Review Article
Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis

https://doi.org/10.1016/j.jse.2014.02.002Get rights and content

Background

This meta-analysis assessed the short-term to midterm effectiveness of minimally invasive treatments in the management of calcifying tendinopathy of the shoulder cuff, a common source of chronic shoulder pain that leads to pain, a decreased active range of motion, and loss of muscular strength. When conservative therapies fail, minimally invasive treatment options can be considered before resulting to surgery.

Materials and methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this review. A systematic literature search was conducted in May 2013 to identify all studies that examined the short-term to midterm effectiveness of minimally invasive treatments for chronic calcifying tendinopathy. The primary end points were identified as function, pain, and total resorption rates. Grades of Recommendation Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence.

Results

Included were 20 studies (1544 participants). Common methodological flaws were related to randomization. In general, there is moderate-quality GRADE evidence that high-energy extracorporeal shockwave therapy has a significant effect on pain relief and functional status compared with other interventions. There is variable-quality GRADE evidence on the efficiency of other interventions.

Conclusion

High-energy extracorporeal shockwave therapy is the most thoroughly investigated minimally invasive treatment option in the short-term to midterm and has proven to be a safe and effective treatment. Ultrasound-guided needling is safe but has not been proven to be more effective than an ultrasound-guided subacromial corticosteroid injection in recent level I research, and further research will have to prove its effectiveness.

Section snippets

Studies

The literature search performed for this review was limited to published original randomized (RCT), quasi-randomized controlled (qRCT), and controlled clinical trials (CCT) concerning the minimally invasive treatment of chronic calcifying tendinopathy of the rotator cuff with at least 3 months of follow-up.

Participants

Inclusion was limited to articles reporting results for patients older than 18 years with symptoms of calcific tendinopathy of the rotator cuff for more than 6 months who did not respond to

Search results

The search of Medline, Embase, CINAHL, PubMed, Cochrane, PEDro, and SPORTDiscus databases provided 772 citations. The search was performed on May 25, 2013, with a final search update on August 24, 2013. After adjusting for duplicates, 306 studies remained, and after reviewing the abstracts, 254 studies were discarded for not meeting the inclusion criteria. The full text of the remaining 52 studies was examined in more detail, and we identified 20 studies for inclusion in the review.2, 6, 9, 15,

Discussion

The objective of this systematic review was to assess the effectiveness of different minimally invasive treatment modalities for patients with chronic calcifying tendinopathy after a short-term to midterm follow-up. This review was primarily focused on functional outcome and secondarily on the change in pain and resorption of the calcific deposit. The quantitative analysis provided moderate-quality GRADE evidence that high-energy ESWT is superior to low-energy ESWT and to no treatment or sham

Conclusions

High-energy ESWT is the most thoroughly investigated minimally invasive treatment option in the short-term to midterm, and SWT has proven to be a safe and effective treatment. With regard to the other treatment options, ultrasound-guided needling has proven to be safe but not proven to be more effective than an ultrasound-guided subacromial corticosteroid injection in recent level I research. In theory, this technique directly addresses the source of pain by removing as much intratendinous

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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