapula syndrome in this study) compared shockwave therapy to corticosteroid injection. At six months, the shockwave group had notably lower pain scores (16 vs. 36 on a 100-point scale) and a higher proportion reporting excellent or good satisfaction (82% vs. 57%).

Limitations: Small sample (n=43), single-institution study — a genuinely positive comparative result, but not yet independently replicated at scale.

Medicine (Baltimore) · 2024 · Li, Liu, Wang, Zhu, Tang, Gu

This multicenter, sham-controlled randomized trial of 320 patients with cervical spondylotic radiculopathy compared focused shockwave therapy plus stabilization training to sham shockwave plus the same training. The shockwave group had a substantially higher overall improvement rate (95% vs. 65%), along with better pain, disability, and cervical range-of-motion outcomes.

Limitations: This is a large, sham-controlled trial and the headline efficacy finding is well-supported, but some granular, study-by-study sub-values reported in secondary summaries of this trial appeared internally inconsistent — we're citing the overall efficacy result with confidence while being cautious about finer sub-details.

Pain Practice · 2018 · Liu, Zhang, Feng

This uncontrolled case series of 15 rheumatoid arthritis patients found that adding radial shockwave therapy over three months reduced resting pain (2.90 to 0.80), active pain (5.70 to 2.20), and morning stiffness (2.25 to 1.05 hours), and let 11 of 15 patients stop pain medication entirely, with the remainder reducing their dose.

Limitations: Small, uncontrolled, single-arm study with no comparison group — the authors themselves describe this as the first report of this therapy for RA arthralgia, so it should be understood as an early, exploratory finding, not established evidence.

Phlebology · 2025 · Agostino, Cilluffo

This prospective comparative study of 75 women with stage II-III lipedema who had undergone liposuction surgery found that the 50 women who received shockwave therapy starting about one week after surgery (3x/week for 3 weeks) had significantly less post-surgical fibrosis, better skin elasticity, lower pain scores, and higher satisfaction than the 25 who didn't.

Limitations: This evidence is specifically about shockwave therapy as a post-liposuction recovery aid, not a standalone or non-surgical lipedema treatment — that scope should not be blurred. This is also a recently published study we have not been able to confirm independent replication of elsewhere.

Annals of Surgery · 2012 · Ottomann, Stojadinovic, Lavin, Gannon, Heggeness, Thiele, Schaden, Hartmann

This phase II randomized trial of 50 patients with acute second-degree burns compared standard wound care alone to standard care plus a single session of shockwave therapy, finding significantly faster complete wound healing in the shockwave group (about 9.6 days on average) than with standard care alone (about 12.5 days).

Limitations: This is a phase II trial with a baseline age imbalance between groups that required statistical adjustment, and some follow-up data were missing. The authors call for confirmation in larger phase III trials before considering this a definitive finding.

Journal of the American College of Surgeons · 2010 · Ottomann, Hartmann, Tyler, Maier, Thiele, Schaden, Stojadinovic

This randomized trial, from the same research group and using a similar design to the related 2012 burn-wound trial above, evaluated whether a single session of shockwave therapy accelerates healing at skin graft donor sites (the secondary wound created when skin is harvested for a graft elsewhere on the body).

Limitations: We were not able to independently access the full results of this study (the publisher page was paywalled) — this citation is included on the strength of its confirmed, independently indexed bibliographic record (title, authors, journal, year, DOI), not a confirmed reading of its specific findings. Read the source directly before relying on any specific outcome claim.

Clinical Rehabilitation · 2010 · Larking, Duport, Clinton, Hardy, Andrews

This placebo-controlled randomized trial evaluated extracorporeal shockwave therapy for chronic decubitus ulcers (pressure sores) compared with sham treatment.

Limitations: We were not able to independently access this study's specific outcome data during our research — this citation is included on the strength of its confirmed, independently indexed bibliographic record. Notably, a published response/critique letter about this trial exists in the medical literature (PMID 21115686), which is worth reading before relying on this study's conclusions.

Journal of Surgical Research · 2009 · Wang, Kuo, Wu, Liu, Hsu, Wang, Yang

This study evaluated extracorporeal shockwave therapy for chronic diabetic foot ulcers, a serious wound-healing complication of diabetes.

Limitations: We were not able to independently access this study's specific outcome data during our research — this citation is included on the strength of its confirmed, independently indexed bibliographic record. Diabetic foot ulcers require comprehensive medical management (blood sugar control, offloading, infection monitoring, vascular assessment); shockwave therapy, if used at all, would be one part of a broader care plan, not a replacement for it.

The Annals of Thoracic Surgery · 2008 · Dumfarth, Zimpfer, Vögele-Kadletz, Holfeld, Sihorsch, Schaden, Czerny, Aharinejad, Wolner, Grimm

This randomized trial evaluated whether prophylactic low-energy shockwave therapy improves wound healing at the leg incision site used to harvest a vein for coronary artery bypass graft (heart bypass) surgery.

Limitations: We were not able to independently access this study's specific outcome data during our research — this citation is included on the strength of its confirmed, independently indexed bibliographic record. This is a surgical-wound-prevention context, not established chronic wound treatment, so it doesn't directly generalize to non-healing wounds.

