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The patients were divided into two groups. All patients underwent 5 sessions of ESWT during each seven-day interval. One group received ESWT according to the fascial manipulation theory (ESWT-FM) and the other had local ESWT(L-ESWT)only.ASwissDolorClastradialshockwave device (EMS Electro Medical Systems, Nyon, Switzerland) with pressure in the range of 1.5 to 2.5 bars was employed at 0.08 to 0.28mJ/mm2 and 10 to 13Hz frequency. In the case of the L-ESWT group, the two chosen local tender treatment points were the anterior shoulder joint, with the
superioredgeofthepainfultreatmentareabeingjustlateral to the coracoid process, and an area that was 1cm proximal to the tendon attachment to bone. For those in the ESWTFM group, FM guidelines were followed to choose centers of coordination points based on the physical examination, in addition to the two local tender treatment points [15]. The horizontal plane was often chosen, and the treatment points were at the lower section of the intrarotator muscle insertions at the humerus (IR-Hu); below the elbow crease at pronator teres, for the point with highest sensitivity (IRCU); at trapezius, immediately above the superior angle of the scapula (ER-SC); and at the posterior aspect of the rotatorcuff(ER-HU),laterallytotricepstendon,inthefascia and lateral septum (ER-CU) [16]. Approximately 450 to 500 shockswereappliedateverytreatmentpoint,accordingtothe patient’stolerance.Duringthe5-weektreatmentperiod,local electrotherapy was administered to all patients as the standard and baseline treatment, consisting of ultra-short-wave therapy,intermediatefrequencyelectrotherapy,orultrasonic therapy.