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Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs

  • Alisara Arirachakaran
  • Manusuk Boonard
  • Sarunpong Yamaphai
  • Akom Prommahachai
  • Suraphol Kesprayura
  • Jatupon Kongtharvonskul
Original Article • SHOULDER - SPORT

Abstracts

Treatment of calcific tendinitis using extracorporeal shock wave therapy (ESWT), ultrasound-guided percutaneous lavage (UGPL or barbotage), subacromial corticosteroid injection (SAI) and combined treatment is still controversial. This systematic review and meta-regression aimed to compare clinical outcomes between treatments. Relevant RCTs were identified using PubMed and Scopus search engines to date of September 23, 2015. Seven of 920 studies identified were eligible. Compared to the other treatments, the results of this study indicate that ESWT significantly improved CMS and VAS when compared to placebo. Barbotage plus ESWT significantly improved CMS, VAS and decreased size of calcium deposit when compared to ESWT, while barbotage plus SAI significantly improved CMS and decreased size of calcium deposit when compared to SAI. There have no different adverse effects of all treatment groups. Multiple active treatment comparisons indicated that barbotage plus SAI significantly improved VAS and size of calcium deposit when compared to other groups, while barbotage plus SAI improved CMS when compared to other groups. But there was no significant difference. The network meta-analysis suggested that combined US-guided needling and subacromial corticosteroid injection significantly decreased shoulder pain VAS, improved CMS score and decreased the size of calcium deposits, while also lowering risks of adverse event when compared to barbotage plus ESWT, ESWT and subacromial corticosteroid injection; therefore, the evidence points to UGPL as being the treatment of choice for nonsurgical options of treatment in calcific tendinitis of the shoulder.

Level of evidence I.

Keywords

Calcific tendinitis ESWT UGPL CS Ultrasound guide Extracorporeal shock wave therapy 

Notes

Acknowledgments

All authors declare no funding source or sponsor involvement in the study design, collection, analysis and interpretation of the data, in writing the manuscript and in submission of the manuscript for publication.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interests.

Ethical standards

This article does not contain any studies with human participants performed by any of the authors.

