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


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.


Calcific tendinitis ESWT UGPL CS Ultrasound guide Extracorporeal shock wave therapy 



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.


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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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