SummaryExtracorporeal Shock Wave Therapy (ESWT) refers to the clinical use of shock waves for orthopaedic applications. ESWT developed form studies on the possible side effects of Extracorporeal Shock Wave Lithotripsy (ESWL) on the spine and pelvis. These studies attracted the interest of orthopaedic surgeons, and eventually led to wide scale research and use of ESWT as an alternative to surgery.Shock wave generators are:(1) Electrohydraulic system.(2) Electromagnetic system.(3) Piezo-electric system.Target tissue localization is divided into:(1) Fluoroscopic localization.(2) Ultrasound localization.(3) Combined ultrasound and fluoroscopic localization.Several manufacturers have developed devices specifically for bone and contiguous soft tissue applications. Three of which are the Ossatron, the Epos, and the Sonocur.For every orthopaedic indication, there are specific number of shock wave pulses, specific energy flux density, specific duration of exposure, and specific number of cessions.Treatment can be done on an outpatient basis, and is usually performed without or under consumption of little anaesthetic drugs.The exact mechanism of action of ESWT on human tissues is still unclear. Several theories were done to explain it:(1) Theory of acoustic impedance.(2) Theory of cavitation.(3) Theory of revascularization.(4) Theory of microtrauma.(5) Theory of hyperstimulation analgesia.Indications are:(1) Delayed unions and non-unions.(2) Lateral epicondylitis of the elbow (tennis elbow).(3) Calcifying tendonitis of the shoulder.(4) Painful heel and chronic plantar fasciitis.(5) Femoral head necrosis in adults.Approximately ? of patients have some discomfort at the treatment site. Others adverse effects of ESWT are very rare, including swelling, ecchymosis, local reddening, and hematoma that resolve spontaneously after 48 hours.Unsuitable patients are:(1) Local arthrosis, arthritis, or rheumatoid arthritis.(2) Pathological neurological findings.(3) Pregnancy.(4) Patients less than 18 years of age.(5) Coagulopathy or anticoagulant therapy.(6) Thyrotoxicosis.(7) Tumours.Most, or nearly all, clinical work and scientific papers reported that success rates for ESWT are good to excellent. ESWT is considered to be an alternative or even superior, to surgery because of safety, noninvasiveness, and high success rates.