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European Journal of Orthopaedic Surgery & Traumatology

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01-04-2017 | Original Article • SHOULDER - SPORT

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

Authors: Alisara Arirachakaran, Manusuk Boonard, Sarunpong Yamaphai, Akom Prommahachai, Suraphol Kesprayura, Jatupon Kongtharvonskul

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 3/2017

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.

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 PubMedCrossRef

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 PubMedCrossRef

Altman DG, Bland JM (2003) Interaction revisited: the difference between two estimates. BMJ 326(7382):219PubMedPubMedCentralCrossRef

Ark JW, Flock TJ, Flatow EL, Bigliani LU (1992) Arthroscopic treatment of calcific tendinitis of the shoulder. Arthroscopy 8(2):183–188PubMedCrossRef

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):672–682PubMed

Comfort TH, Arafiles RP (1978) Barbotage of the shoulder with image-intensified fluoroscopic control of needle placement for calcific tendinitis. Clin Orthop Relat Res 135:171–178

Conboy VB, Morris RW, Kiss J, Carr AJ (1996) An evaluation of the Constant–Murley shoulder assessment. J Bone Joint Surg Br 78(2):229–232PubMed

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):248–250PubMedPubMedCentralCrossRef

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 PubMedCrossRef

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):145–151PubMed

11.

Depalma AF, Kruper JS (1961) Long-term study of shoulder joints afflicted with and treated for calcific tendinitis. Clin Orthop 20:61–72PubMed

12.

Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634PubMedPubMedCentralCrossRef

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 PubMedCrossRef

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 PubMedCrossRef

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 PubMedCrossRef

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 PubMedCrossRef

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 PubMedCrossRef

18.

Hurt G, Baker CL Jr (2003) Calcific tendinitis of the shoulder. Orthop Clin N Am 34(4):567–575CrossRef

19.

Jacobs R, Debeer P (2006) Calcifying tendinitis of the rotator cuff: functional outcome after arthroscopic treatment. Acta Orthop Belg 72(3):276–281PubMed

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 PubMedCrossRef

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 PubMedCrossRef

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 PubMedPubMedCentralCrossRef

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 PubMedCrossRef

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 PubMed

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 PubMedCrossRef

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):532–541PubMed

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 PubMedCrossRef

28.

Palmer TMPJ, Sutton AJ, Moreno SG (2008) Contour-enhanced funnel plots in meta-analysis. STATA J 8(2):242–254

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):991–996PubMedCrossRef

30.

Re LP Jr, Karzel RP (1993) Management of rotator cuff calcifications. Orthop Clin N Am 24(1):125–132

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 PubMedPubMedCentralCrossRef

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):505–509PubMedCrossRef

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 387:72–82CrossRef

34.

Rowe CR (1988) Injection technique for the shoulder and elbow. Orthop Clin N Am 19(4):773–777

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 PubMedCrossRef

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 PubMedCrossRef

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 PubMedPubMedCentralCrossRef

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 PubMedCrossRef

39.

Speed CA, Hazleman BL (1999) Calcific tendinitis of the shoulder. N Engl J Med 340(20):1582–1584. doi:10.1056/nejm199905203402011 PubMedCrossRef

40.

StataCorp (2014) Stata 14 base reference manual. Stata Press, College Station

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 PubMedCrossRef

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):425–430PubMed

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 PubMedCrossRef

Title: 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
Authors: Alisara Arirachakaran
Manusuk Boonard
Sarunpong Yamaphai
Akom Prommahachai
Suraphol Kesprayura
Jatupon Kongtharvonskul
Publication date: 01-04-2017
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 3/2017
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-016-1839-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstracts

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstracts

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