***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: We carried out a prospect i ve , r and omised controlled trial on two groups of 40 patients with painful calcific tendonitis and a mean age of 48.4 years ( 32.5 to 67.3 ) . All were to undergo arthroscopic removal of the calcific deposit within six months after r and omisation . The 40 patients in group I received ultrasound-guided needling followed by high-energy shock-wave therapy and the 40 in group II had shock-wave therapy alone . In both groups one treatment consisting of 2500 impulses of shock waves with an energy flux density of 0.36 mJ/mm(2 ) was applied . The clinical and radiological outcome was assessed using the 100-point Constant shoulder scoring system and st and ardised radiographs . The mean follow-up was 4.1 months and no patient was lost to follow-up . Both groups had significant improvement in their Constant shoulder score . Radiographs showed disappearance of the calcific deposit in 60.0 % of the shoulders in group I and in 32.5 % of group II ( p < 0.05 ) . Significantly better clinical and radiological results were obtained in group I than in group II . Arthroscopic removal of the deposit was avoided in 32 patients of group I and in 22 of group II . No severe side-effects were recorded . Ultrasound-guided needling in combination with high-energy shock-wave therapy is more effective than shock-wave therapy alone in patients with symptomatic calcific tendonitis , giving significantly higher rates of elimination of the calcium deposits , better clinical results and reduction in the need for surgery OBJECTIVES To evaluate the therapeutic effect of extracorporeal shock wave therapy ( ESWT ) in shoulders with chronic calcific tendinitis , to compare the functional outcomes of ESWT and transcutaneous electric nerve stimulation ( TENS ) therapy , and to investigate which types of calcium deposit effectively respond to ESWT . DESIGN R and omized controlled trial . SETTING Outpatient clinics of the departments of physical medicine and rehabilitation and of orthopedics and traumatology of a veterans hospital in Taiwan . PARTICIPANTS Sixty patients with continuous shoulder pain for 6 months or more and with radiographically and sonographically verified calcific tendinitis . Patients were r and omly allocated to receive ESWT ( 33 shoulders ) or TENS treatment ( 30 shoulders ) . INTERVENTIONS ESWT was performed with 2000 shock waves at 2Hz and energy level between.26 and .32mJ/mm(2 ) per session . Treatment was given in 2 sessions , 14 days apart . TENS therapy was given 3 times a week for 4 weeks . MAIN OUTCOME MEASURES Mean Constant score , visual analog scale ( VAS ) , manual muscle test , and changes of sonographic size and shape of calcium deposits were calculated for 4 time points : at baseline , 2 weeks , 4 weeks , 12 weeks posttherapy . RESULTS In both groups , Constant score and VAS improved significantly at 2- , 4- , and 12-week follow-ups ( P<.05 ) , and the size of calcium deposits decreased significantly at the 4- and 12-week follow-ups . Moreover , the arc-shaped calcific plaques of the rotator cuff were markedly meliorated with ESWT . CONCLUSIONS ESWT is more effective in the treatment of chronic calcific tendinitis of the shoulder than is TENS therapy , especially for arc-type calcific plaque In a prospect i ve r and omised trial of calcifying tendinitis of the rotator cuff , we compared the efficacy of dual treatment sessions delivering 2500 extracorporeal shock waves at either high- or low-energy , via an electromagnetic generator under fluoroscopic guidance .  Patients were eligible for the study if they had more than a three-month history of calcifying tendinitis of the rotator cuff , with calcification measuring 10 mm or more in maximum dimension . The primary outcome measure was the change in the Constant and Murley Score .  A total of 80 patients were enrolled ( 40 in each group ) , and were re-evaluated at a mean of 110 ( 41 to 255 ) days after treatment when the increase in Constant and Murley score was significantly greater ( t-test , p = 0.026 ) in the high-energy treatment group than in the low-energy group . The improvement from the baseline level was significant in the high-energy group , with a mean gain of 12.5 ( -20.7 to 47.5 ) points ( p < 0.0001 ) . The improvement was not significant in the low-energy group . Total or subtotal resorption of the calcification occurred in six patients ( 15 % ) in the high-energy group and in two patients ( 5 % ) in the low-energy group . High-energy shock-wave therapy significantly improves symptoms in refractory calcifying tendinitis of the shoulder after three months of follow-up , but the calcific deposit remains unchanged in size in the majority of patients Background Low-energy extracorporeal shock wave therapy is an alternative treatment , with limited evidence for effectiveness , for calcific tendinitis of the rotator cuff . Hypothesis Objective localization of the calcium deposit by 3-dimensional , computer-assisted