Efficacy of radial and focused shockwave therapy for tendinopathy: a systematic review and meta-analysis

Tendinopathy is a common musculoskeletal condition that impairs body function and quality of life. Extracorporeal shockwave therapy is a widely used non-invasive treatment method. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of radial shockwave therapy (RSWT) and focused shockwave therapy (FSWT) in the treatment of upper and lower limb tendinopathies, based on randomized controlled trials (RCTs) assessing pain intensity, physical function, muscle strength, and adverse effects. The review protocol was registered in the PROSPERO database under the registration number CRD420251011209. A comprehensive search of PubMed, EBSCOhost, Ovid MEDLINE, and Embase was conducted to identify RCTs. Databases were searched from their inception until the last update-26 March 2025 for PubMed, EBSCOhost and Ovid MEDLINE, and 27 March 2025 for Embase. Review methods: Risk ratios and mean differences (MD) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I² statistic. The risk of bias and methodological quality of the included studies were evaluated using the Cochrane Risk of Bias tool and the Physiotherapy Evidence Database scale. The overall quality of the body of evidence was assessed using the GRADE approach. Of the 102 records identified, 9 articles met the inclusion criteria, comprising a total of 530 patients with upper or lower limb tendinopathy. No clear superiority of RSWT or FSWT was observed for pain or functional outcomes, owing to low or very low certainty of evidence. Moderate-quality evidence indicated that RSWT significantly improved wrist extensor strength in patients with tennis elbow compared to FSWT (MD: 1.81; 95% CI 0.97 to 2.64; p < 0.001; I² = 0%), while grip strength did not differ significantly between the modalities (MD: 0.57; 95% CI -1.68 to 2.82; p = 0.62; I² = 0%). Both treatments were similarly safe, but conclusions are limited by low-quality evidence.