Effectiveness of conservative therapy in tendinopathy-related shoulder pain: A systematic review of randomized controlled trials.

Objective: Systematic review investigated efficacy of conservative therapy on pain and function in people with tendinopathy-related shoulder pain.

Methods: Searches were conducted on six databases. All randomized controlled trials investigating efficacy of any conservative therapy on pain and function in people with tendinopathy-related shoulder pain were included. Estimates for each specific conservative therapy were presented as weighted mean differences (WMDs) or mean differences (MDs), with 95% confidence intervals (CIs). Quality of the evidence was assessed using GRADE.

Results: Five randomized controlled trials were included. Extracorporeal shock-wave therapy (ESWT) was effective on pain at short-term (i.e., ≤3 months) when compared with control (WMD = -1.7 out of 101 points, -3.1 to -0.3; n = 158). Individual trials also suggested effects of non-steroidal anti-inflammatory drugs (NSAIDs) (-13.7 to -2.3; n = 365) and extracorporeal radial pressure pulse therapy (rESWT) (-40.0 to -27.0; n = 79). Laser therapy and ESWT were not effective on pain and function at short-term, respectively. No trials investigated medium- or long-term effects, and quality of the evidence ranged from low to very low quality.

Conclusions: Conservative therapies currently available for the rotator cuff management and biceps tendinopathy are not supported by low to very-low quality evidence.