Technological change in general orthopaedics and its multiple subspecialisations is continual. These changes are regulated, to varying degrees, by delegated authorities within appropriately mandated concepts. One relatively recent technology, since approximately 1990, has been the revision of treating relatively deep seated urolithiasis, whether in the renal parenchyma or the ureter, to more superficial musculoskeletal indications. Although originally conceived to dissipate calcifications in rotator cuff tendinopathy and to alter osseous biology, the technology rapidly spread to other common disorders that affect the musculoskeletal system. Unfortunately many of these applications were not tested through appropriate randomised clinical trials or practical clinical trials, which could adequately assess clinical efficacy and significant modification of the natural history of a given musculoskeletal disorder. Such studies are obviously in demand by clinicians and healthcare provider organisations to justify the application of both a given treatment modality and the efficiency of a new drug or device to accomplish an end result that is personally satisfactory to the patient and doctor and economically justifiable to the healthcare insurer/provider. …