Extracorporeally generated shock waves were first used for kidney stone fragmentation in the early eighties. The treatment modality revolutionized urological stone management and developed into today's method of choice. Since the mid nineties shock waves are also used for several kinds of musculoskeletal applications such as tennis elbow, calcified shoulder, heel spur and nonunions. Analgesic effects as well as healing effects due to enhanced metabolism, circulation and revascularization are reported. Astonishingly, significant improvements up to complete reduction of pain even in chronic complaints and stable reunion of non-unions are gained. Using basically the same technology as for stone fragmentation, extracorporeal shock wave therapy (ESWT) stands for shock wave application in general, with a specific impact on orthopaedic indications, both, non-unions and tendopathies as well as others.