navigation reveals superior clinical and radiographic outcomes compared to localization through patient-to-therapist feedback . Study Design R and omized controlled clinical trial ; Level of evidence , 1 . Methods A prospect i ve , r and omized , single-blind study was carried out on 50 patients . The population was divided into 2 groups of equal numbers ( navigation group and feedback group ) . In all patients , treatment-resistant pain was evident for longer than 6 months . A total of 3 therapy sessions of constant low-energy focused shock wave therapy was administered in weekly intervals in both groups . Local anesthesia was not applied . Radiographs and clinical assessment , including the Constant and Murley shoulder scoring system and the visual analog scale for pain , were performed both before therapy and after 12 weeks . In the navigation group , the calcium deposit was localized using a radiographically guided , 3-dimensional , computer-assisted device . The feedback group was treated after locating the point of maximum tenderness through palpation by the therapist with feedback from the patient . Results Both groups had significant improvements in the Constant and Murley score and the visual analog scale after 12 weeks . The results from the navigation group were statistically significantly superior to those of the feedback group . In the navigation group , 6 calcium deposits disappeared and 9 altered , compared to 1 disappearance and 12 alterations in the feedback group . No severe complications occurred . Conclusion Three-dimensional , computer-assisted navigation reveals significantly better results and is therefore recommended when extracorporeal shock wave therapy is used in the treatment of calcific tendinitis of the rotator cuff Objective : To compare the effectiveness of different energy densities of extracorporeal shock wave therapy ( ESWT ) for managing chronic heel pain . Design : A r and omized clinical trial . Setting : Hospital-based practice . Subjects : Fifty-seven patients with chronic heel pain were recruited ; eight patients withdrew from the study . Interventions : Subjects were r and omized into three groups receiving : ( 1 ) a ‘ fixed ’ energy density , ( 2 ) ‘ maximum tolerable ’ energy density , or ( 3 ) control treatment once a week for three weeks . Outcome measures : Pain on palpation , pain on tension , maximum tolerable walking/st and ing duration and Foot Function Index were assessed before treatment in each treatment session and at the three-week follow-up . Results : By week 3 , the ‘ maximum tolerable ’ energy density group experienced a 66 % cumulative reduction in pain from tension , a 65 % reduction on palpation and a 112 % cumulative increase in maximum tolerable walking/st and ing duration . The ‘ fixed ’ energy density group experienced a 45 % cumulative reduction in pain from tension , a 32 % reduction in pain on palpation , and a 45 % increase in walking/st and ing tolerance . The ‘ maximum tolerable ’ energy density group also showed a significantly greater reduction in Foot Function Index scores than the other two groups . Therapeutic effects were maintained at least up to the three-week follow-up period . The control group had no significant changes in any outcome measures across time periods . Conclusion : The delivery of ESWT with a maximum tolerable energy density is a more effective treatment protocol than a fixed energy density in terms of relieving pain and restoring the functional activity of people suffering from chronic heel pain . The analgesic effects were maintained at least up to the three-week follow-up We have performed a double-blind placebo-controlled trial of moderate doses of extracorporeal shock-wave therapy ( ESWT ) for non-calcific tendonitis of the rotator cuff . Adults ( 74 ) with chronic tendonitis of the rotator cuff were r and omised to receive either active ( 1500 pulses ESWT at 0.12 mJ/mm2 ) or sham treatment , monthly for three months . All were assessed before each treatment , and at one and three months after the completion of treatment . The outcome was measured with regard to pain in the shoulder , including a visual analogue score for night pain , and a disability index . There were no significant differences between the two groups before treatment . The mean duration of symptoms in both groups was 23.3 months . Both showed significant and sustained improvements from two months onwards . There was no significant difference between them with respect to change in the Shoulder Pain and Disability Index ( SPADI ) scores or night pain over the six-month period . A mean ( + /-SD ; range ) change in SPADI of 16.1 + /- 27.2 ( 0 to 82 ) in the treatment group and 24.3 + /- 24.8 ( -11 to 83 ) in the sham group was noted at three months . At six months the mean changes were 28.4 + /- 25.9 ( -24 to 69 ) and 30.4 + /- 31.2 ( -12 to 88 ) , respectively . Similar results were noted for night pain . We conclude that there is a significant and sustained placebo effect after moderate doses of ESWT in patients with non-calcific tendonitis of the rotator cuff , but there is no evidence of added benefit when compared with sham treatment UNLABELLED The aim of a prospect i ve study was to examine the effects of high energetic shock wave treatment on the course of calcareous tendinitis of the shoulder . 