The purpose of this study was to assess the efficacy of physiotherapy approaches to treatment of rotator cuff tendinopathies (RCT). Ninety shoulders were randomised in the study. A power calculation performed demonstrated using a factorial study design, 85 shoulders would be needed for 80% power at 95% confidence. All participants gave informed consent and ethical approval was granted by the Cambridge LREC. The primary outcome measure was the Shoulder Pain and Disability Index. Participants were blinded to their allocation and were randomised to one of four groups: Therapeutic Exercise(T), Manual Therapy(M), combined T/M (X), or Placebo(P). Participants were seen for two baseline assessments with a 4-week interval and then randomised. Final assessments were performed one week after the last session. The analysis involved a comparison between groups in change from baseline SPADI using ANCOVA adjusting for baseline scores. This involved testing for any interaction between M and T, and subsequently testing for main effects of M and T. Adjusted baseline and final SPADI scores (SD) by group were: X 41.6(15.4), 21.1(20.8); T 47.6(19.3), 26.3(14.7); M 44.1(17.9), 33.1(23.3); and P 39.5(24.7), 36.6(30.6). The main effects (with Significance, Standard Error and Confidence Interval) by group were: Baseline=0.686 (SE=0.104;CI=0.479,0.892); T=−13.347 (p=0.002;SE=4.091;CI=−21.479,−5.215); X=5.479 (p=0.510;SE=8.284; CI=−10.991,21.950); M=−4.126 (p=0.314;SE=4.077;CI=−12.230,3.978). A statistically significant reduction in SPADI was observed for the T group alone. There was no significant interaction effect with the addition of manual therapy and the M group did not improve significantly. It appears that best practice for treatment of RCT should centre around therapeutic exercise.

We have performed a double-blind placebo-controlled trial of moderate doses of extracorporeal shock-wave therapy (ESWT) for non-calcific tendonitis of the rotator cuff. Adults (74) with chronic tendonitis of the rotator cuff were randomised to receive either active (1500 pulses ESWT at 0.12 mJ/mm²) or sham treatment, monthly for three months. All were assessed before each treatment, and at one and three months after the completion of treatment. The outcome was measured with regard to pain in the shoulder, including a visual analogue score for night pain, and a disability index. There were no significant differences between the two groups before treatment.

The mean duration of symptoms in both groups was 23.3 months. Both showed significant and sustained improvements from two months onwards. There was no significant difference between them with respect to change in the Shoulder Pain and Disability Index (SPADI) scores or night pain over the six-month period. A mean (±sd; range) change in SPADI of 16.1 ± 27.2 (0 to 82) in the treatment group and 24.3 ± 24.8 (−11 to 83) in the sham group was noted at three months. At six months the mean changes were 28.4 ± 25.9 (−24 to 69) and 30.4 ± 31.2 (−12 to 88), respectively. Similar results were noted for night pain.

We conclude that there is a significant and sustained placebo effect after moderate doses of ESWT in patients with non-calcific tendonitis of the rotator cuff, but there is no evidence of added benefit when compared with sham treatment.