Journal of Surgical Research · 2007 · Schaden, Thiele, Kölpl, Pusch, Nissan, Attinger, Maniscalco-Theberge, Peoples, Elster, Stojadinovic

This feasibility study evaluated shockwave therapy for a mix of acute and chronic soft-tissue wounds.

Limitations: Note on citation accuracy: the manufacturer compendium that also references this study lists its first author as 'Pusch,' but the independently indexed record shows Wolfgang Schaden as first author, with Michael Pusch as a co-author — corrected here. We were not able to independently access this study's specific outcome data during our research; as a feasibility study, it's designed to establish that a larger trial is practical, not to prove treatment efficacy.

International Journal of Molecular Sciences · 2021 · Holsapple, Cooper, Berry, Staniszewska, Dickson, Taylor, Bachoo, Wilson

This translational study examined how shockwave therapy affects immune cells (macrophages) involved in wound healing, using tissue samples from patients with chronic venous leg ulcers before and after treatment, alongside laboratory experiments on cultured macrophages. It found shockwave-treated wound tissue showed signs of improved healing activity and reduced inflammatory macrophage density, and shockwave-exposed macrophages in the lab showed increased activity relevant to tissue repair.

Limitations: The clinical portion involved a small number of patients (9 completed the study), a short 2-week follow-up period, and some patients did not respond to treatment for reasons the authors say remain unclear. The laboratory findings help explain a possible biological mechanism but don't by themselves establish clinical effectiveness.

International Wound Journal · 2023 · Hitchman, Totty, Smith, Carradice, Twiddy, Iglesias, Russell, Chetter

This independent systematic review — from a UK academic medical research group (Hull University Teaching Hospitals NHS Trust / University of Hull) with no apparent connection to any shockwave device manufacturer — evaluated the published evidence on extracorporeal shockwave therapy compared with standard wound care for diabetic foot ulcer healing.

Limitations: We were not able to independently access this review's specific pooled results/effect sizes during our research — this citation is included on the strength of its confirmed, independently indexed bibliographic record from a genuinely independent academic research group. Diabetic foot ulcers require comprehensive medical management; shockwave therapy is, at most, one component of a broader care plan overseen by a physician.

Archives of Plastic Surgery · 2022 · Chuangsuwanich, Kongkunnavat, Kamanamool, Maipeng, Kamanamool, Tonaree

This study from a Thai academic plastic surgery department investigated extracorporeal shockwave therapy as a noninvasive approach to hypertrophic scars, examining its effects on the scar-forming cells (fibroblasts) involved in scar remodeling.

Limitations: We were not able to independently confirm this study's exact design or specific outcome data beyond a bibliographic/abstract-database summary during our research — this citation is included on the strength of its confirmed, independently indexed bibliographic record (title, authors, journal, DOI), not a confirmed reading of its full results.

Ultrasound in Medicine & Biology · 2016 · Saggini, Saggini, Spagnoli, Dodaj, Cigna, Maruccia, Soda, Bellomo, Scuderi

This study examined extracorporeal shockwave therapy for retracting (contracted) scars of the hands, a narrower and more functionally significant scar presentation than general hypertrophic scarring.

Limitations: Note on citation accuracy: the manufacturer compendium that inspired this section cites a differently-titled 'Saggini et al., 2013' record on 'surgical hand scars' that we could not independently verify under that title or year despite extensive searching — this is the real, independently indexed Saggini paper on hand scarring, with the corrected title and year. We were not able to independently access its specific outcome data beyond a confirmed bibliographic record during our research.

Lymphatic Research and Biology · 2020 · Joos, Vultureanu, Nonneman, Adriaenssens, Hamdi, Zeltzer

This pilot study of 10 patients with late-stage secondary lymphedema of the arm following breast cancer treatment (a swelling complication that can develop after lymph node surgery or radiation, sometimes years afterward) added low-energy shockwave therapy to standard physical therapy, finding significant improvements in arm circumference and patient-reported tissue firmness/swelling, though the study's own primary measure — total limb volume — did not reach statistical significance.

Limitations: This is a small (10-patient), uncontrolled pilot study — the primary volumetric outcome did not reach statistical significance, and without a comparison group it isn't possible to know how much of the improvement in the secondary measures came from the added shockwave therapy versus the physical therapy alone. This study is about treating a wound/swelling complication that can occur after breast cancer treatment — it is not a claim about treating cancer itself, and this practice does not treat cancer.

Annals of Rehabilitation Medicine · 2020 · Lee, Kim, Lee, Kim

This randomized trial of 30 women with stage-2 breast cancer-related lymphedema compared shockwave therapy plus standard complex decongestive therapy against complex decongestive therapy alone, and found the shockwave group had a greater reduction in limb volume and a greater reduction in skin thickness (a marker of the fibrous tissue change that makes lymphedema harder to treat with compression alone) after six sessions over three weeks.

Limitations: A small sample, restricted to stage-2 lymphedema only, no long-term follow-up, and the authors themselves describe their fibrosis-measurement approach as imprecise.