20 patients were entered into the study .  Shock waves were applied to the calcifications with a Lithotripter MFL 5000 in two sessions of 2000 impulses each . The shock wave producing energy was 18 kV-22 kV. 6 and 12 weeks after treatment subjective and functional condition was checked by means of a 100-points functional score ; all patients underwent x-ray control and MRI imaging . RESULTS After 12 weeks 14 patients showed a marked improvement of symptoms , the average improvement on score measuring 25 points . The x-rays of 7 patients showed a complete resorption of the calcifications , in 5 cases partial disintegration of the calcium deposits was seen . The overall morbidity was low with 14 patients developing transient hematomas ; MRI imaging showed no severe damages of bone and soft tissue Arm , neck and /or shoulder complaints are common in western societies . In the Netherl and s , general practice guidelines are issued on shoulder pain and epicondylitis only . Little is known about actual management of the total range of diagnoses . The objectives of the study are : to determine management in patients consulting the GP with a new episode of non-traumatic arm neck and shoulder complaints up to 6 months after the first consultation . To evaluate differences in management between patients with specific diagnoses versus non-specific diagnoses and between specific diagnostic groups . In a prospect i ve cohort study in general practice . We recruited 682 eligible patients .  Data on diagnosis , management , patient- and complaint-characteristics were collected . Co-occurrence of treatment options was presented in scaled rectangles . After 6 months , additional diagnostic tests had been performed in 18 % of the patients , mainly radiographic examination ( 14 % ) . Further , 49 % had been referred for physiotherapy and 12 % to the medical specialist . Patients with specific diagnoses were more frequently referred for specialist treatment , and patients with non-specific diagnoses for physiotherapy . Corticosteroid injections ( 17 % ) were mainly applied specific diagnoses ( e.g. impingement syndrome , frozen shoulder , carpal tunnel and M. Quervain ) . Frequencies of prescribed medication ( 51 % ) did not differ between specific and non-specific diagnoses . In 19 % of the patients no referral , prescribed analgesics or injection  was applied .  Braces  ( 4 % ) were mainly prescribed in epicondylitis . Overall , management most frequently consisted of prescribed analgesics and referral for physiotherapy . Specific and non-specific diagnostic subgroups differed in the frequency corticosteroid injections were applied , and referrals to physiotherapy and to a medical specialist We report a prospect i ve study of the effects of extracorporeal shock-wave therapy in 195 patients with chronic calcifying tendinitis . In part A 80 patients with chronic symptoms were r and omly assigned to a control and three subgroups which had different treatment by  low-energy and high-energy shock waves . In part B 115 patients had either one or two high-energy sessions .  We recorded subjective , functional and radiological findings at six months after treatment . The results showed energy-dependent success , with relief of pain ranging from 5 % in our control group up to 58 % after two high-energy sessions . The Constant scores and the radiological disintegration of calcification were also dose-dependent . Shockwave therapy should be considered for chronic pain due to calcific tendinitis which is resistant to conservative treatment A prospect i ve , controlled , r and omised trial was performed to compare the effect of high-energy extracorporeal shock wave therapy ( ESWT ) versus low-energy ESWT in treatment of rotator cuff tendinopathy . Forty adult patients were included in the study . Patients in the intervention group 
    Output:
    
For calcific RC-tendinosis , strong evidence was found for effectiveness in favour of high-ESWT versus low-ESWT in short-term .
Moderate evidence was found in favour of high-ESWT versus placebo in short- , mid- and long-term and versus low-ESWT in mid- and long-term .
Moreover , high-ESWT was more effective ( moderate evidence ) with focus on calcific deposit versus focus on tuberculum major in short- and long-term .
RSWT was more effective ( moderate evidence ) than placebo in mid-term .
For non-calcific RC-tendinosis , no strong or moderate evidence was found in favour of low- , mid- or high-ESWT versus placebo , each other , or other treatments .
This review shows that only high-ESWT is effective for treating calcific RC-tendinosis .
No evidence was found for the effectiveness of ESWT to treat non-calcific RC-tendinosis