eng Oriental Scientific Publishing Company Biomedical and Pharmacology Journal 0974-6242 2025-03-31 18 1 849 866 10.13005/bpj/3134 63708 article Nithyanisha Ranjithkumar 1 Jibi Paul 1 Jagatheesan Alagesan 2 Rajalaxmi Viswanathan 1 Faculty of physiotherapy, Dr. M. G. R Educational and Research Institute, Velappanchavadi, Chennai, Tamil nadu, India School of Paramedical Allied and healthcare sciences, Mohan Babu University, Tirupati, India Rotator cuff tendinopathy (RCT), often known as tendinitis, is an inflammation or degeneration of the shoulder's rotator cuff tendons caused by a combination of internal and environmental factors. Topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs), extracorporeal short-wave therapy (ESWT), and corticosteroid injections, along with ultrasound (US), have been evaluated in randomized controlled trials (RCTs). Patients and physicians often favor low-level laser therapy (LLLT), ultrasound therapy (UST), and ESWT for RCTs due to their non-invasive nature and reduced risk of side effects. Few studies have shown that ESWT, UST, and LLLT reduce post-treatment discomfort. The extent to which these treatment modalities into exercise yield benefits has yet to be well understood, even though combining therapies to maximize effectiveness is presumably common in clinical practice. Furthermore, the effectiveness of these three treatments has been substantiated by increasing clinical trials. Typically, the UST, LLLT, or the ESWT is chosen on a case-by-case basis due to their comparable capabilities. However, there currently needs to be an agreement on which therapy strategy is more effective. Our study aims to evaluate and compare these treatments with standard dynamic rotator cuff loading exercises to determine their effectiveness and identify the optimal approach for managing rotator cuff tears. Group A received low-energy ESWT (0.2mJ/mm²) twice weekly for 4 weeks with dynamic rotator cuff loading exercises. Group B underwent LLLT with dynamic loading exercises. Group C had UST with dynamic rotator cuff loading exercises. CMS scores improved over four weeks post-intervention for all groups. Group A's scores increased from 65.8 ± 5.8 to 71.3 ± 4.2, Group B’s from 66.2 ± 6.2 to 70.4 ± 4.4, and Group C’s from 66.9 ± 5.6 to 70.6 ± 4.5 (p > 0.05). ANOVA post-test values revealed significant differences for Group A exhibiting improved muscle thickness by 20%, SPADI scores from 55 ± 4 to 30 ± 3, and reduced serum cortisol levels by 25%. Post hoc tests confirmed that ESWT was significantly more effective, with improvements in ultra-sonographic findings, pain reduction (from 7 ± 1 to 3 ± 0.5), shoulder function, and reduced serum cortisol levels (from 10.5 ± 1.2 to 7.8 ± 1.0 µg/dL). Over four weeks post-intervention, Group A showed the most improvement in Constant and Murley Scale (CMS) scores, increasing from 65.8 ± 5.8 to 71.3 ± 4.2. Groups B and C also improved but to a lesser extent. Group A's Numerical rating scale (NRS) scores progressively decreased to 2.5 ± 0.65 by week 4. Group B also showed notable improvement, from 4.8 ± 0.6 at baseline to 3.2 ± 0.92 at week 4. Group C experienced the least improvement, with NRS scores decreasing from 4.8 ± 0.8 to 3.7 ± 1.00 over the same period, thus displaying Group A as more effective improvement in shoulder function with less pain over the study period. https://biomedpharmajournal.org/vol18no1/comparative-effectiveness-of-extracorporeal-short-wave-therapy-low-level-laser-therapy-and-ultrasound-in-the-treatment-of-rotator-cuff-tendinopathy/ Dynamic Rotator Cuff Loading Exercises Extracorporeal Shock Wave Therapy (ESWT) Low-Level Laser Therapy (LLLT) RCT Shoulder Pain Management Ultrasound Therapy (UST)