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