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Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study

BMJ 2009; 339 doi: (Published 15 September 2009) Cite this as: BMJ 2009;339:b3360
  1. Kaia Engebretsen, physiotherapist12,
  2. Margreth Grotle, research leader23,
  3. Erik Bautz-Holter, professor12,
  4. Leiv Sandvik, professor4,
  5. Niels G Juel, MD consultant12,
  6. Ole Marius Ekeberg, Research fellow12,
  7. Jens Ivar Brox, MD consultant25
  1. 1Department of Physical Medicine and Rehabilitation, Ullevaal University Hospital, Kirkeveien 166, 0407 Oslo, Norway
  2. 2Medical Faculty, University of Oslo, Oslo
  3. 3FORMI, Division for Neuroscience and Musculoskeletal Medicine, Ullevaal University Hospital
  4. 4Section for Biostatistics and Epidemiology, Ullevaal University Hospital
  5. 5Department of Orthopaedics, Section for Physical Medicine and Rehabilitation, National Hospital, Oslo
  1. Correspondence to: K Engebretsen kaiabe{at}
  • Accepted 25 May 2009


Objective To compare the effectiveness of radial extracorporeal shockwave treatment with that of supervised exercises in patients with shoulder pain.

Design Single blind randomised study.

Setting Outpatient clinic of physical medicine and rehabilitation department in Oslo, Norway.

Participants 104 patients with subacromial shoulder pain lasting at least three months.

Interventions Radial extracorporeal shockwave treatment: one session weekly for four to six weeks. Supervised exercises: two 45 minute sessions weekly for up to 12 weeks.

Primary outcome measure Shoulder pain and disability index.

Results A treatment effect in favour of supervised exercises at 6, 12, and 18 weeks was found. The adjusted treatment effect was −8.4 (95% confidence interval −16.5 to −0.6) points. A significantly higher proportion of patients in the group treated with supervised exercises improved—odds ratio 3.2 (1.3 to 7.8). More patients in the shockwave treatment group had additional treatment between 12 and 18 weeks—odds ratio 5.5 (1.3 to 26.4).

Conclusion Supervised exercises were more effective than radial extracorporeal shockwave treatment for short term improvement in patients with subacromial shoulder pain.

Trial registration Clinical trials NCT00653081.


  • We thank Stine O Eriksen for doing all the assessments, Roald Danielsen for administering radial extracorporeal shockwave treatment, and Mona Mortensen and Helene Skaara for leading the supervised exercises. We also thank Egil Knag, Enimed, for lending us the Swiss Dolor Clast. A special thanks to all the patients who made this study possible.

  • Contributors: KE contributed to the study design; data collection, analysis, and interpretation; and writing of the manuscript. MG and JIB contributed to the study design, data analysis and interpretation, and writing of the manuscript. EB-H contributed to the study design and data collection and interpretation. LS contributed to data analysis and interpretation. NGJ and OME contributed to the study design and data collection and interpretation. KE is the guarantor.

  • Funding: The study was supported by Health Region East, Norway.

  • Competing interests: None declared.

  • Ethical approval: The study protocol was approved by the ethics committee for Medical Research Region 1 of Norway.

  • Accepted 25 May 2009

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