Review ArticleEvidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis
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.
References (62)
- et al.
Percutaneous ultrasound-guided treatment of shoulder tendon calcifications: clinical and radiological follow-up at 6 months
J Ultrasound
(2010) - et al.
Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder
J Shoulder Elbow Surg
(2008) - et al.
Evidence for effectiveness of extracorporal shock-wave therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis–a systematic review
Man Ther
(2011) - et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials
(1996) - et al.
The midterm effectiveness of extracorporeal shockwave therapy in the management of chronic calcific shoulder tendinitis
J Shoulder Elbow Surg
(2011) - et al.
Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study
Arch Phys Med Rehabil
(2003) - et al.
Efficacy of extracorporal shock-wave treatment for calcific tendinitis of the shoulder: experimental and clinical results
J Orthop Sci
(2003) - et al.
Shoulder function after extracorporal shock wave therapy for calcific tendinitis
J Shoulder Elbow Surg
(1998) - et al.
Balneotherapy and quality assessment: interobserver reliability of the Maastricht criteria list and the need for blinded quality assessment
J Clin Epidemiol
(1998) - et al.
Effect sizes can be calculated for studies reporting ranges for outcome variables in systematic reviews
J Clin Epidemiol
(2007)
Calcific shoulder tendinitis: treatment with modified US-guided fine-needle technique
Radiology
High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial
J Bone Joint Surg Br
Shoulder. Ultrasound of the musculoskeletal system
Calcium deposits in the shoulder and subacromial bursitis: a survey of 12,122 shoulders
JAMA
Shock wave therapy for lateral elbow pain
Cochrane Database Syst Rev
Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study
Phys Ther
Barbotage of the shoulder with image-intensified fluoroscopic control of needle placement for calcific tendinitis
Clin Orthop Relat Res
Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study
Ann Rheum Dis
Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results
AJR Am J Roentgenol
Extracorporeal shockwave therapy (ESWT) in tendinosis calcarea of the rotator cuff. Long-term results and efficacy
Orthopade
Calcific tendinitis of the shoulder
Der Orthopade
Ultrasound therapy for calcific tendinitis of the shoulder
N Engl J Med
Rotator cuff calcifications: treatment with ultrasound-guided percutaneous needle aspiration and lavage
Skeletal Radiol
Extracorporeal shockwave therapy in calcifying tendinitis of the shoulder
Knee Surg Sports Traumatol Arthrosc
Analysis of calcific deposits in calcifying tendinitis
Clin Orthop Relat Res
Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial
JAMA
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
BMJ
Exact focusing of extracorporeal shock wave therapy for calcifying tendinopathy
Clin Orthop Relat Res
Assessment of the treatment costs of extracorporeal shock wave therapy versus surgical treatment for shoulder diseases
Int J Technol Assess Health Care
Neue aspekte zur morphologie und therapie der tendinosis calcarea der schultergelenke
Arthroskopie
Extracorporeal shock wave therapy in chronic calcific tendonitis of the shoulder– is it effective?
Acta Orthop Belgica
Cited by (58)
Combined extracorporeal shockwave therapy and exercise for the treatment of tendinopathy: A narrative review
2022, Sports Medicine and Health ScienceThe Impact of Minimally Invasive Treatment for Rotator Cuff Calcific Tendinitis on Self-Reported Work Ability and Sick Leave
2020, Arthroscopy, Sports Medicine, and RehabilitationComparing Ultrasound-Guided Needling Combined With a Subacromial Corticosteroid Injection Versus High-Energy Extracorporeal Shockwave Therapy for Calcific Tendinitis of the Rotator Cuff: A Randomized Controlled Trial
2020, Arthroscopy - Journal of Arthroscopic and Related Surgery
Investigational Review Board approval was not required for this study.