RADIAL SHOCKWAVE THERAPY

General Orthopedic Surgeons located in Benbrook, Ft Worth, TX

A noninvasive treatment for chronic tendon, fascia, and selected musculoskeletal pain conditions

WHAT RADIAL SHOCKWAVE IS

Radial extracorporeal shockwave therapy (rESWT) uses rapid pressure pulses delivered through the skin by a handheld applicator. Energy is highest near the applicator and spreads outward through superficial tissues. It is different from focused shockwave, which concentrates energy at a deeper focal point.

HOW IT MAY WORK

• Mechanotransduction: mechanical energy is converted into cellular signaling that can influence tendon cells, extracellular matrix, and remodeling.

• Pain modulation: treatment can alter peripheral nociceptive signaling and reduce pain sensitivity over time. • Circulation and repair signaling: shockwave can stimulate local vascular and growth-factor responses in some tissues. • Calcific disease: shockwave may help fragment or promote resorption of calcium deposits, especially in calcific rotator cuff tendinopathy, although focused/high-energy approaches may be more effective for some calcific lesions. • Works best with rehab: shockwave is usually an adjunct to progressive loading, mobility, and correction of the factors that overloaded the tissue in the first place

COMMON USES OF RADIAL SHOCKWAVE

WHY RADIAL VS FOCUSED MATTERS

Radial and focused devices are not interchangeable. Radial waves spread over a broader, more superficial area and are practical for large tendons and fascial targets. Focused shockwave can reach deeper structures and deliver a more concentrated energy density. The best device depends on the diagnosis, tissue depth, calcification, and treatment goal.

WHAT A TREATMENT SESSION FEELS LIKE

The clinician identifies the painful structure, applies coupling gel, and moves the applicator over the target while adjusting pressure/energy to tolerance. Treatment is usually uncomfortable but brief. Patients commonly describe tapping, pounding, or deep pressure. A typical course often involves several sessions spaced about a week apart, but the number of treatments and settings should be individualized rather than copied from a single universal protocol.

WHY CLINIC QUALITY MATTERS

• Correct diagnosis: shockwave does not fix every painful tendon or heel. Stress fracture, nerve entrapment, inflammatory arthritis, full-thickness rupture, or referred pain require a different plan.

• Correct device: ask whether the clinic is using true radial pressure-wave therapy, focused shockwave, or a different device marketed with similar language.

• Targeting: treatment should be directed to the actual pathologic tendon, fascia, calcific deposit, or enthesis identified on examination and, when useful, ultrasound.

• Dose progression: pressure, frequency, number of pulses, and treatment area should be adjusted to tissue and tolerance. More intensity is not automatically better.

• Rehabilitation: high-quality care pairs shockwave with progressive strength and load management instead of using the machine as a stand-alone cure.

AFTER TREATMENT

Mild soreness, tenderness, redness, or bruising can occur for a day or two. Most patients can continue normal daily activity, but high-load sport may be modified depending on the tendon. Because the desired response includes remodeling, symptom improvement can continue over several weeks after the final treatment.

RISKS AND WHEN IT MAY NOT BE APPROPRIATE

• Temporary pain, skin redness, bruising, petechiae, swelling, or numbness.

• Treatment directly over active infection, open wounds, or a tumor is generally avoided. • Bleeding disorders, anticoagulant use, pregnancy near the treatment field, severe neuropathy, growth plates, and treatment near major neurovascular structures require individualized screening and may change whether or how shockwave is used. • A suspected acute tendon rupture, fracture, or major structural failure should be diagnosed before shockwave is considered.

SELECTED REFERENCES

These references are provided for clinical transparency and further reading. Individual treatment decisions require an in-person evaluation.

[1] Elgendy MH, Khalil SE, ElMeligie MM, Elazab DR. Effectiveness of extracorporeal shockwave therapy in treatment of upper and lower limb tendinopathies: A systematic review and meta-analysis. Physiother Res Int. 2024;29(1):e2042. doi:10.1002/pri.2042. [2] Majidi L, Khateri S, Nikbakht N, et al. The effect of extracorporeal shock-wave therapy on pain in patients with various tendinopathies: systematic review and meta-analysis of randomized trials. BMC Sports Sci Med Rehabil. 2024;16(1):93. doi:10.1186/s13102-024-00884-8. [3] Tung WS, Daher M, Covarrubias O, et al. Extracorporeal shock wave therapy shows comparative results with other modalities for the management of plantar fasciitis: systematic review and meta-analysis. Foot Ankle Surg. 2025;31(4):283-290. doi:10.1016/j.fas.2024.11.005. [4] Rhim HC, Shin J, Beling A, et al. Extracorporeal Shockwave Therapy for Greater Trochanteric Pain Syndrome: A Systematic Review with Meta-Analysis of Randomized Clinical Trials. JBJS Rev. 2024;12(8). doi:10.2106/JBJS.RVW.24.00091. [5] Brindisino F, Marruganti S, Lorusso D, et al. The effectiveness of extracorporeal shock wave therapy for rotator cuff calcific tendinopathy: a systematic review with meta-analysis. Physiother Res Int. 2024;29(3):e2106. doi:10.1002/pri.2106. [6] Efficacy and safety of extracorporeal shock wave therapy for upper limb tendonitis: a systematic review and meta-analysis of randomized controlled trials. Front Med. 2024. PubMed PMID: 39139789. [7] Efficacy of radial and focused shockwave therapy for tendinopathy: a systematic review and meta-analysis. PubMed PMID: 41651897. 2026. [8] Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review. Br J Sports Med. 2024;58(3):154-163. PubMed PMID: 38228375.

Southwest Orthopedic Associates

✆ Phone (appointments): 817-731-9400

Fax: 817-731-4282

Address: 6311 Southwest Blvd., Ft Worth, TX 76132

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