Eighty-six patients with calcific tendinitis of the rotator cuff were randomized to receive 4 sessions of extracorporeal shockwave therapy (ESWT) or 1 session of ultrasound (US) guided needling. Outcomes of interest included pain on a Visual Analog Scale (VAS), Constant Murley Scores (CMS), Disability of the Arm, Shoulder and Hand (DASH) score, change in symptoms, and the magnitude of calcific deposit resorption. Outcomes were assessed up to 1 year post-treatment. No significant differences in the change from baseline in DASH scores, CMS, or VAS pain scores were observed between the 2 groups at all time-points. Yet, one exception included DASH scores at 6 weeks where the ESWT group demonstrated significantly greater improvement. The magnitude of calcific deposit resorption was significantly greater in the US-guided needling group compared to the ESWT group. No significant differences in the change in symptoms were observed between the EWST and US-guided needling treatment arms.