Extracorporeal shockwave therapy

Topic Status Complete

Extracorporeal shockwave therapy for the treatment of musculoskeletal conditions.

Outcome of the appraisal


HTW undertook an evidence review to address the following question: is extracorporeal shockwave therapy (ESWT) clinically and cost effective in comparison to other interventions, no treatment or placebo for the treatment of musculoskeletal conditions.


The review identified a large body of evidence on the use of ESWT to treat a range of different musculoskeletal conditions, including tendinopathies and plantar fasciitis, of which we found the most evidence; greater trochanteric pain syndrome; osteoarthritis; myofascial pain syndrome; carpal tunnel syndrome and Morton’s neuroma. The quality and quantity of evidence regarding the effectiveness of ESWT varied for each condition. Overall, the evidence identified by HTW suggests that ESWT is a safe treatment option. However, its effectiveness varied according to the specific condition treated and what outcomes were measured. For most outcomes and conditions, the available evidence suggests that there is no statistically significant difference between ESWT and no treatment/placebo/sham treatment. . It was difficult to fully assess the health economic implications of using ESWT because of a lack of evidence on outcomes relevant to health economic analysis.


The HTW Assessment Group concluded that the evidence for ESWT for the treatment of musculoskeletal conditions is currently too heterogeneous to inform the production of Guidance at this time. Therefore, this topic will not progress to Appraisal Panel and will not receive HTW Guidance recommendations.

Why was this topic appraised?


Musculoskeletal conditions affect the muscle or bone. They are typically characterised by pain and limitations in mobility, dexterity and functional ability. This can reduce people’s ability to work and participate in social roles, with associated impacts on mental wellbeing.


ESWT is a non-invasive treatment in which a device is used to pass acoustic shockwaves through the skin to the affected area. The mechanism by which ESWT might work is unknown, but different mechanisms have been speculated. There are many different treatment options for the pain associated with musculoskeletal conditions, including ice and rest; nonsteroidal anti-inflammatory drugs; physical therapy; corticosteroid injections; or, in more severe cases, surgery. Other non-drug treatment options include ESWT, laser therapy, radiation therapy, and transcutaneous electric nerve stimulation.


ESWT is currently being used by some health boards in Wales. This topic was suggested by physiotherapists from two different health boards to help establish consistency in use of ESWT across Wales.

Plain language summary


Musculoskeletal conditions include conditions that affect joints, bones and muscles. People with musculoskeletal conditions can experience pain and a limited ability to use their affected limbs. This in turn affects their ability to work and take part in family and community life. There are many different types of musculoskeletal conditions, including arthritis, tendinopathies and carpal tunnel syndrome. Usual treatment for the pain of these conditions includes applying ice, rest, physical therapy, medication and in severe cases, surgery.


Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment in which a device is used to pass low-energy sound waves from outside of the body (extracorporeal), through the skin to the affected area. ESWT is speculated to work in a number of ways: by destroying the nerve endings, by giving pain relief from affecting the nerve cells, and by increasing blood flow to the area to promote healing.


Health Technology Wales looked for evidence that ESWT is an effective treatment for musculoskeletal conditions when compared to other interventions, no intervention or placebo. Evidence was found for a wide range of musculoskeletal conditions. There were many differences in the evidence found for each type of musculoskeletal condition, making the production of a single piece of Guidance on ESWT unsuitable at this time.

Topic Exploration Report

TER141 03.2020

Evidence Appraisal Review

EAR022 11.2020

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