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
- 1.1k Downloads
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.
KeywordsCalcific 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.
This article does not contain any studies with human participants performed by any of the authors.
- 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
- 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.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
- 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
- 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
- 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.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.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
- 28.Palmer TMPJ, Sutton AJ, Moreno SG (2008) Contour-enhanced funnel plots in meta-analysis. STATA J 8(2):242–254Google Scholar
- 30.Re LP Jr, Karzel RP (1993) Management of rotator cuff calcifications. Orthop Clin N Am 24(1):125–132Google Scholar
- 34.Rowe CR (1988) Injection technique for the shoulder and elbow. Orthop Clin N Am 19(4):773–777Google Scholar
- 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
- 40.StataCorp (2014) Stata 14 base reference manual. Stata Press, College StationGoogle Scholar