Effect of Adding Extracorporeal Shock Wave Therapy to Exercises in Rotator Cuff Tendinopathy

Inclusion Criteria: * Medically stable individuals who consent to participate in the study. * Male and female participants aged between 30 and 55 years. * Diagnosed with rotator cuff tendinopathy, confirmed clinically and by ultrasound or MRI. * Duration of symptoms greater than 3 months. * Supraspinatus tendon thickness \> 5.85 mm as measured by ultrasound (based on Hunter et al., 2021). * Able to follow the treatment plan and attend all therapy sessions. Exclusion Criteria: * Massive rotator cuff tear or complete tendon rupture. * Adhesive capsulitis or significant limitation of passive shoulder motion. * History of shoulder fracture, dislocation, or surgery in the affected limb. * Rheumatoid arthritis, diabetes mellitus, or systemic inflammatory disease. * Cervical radiculopathy or neurological involvement affecting the shoulder. * Corticosteroid injection in the affected shoulder within the last 6 months. * Pregnancy or breastfeeding. * BMI \> 30 kg/m² (obese individuals excluded). * Current malignancy, open wounds, or local infection at the treatment site. * Inability to tolerate shock wave therapy or perform exercise sessions.