Comparing 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

Louwerens, Jan K. G.; Sierevelt, Inger N.; Kramer, Erik T.; Boonstra, Rob; Bekerom, Michel P.J. van den; Royen, Barend J. van; Eygendaal, Denise

doi:10.1016/j.arthro.2020.02.027

Cited by 36 publications

(50 citation statements)

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“…The study population consisted of patients included in a randomized clinical trial evaluating the effect of high-energy shockwave therapy and ultrasound-guided needling for calcific tendinitis of the rotator cuff. 23 The inclusion criteria for this study were as follows: age ≥ 18 years; clinical signs of subacromial pain syndrome for >4 months; standardized radiographs showing a calcific deposit with a diameter ≥5 mm in the rotator cuff; and completion of a nonsurgical treatment program that was unsuccessful, including nonsteroidal anti-inflammatory drugs, physiotherapy (centric and eccentric rotator cuff–strengthening exercises in combination with scapular stabilization), and subacromial infiltration with a corticosteroid.…”

Section: Methodsmentioning

confidence: 99%

Quantifying the minimal and substantial clinical benefit of the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand score in patients with calcific tendinitis of the rotator cuff

et al. 2020

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Background To aid the interpretation of clinical outcome scores, it is important to determine the measurement properties. The aim of this study was to establish the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the Constant-Murley score and Disabilities of the Arm, Shoulder and Hand score in patients with long-lasting rotator cuff calcific tendinitis treated with high-energy extracorporeal shockwave therapy and ultrasound guided needling. The secondary purpose was to assess the responsiveness of both questionnaires and to identify variables associated with achieving the MCID and SCB. Methods A prospective cohort of 80 patients with rotator cuff calcific tendinitis was analyzed. Two anchor-based methods were used to calculate the MCID and SCB. Effect sizes and standardized response means were calculated to assess the responsiveness. Additional univariate logistic regression analyses were performed to identify factors associated with the achievement of the MCID and SCB. Results For the Constant-Murley score, we found an MCID and SCB of 9.8 and 19.9, respectively, based on the mean change method and 5.5 and 10.5, respectively, based on receiver operating characteristic analysis. For the Disabilities of the Arm, Shoulder and Hand score, we found an MCID and SCB of –8.2 and –19.6, respectively, with the former and –11.7 and –12.5, respectively, with the latter. The responsiveness of both outcome measures was good, with large effect sizes and standardized response means. The radiographic resorption after 6 weeks and after 6 months appeared to be the most important positive predictor for achieving the MCID and SCB after 6 months. Conclusion This study established the MCID, SCB, and responsiveness for patients with long-lasting rotator cuff calcific tendinitis who were treated with minimally invasive treatment options. With this information, physicians can distinguish between a statistically significant difference and a clinically relevant benefit. Successful radiographic resorption after 6 weeks and after 6 months was associated with achieving clinically significant improvement after treatment.

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Section: Methodsmentioning

confidence: 99%

Quantifying the minimal and substantial clinical benefit of the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand score in patients with calcific tendinitis of the rotator cuff

et al. 2020

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“…However, in general, patients have to undergo multiple ESWT sessions to achieve these results, which makes this treatment more time-consuming than US-guided needling. [31] Jan Louwerens et al [6] found when comparing ESWT with UGN that both treatment techniques show clinically relevant improvements in terms of shoulder function and pain (CMS:24⁒-19⁒; DASH: 57⁒-51⁒; VAS:65⁒-45⁒) for UGN and ESWT respectively after 1-year follow-up. UGN was more effective in eradicating the calcific deposit than ESWT (89⁒ vs 45⁒ for UGN).…”

