We report a controlled, prospective study that explored the effect of extracorporal shock waves of low- versus high-energy density in patients with chronic shoulder pain and calcific tendinitis. We assigned at random 100 patients who had had calcific tendinitis for more than 12 months to 2 groups to receive shock wave therapy either of a low- or high-energy density. Group 1 received 1,500 impulses of 0.06 mJ/mm2, whereas group 2 received 1,500 impulses of 0.28 mJ/mm2. Unlike group 1, in which the shock wave application could be performed without local anesthesia, all patients in group 2 required brachial plexus anesthesia. The patients were reviewed at 6 and 24 weeks. Partial or complete disintegration of the calcareous deposit was observed in 50% of the patients in group 1 and 64% of the patients in group 2 (p < 0.01). According to the Constant score, ratings increased from 48 to 71 points in group 1 (p < 0.001) and from 53 to 88 in group 2 (p < 0.001) (out of a total possible 100 points), the end values of both groups differing significantly (p < 0.01). After 24 weeks, 52% of the patients in group 1 rated the results of treatment as good or excellent, compared with 68% in group 2 (p < 0.01). No improvement was reported by 24% versus 10%, respectively, at the 24-week follow-up.

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