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3	Shock-wave therapy (ESWT), as used for various recently-introduced treatments, performed in specialist centres, is often misinterpreted an incorrect diagnosis a certain lack of awareness by general practitioners or specialists on this type of therapy our decision to treat similar pathologies with less expensive and more available therapies
4	STUDY DESIGN We have performed a systematic review of our clinical cases evaluated over a one-year period We reported all referrals in our ESWT out-patient service to the Azienda Ospedaliera of Lodi throughout 2007
5	Tendinopathy referrals
6	Bone and other pathology referrals
7	Case-history and previous therapies
8	Correct and incorrect diagnosis
9	Incorrect referrals
10	Tendinopathies (correct diagnosis) with or without ESWT
11	ESWT as first choice or after other therapies
12	Effect of other therapies
13	ESWT performed in relation to total referrals
14	Reflections Soft tissue pathologies make up more than 90% of ESWT requests Shoulder tendinopathy is the most frequent complaint, followed by plantar fasciitis and elbow lateral epicondylitis The most frequent incorrect referrals are vascular pathology, arthropathy, neuropathy and tendon lesions
15	Discussion The specialist who perfoms ESWT is responsible for this treatment. As a result, in order avoid possible legal complications, physicians who perform ESWT should be extremely careful about incorrect diagnosis increase of costs lack of results discrediting the ESWT
16	Conclusions We noted that ESWT was all too often proposed as initial treatment (33,7%) and, in a large number of cases,we found discrepancies with the real clinical situation of the patients ESWT was used on far fewer cases than initially brought to our attention In the end only half of the examined patients (51,4%) were treated with ESWT
17	Future perspectives We intend to organise awareness-raising activities among GPs and specialists We wish to work in agreement to ISMST and National Societies on clinical indications to promote strict guidelines regarding the treatment of various pathologies evaluation and qualification criteria for operators
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