References

  1. 1.
    Aina R, Cardinal E, Bureau NJ, Aubin B, Brassard P (2001) Calcific shoulder tendinitis: treatment with modified US-guided fine-needle technique. Radiology 221(2):455–461. doi: 10.1148/radiol.2212000830 PubMedCrossRefGoogle Scholar
  2. 2.
    Albert JD, Meadeb J, Guggenbuhl P, Marin F, Benkalfate T, Thomazeau H, Chales G (2007) High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial. J Bone Joint Surg Br 89(3):335–341. doi: 10.1302/0301-620x.89b3.18249 PubMedCrossRefGoogle Scholar
  3. 3.
    Altman DG, Bland JM (2003) Interaction revisited: the difference between two estimates. BMJ 326(7382):219PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Ark JW, Flock TJ, Flatow EL, Bigliani LU (1992) Arthroscopic treatment of calcific tendinitis of the shoulder. Arthroscopy 8(2):183–188PubMedCrossRefGoogle Scholar
  5. 5.
    Cacchio A, Paoloni M, Barile A, Don R, de Paulis F, Calvisi V, Ranavolo A, Frascarelli M, Santilli V, Spacca G (2006) Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther 86(5):672–682PubMedGoogle Scholar
  6. 6.
    Comfort TH, Arafiles RP (1978) Barbotage of the shoulder with image-intensified fluoroscopic control of needle placement for calcific tendinitis. Clin Orthop Relat Res 135:171–178Google Scholar
  7. 7.
    Conboy VB, Morris RW, Kiss J, Carr AJ (1996) An evaluation of the Constant–Murley shoulder assessment. J Bone Joint Surg Br 78(2):229–232PubMedGoogle Scholar
  8. 8.
    Cosentino R, De Stefano R, Selvi E, Frati E, Manca S, Frediani B, Marcolongo R (2003) Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study. Ann Rheum Dis 62(3):248–250PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    de Witte PB, Selten JW, Navas A, Nagels J, Visser CP, Nelissen RG, Reijnierse M (2013) Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med 41(7):1665–1673. doi: 10.1177/0363546513487066 PubMedCrossRefGoogle Scholar
  10. 10.
    Del Castillo-Gonzalez F, Ramos-Alvarez JJ, Rodriguez-Fabian G, Gonzalez-Perez J, Jimenez-Herranz E, Varela E (2016) Extracorporeal shockwaves versus ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a randomised controlled trial. Eur J Phys Rehabil Med 52(2):145–151PubMedGoogle Scholar
  11. 11.
    Depalma AF, Kruper JS (1961) Long-term study of shoulder joints afflicted with and treated for calcific tendinitis. Clin Orthop 20:61–72PubMedGoogle Scholar
  12. 12.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Gerdesmeyer L, Wagenpfeil S, Haake M, Maier M, Loew M, Wortler K, Lampe R, Seil R, Handle G, Gassel S, Rompe JD (2003) Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA 290(19):2573–2580. doi: 10.1001/jama.290.19.2573 PubMedCrossRefGoogle Scholar
  14. 14.
    Harniman E, Carette S, Kennedy C, Beaton D (2004) Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review. J Hand Ther 17(2):132–151. doi: 10.1197/j.jht.2004.02.003 PubMedCrossRefGoogle Scholar
  15. 15.
    Harvie P, Pollard TC, Carr AJ (2007) Calcific tendinitis: natural history and association with endocrine disorders. J Shoulder Elbow Surg 16(2):169–173. doi: 10.1016/j.jse.2006.06.007 PubMedCrossRefGoogle Scholar
  16. 16.
    Hirschmann MT, Wind B, Amsler F, Gross T (2010) Reliability of shoulder abduction strength measure for the Constant–Murley score. Clin Orthop Relat Res 468(6):1565–1571. doi: 10.1007/s11999-009-1007-3 PubMedCrossRefGoogle Scholar
  17. 17.
    Hsu CJ, Wang DY, Tseng KF, Fong YC, Hsu HC, Jim YF (2008) Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. J Shoulder Elbow Surg 17(1):55–59. doi: 10.1016/j.jse.2007.03.023 PubMedCrossRefGoogle Scholar
  18. 18.
    Hurt G, Baker CL Jr (2003) Calcific tendinitis of the shoulder. Orthop Clin N Am 34(4):567–575CrossRefGoogle Scholar
  19. 19.
    Jacobs R, Debeer P (2006) Calcifying tendinitis of the rotator cuff: functional outcome after arthroscopic treatment. Acta Orthop Belg 72(3):276–281PubMedGoogle Scholar
  20. 20.
    Kim YS, Lee HJ, Kim YV, Kong CG (2014) Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. J Shoulder Elbow Surg 23(11):1640–1646. doi: 10.1016/j.jse.2014.06.036 PubMedCrossRefGoogle Scholar
  21. 21.
    Krasny C, Enenkel M, Aigner N, Wlk M, Landsiedl F (2005) Ultrasound-guided needling combined with shock-wave therapy for the treatment of calcifying tendonitis of the shoulder. J Bone Joint Surg Br 87(4):501–507. doi: 10.1302/0301-620x.87b4.15769 PubMedCrossRefGoogle Scholar
  22. 22.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. doi: 10.1001371/journal.pmed.1000100 PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Louwerens JK, Sierevelt IN, van Noort A, van den Bekerom MP (2014) Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis. J Shoulder Elbow Surg 23(8):1240–1249. doi: 10.1016/j.jse.2014.02.002 PubMedCrossRefGoogle Scholar
  24. 24.
