The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on extra-corporeal shockwave lithotripsy for calcific tendonitis (tendinopathy) of the shoulder.


Calcifying tendonitis most commonly occurs in the shoulder joint, specifically the supraspinatus tendon of the rotator cuff, where crystalline calcium phosphate is deposited in the tendon.

Treatment includes non-steroidal anti-inflammatory drugs, corticosteroids, regular physiotherapy, aspiration and lavage.

For patients refractory to these approaches, open shoulder surgery has been offered and the introduction of shoulder arthroscopy introduced a minimally invasive approach.

Extracorporeal shock wave lithotripsy (ESWT) may be an alternative to surgery.  ESWT allows controlled sonic pulses of short duration to produce transient pressure disturbances in the shoulder with the aim of fragmenting deposits. The procedure aims to improve shoulder function and reduce pain. The mechanism of ESWT on calcifying tendonitis is unknown. ESWT is an established technique for the treatment of renal calculi and has since been used in orthopaedics. 

Coding and clinical classification codes for this guidance

Guidance development process

How we develop NICE interventional procedures guidance

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.