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Are blood-thinners a contraindication to shockwave therapy?

I have a client who is interested in shockwave therapy for his left shoulder. He’s got pain and limited range of motion and a recent ultrasound showed calcifications of the supraspinatus and subscapularis tendons. He is on a blood-thinner (xarelto 20 mg) which he takes once a day (at the end of the day). He also has a history of Atrial fibrillation.

If you have any comments on whether or not 1) I can use shockwave therapy on him (i.e. are all blood-thinners absolute contraindications?), and 2) if I need to modify my settings for use, that would be greatly appreciated.

Michelle Reilly

5 months ago

Back to General Electrotherapy

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Cliff Eaton
Cliff Eaton

Dear Michelle if you look on the ISMST and DIGEST websites these international scientific advisory bodies do not contraindicate blood thinners for low energy Focused or Radial shockwave (RPW) I know of some manufacturers contraindicate strong anti co-coagulants like Heparin and Warfarin. This is due to them having to demonstrate their machines will not cause harm, hence easier for them to state blanket contraindications In a recent discussion I had with prof Time Watson on the subject we agreed that this type of medication warrants caution by the clinician and should be considered on a case by case basis As you are treating a tendon, in this case, which is not a highly vascular structure this may influence your clinical decision making Cliff

Prof Gad Alon
Prof Gad Alon
  1. Abate, M., C. Schiavone, and V. Salini, Usefulness of rehabilitation in patients with rotator cuff calcific tendinopathy after ultrasound-guided percutaneous treatment. Med Princ Pract, 2015. 24(1): p. 23-9.
  2. Ataoglu, M.B., et al., The high frequency of superior labrum, biceps tendon, and superior rotator cuff pathologies in patients with subscapularis tears: A cohort study. J Orthop Sci, 2018. 23(2): p. 304-309.
  3. Kang, Y., et al., Instability of the long head of the biceps tendon in patients with rotator cuff tear: evaluation on magnetic resonance arthrography of the shoulder with arthroscopic correlation. Skeletal Radiol, 2017. 46(10): p. 1335-1342.
  4. Leeman, J.J., et al., Extracorporeal shockwave therapy and therapeutic exercise for supraspinatus and biceps tendinopathies in 29 dogs. Vet Rec, 2016. 179(15): p. 385.

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