    Louwerens JK, Veltman ES, van Noort A, van den Bekerom MP (2015) The effectiveness of high-energy extracorporeal shockwave therapy versus ultrasound-guided needling versus arthroscopic surgery in the management of chronic calcific rotator cuff tendinopathy: a systematic review. Arthroscopy. doi: 10.1016/j.arthro.2015.06.049 PubMedGoogle Scholar
  25. 25.
    Lu G, Ades AE (2004) Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med 23(20):3105–3124. doi: 10.1002/sim.1875 PubMedCrossRefGoogle Scholar
  26. 26.
    Mole D, Kempf JF, Gleyze P, Rio B, Bonnomet F, Walch G (1993) [Results of endoscopic treatment of non-broken tendinopathies of the rotator cuff. 2. Calcifications of the rotator cuff]. Rev Chir Orthop Reparatrice Appar Mot 79(7):532–541PubMedGoogle Scholar
  27. 27.
    Mouzopoulos G, Stamatakos M, Mouzopoulos D, Tzurbakis M (2007) Extracorporeal shock wave treatment for shoulder calcific tendonitis: a systematic review. Skeletal Radiol 36(9):803–811. doi: 10.1007/s00256-007-0297-3 PubMedCrossRefGoogle Scholar
  28. 28.
    Palmer TMPJ, Sutton AJ, Moreno SG (2008) Contour-enhanced funnel plots in meta-analysis. STATA J 8(2):242–254Google Scholar
  29. 29.
    Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2008) Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol 61(10):991–996PubMedCrossRefGoogle Scholar
  30. 30.
    Re LP Jr, Karzel RP (1993) Management of rotator cuff calcifications. Orthop Clin N Am 24(1):125–132Google Scholar
  31. 31.
    Rebuzzi E, Coletti N, Schiavetti S, Giusto F (2008) Arthroscopy surgery versus shock wave therapy for chronic calcifying tendinitis of the shoulder. J Orthop Traumatol 9(4):179–185. doi: 10.1007/s10195-008-0024-4 PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Rompe JD, Burger R, Hopf C, Eysel P (1998) Shoulder function after extracorporal shock wave therapy for calcific tendinitis. J Shoulder Elbow Surg 7(5):505–509PubMedCrossRefGoogle Scholar
  33. 33.
    Rompe JD, Zoellner J, Nafe B (2001) Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder. Clin Orthop Relat Res 387:72–82CrossRefGoogle Scholar
  34. 34.
    Rowe CR (1988) Injection technique for the shoulder and elbow. Orthop Clin N Am 19(4):773–777Google Scholar
  35. 35.
    Seil R, Litzenburger H, Kohn D, Rupp S (2006) Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy 22(5):521–527. doi: 10.1016/j.arthro.2006.01.012 PubMedCrossRefGoogle Scholar
  36. 36.
    Serafini G, Sconfienza LM, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F (2009) Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment–nonrandomized controlled trial. Radiology 252(1):157–164. doi: 10.1148/radiol.2521081816 PubMedCrossRefGoogle Scholar
  37. 37.
    Song F, Altman DG, Glenny AM, Deeks JJ (2003) Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses. BMJ 326(7387):472. doi: 10.1136/bmj.326.7387.472 PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Song F, Harvey I, Lilford R (2008) Adjusted indirect comparison may be less biased than direct comparison for evaluating new pharmaceutical interventions. J Clin Epidemiol 61(5):455–463. doi: 10.1016/j.jclinepi.2007.06.006 PubMedCrossRefGoogle Scholar
  39. 39.
    Speed CA, Hazleman BL (1999) Calcific tendinitis of the shoulder. N Engl J Med 340(20):1582–1584. doi: 10.1056/nejm199905203402011 PubMedCrossRefGoogle Scholar
  40. 40.
    StataCorp (2014) Stata 14 base reference manual. Stata Press, College StationGoogle Scholar
  41. 41.
    Wainner RS, Hasz M (1998) Management of acute calcific tendinitis of the shoulder. J Orthop Sports Phys Ther 27(3):231–237. doi: 10.2519/jospt.1998.27.3.231 PubMedCrossRefGoogle Scholar
  42. 42.
    Wang CJ, Yang KD, Wang FS, Chen HH, Wang JW (2003) Shock wave therapy for calcific tendinitis of the shoulder: a prospective clinical study with two-year follow-up. Am J Sports Med 31(3):425–430PubMedGoogle Scholar
  43. 43.
    Yoo JC, Koh KH, Park WH, Park JC, Kim SM, Yoon YC (2010) The outcome of ultrasound-guided needle decompression and steroid injection in calcific tendinitis. J Shoulder Elbow Surg 19(4):596–600. doi: 10.1016/j.jse.2009.09.002 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  • Alisara Arirachakaran
    • 1
  • Manusuk Boonard
    • 2
  • Sarunpong Yamaphai
    • 3
  • Akom Prommahachai
    • 4
  • Suraphol Kesprayura
    • 1
  • Jatupon Kongtharvonskul
    • 5
  1. 1.Orthopedics DepartmentPolice General HospitalBangkokThailand
  2. 2.Orthopedics DepartmentSrinakarin HospitalKhonkanThailand
  3. 3.Orthopaedic DepartmentSaint Louis HospitalBangkokThailand
  4. 4.Orthopedic DepartmentAek Udon International HospitalUdontaniThailand
  5. 5.Section for Clinical Epidemiology and BiostatisticsFaculty of Medicine Ramathibodi HospitalBangkokThailand

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