Section: Discussionmentioning

confidence: 99%

Management of Calcific Supraspinatus TendinitisA Systematic Review

El-Attar

Halawa

Zayed

2021

Benha Journal of Applied Sciences

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Background: The objectives of this comprehensive quantitative review of the treatment of calcific supraspinatus tendinitis were to investigate if there is a sustainable positive effect on outcomes after treatment with extracorporeal shockwave therapy (ESWT) or ultrasound (US)-guided needling and to compare these results with those of treatment with arthroscopic surgery. Method: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this review. A systematic literature search was conducted in December 2019 to identify relevant clinical articles in peer-reviewed journals with at least 3 months' follow-up. Each article was scored using the Coleman Methodology Score. The primary endpoints were functional outcome and radiologic change in the size of the calcific deposit. Results: Twenty-four studies were included (1,509 shoulders). The mean Coleman Methodology Score for the included studies was 77.1± 9.1. Overall, good to excellent clinical outcomes were achieved after treatment with either ESWT, US-guided needling, or arthroscopic surgery, with an improvement in the Constant-Murley score ranging between 26.3 and 41.5 points after 1 year. No severe side effects or long-term complications were encountered. Conclusions: Patients can achieve good to excellent clinical outcomes after ESWT, US-guided needling, and arthroscopy for calcific tendinopathy of the shoulder. Side effects and posttreatment complications should be taken into account when a decision is being made for each individual patient. Physicians should consider ESWT and US-guided needling as minimally invasive treatment options when primary conservative treatment fails. Arthroscopy can safely be used as a very effective but more invasive secondary option, although the extent of deposit removal and the additional benefit of subacromial decompression remain unclear.

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“…12 Four randomized controlled studies have shown that UGPL was more effective than an extracorporeal shock wave in eliminating calcific deposits, restoring function, and relieving pain in the short term. 8,10,19,23 Finally, we and others have found that steroid injections performed after the procedure significantly decreased pain and improved function in the short term but had no added value after 3 months. 7,25 While clinical improvement and the disappearance of calcification are obtained in most patients, some will not improve or will experience a delay in this clinical improvement.…”

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confidence: 81%

Factors Associated With Clinical Improvement and the Disappearance of Calcifications After Ultrasound-Guided Percutaneous Lavage of Rotator Cuff Calcific Tendinopathy: A Post Hoc Analysis of a Randomized Controlled Trial

Dumoulin¹,

Cormier

Varin

et al. 2021

Am J Sports Med

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Background: Calcific tendinitis of the rotator cuff is a frequent cause of shoulder pain. Ultrasound-guided percutaneous lavage (UGPL) is an effective treatment, but factors associated with good clinical and radiological outcomes still need to be identified. Purpose: To study the clinical, procedural, and radiological characteristics associated with improved shoulder function and the disappearance of calcification on radiograph after UGPL. Study Design: Case-control study; Level of evidence, 3. Methods: This is a post hoc analysis of the CALCECHO trial, a double-blinded randomized controlled trial conducted on 132 patients. The trial assessed the effect of corticosteroid injections after UGPL, and patients were randomly assigned to receive either corticosteroid or saline solution in the subacromial bursa. We analyzed all patients included in the randomized controlled trial as 1 cohort. We collected the patients’ clinical, procedural, and radiological characteristics at baseline and during follow-up (3, 6, and 12 months). Univariable analysis, followed by multivariable stepwise regression through forward elimination, was performed to identify the factors associated with clinical success (Disabilities of the Arm, Shoulder and Hand [DASH] score <15) or the disappearance of calcification. Results: Good clinical outcomes at 3 months were associated with steroid injections after the procedure (odd ratio [OR], 3.143; 95% CI, 1.105-8.94). At 6 months, good clinical evolution was associated with a lower DASH score at 3 months (OR, 0.92; 95% CI, 0.890-0.956) and calcium extraction (OR, 10.7; 95% CI, 1.791-63.927). A lower DASH at 6 months was also associated with a long-term favorable outcome at 12 months (OR, 0.939; 95% CI, 0.912-0.966). Disappearance of calcification at 3 and 12 months occurred more frequently in patients in whom communication was created between the calcification and the subacromial bursa during the procedure (OR, 2.728 [95% CI, 1.194-6.234] at 3 months; OR, 9.835 [95% CI, 1.977-48.931] at 12 months). Importantly, an association between calcification resorption and good clinical outcome was found at each time point. Conclusion: Assessing patients at 3 months seems to be an essential part of their management strategy. Calcium extraction and creating a communication between the calcific deposits and subacromial bursa are procedural characteristics associated with good clinical and radiological evolution.

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Comparing 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

Cited by 36 publications

References 31 publications

Quantifying the minimal and substantial clinical benefit of the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand score in patients with calcific tendinitis of the rotator cuff

Quantifying the minimal and substantial clinical benefit of the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand score in patients with calcific tendinitis of the rotator cuff

Management of Calcific Supraspinatus TendinitisA Systematic Review

Factors Associated With Clinical Improvement and the Disappearance of Calcifications After Ultrasound-Guided Percutaneous Lavage of Rotator Cuff Calcific Tendinopathy: A Post Hoc Analysis of a Randomized Controlled Trial

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