Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis

Louwerens, Jan K. G.; Sierevelt, Inger N.; Bekerom, Michel P.J. van den

doi:10.1016/j.jse.2014.02.002

Cited by 76 publications

(71 citation statements)

References 48 publications

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“…More "radical" treatment options include shock wave therapy, 13 image-guided procedures 14 and surgery. [15][16][17] In the 1990s, ultrasound-guided techniques were developed to address this issue. 18,19 Today, ultrasound-guided percutaneous treatment is pivotal.…”

mentioning

confidence: 99%

Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome

Bazzocchi

Pelotti

Serraino

et al. 2016

BJR

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Objective: Rotator cuff calcific tendinitis (RCCT) is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. Between non-surgical and surgical treatment options, today a few minimal invasive techniques are available to remove the calcific deposit, and they represent a cornerstone in the management of this painful clinical condition. The aim of the work was a retrospective evaluation of double-needle ultrasoundguided percutaneous fragmentation and lavage (DNL), focused on understanding the factors which are of major importance in determining a quick and good response at 1 month. Methods: A series of 147 patients affected by RCCT and suitable for DNL were evaluated. A systematic review of anamnestic, clinical and imaging data was performed in 144 shoulders treated in a single-centre setting. Clinical reports and imaging examinations were revisited. The inclusion criteria were submission to DNL, therefore fitness for the percutaneous procedure, and following 1-month follow-up. There was no exclusion owing to risk of bias. The treatment was defined as successful for constant shoulder modified score (CSS) improvement of .50% at 1 month. Results: In 70% of shoulders, the treatment resulted in a quick and significant reduction of symptoms (successful). On the whole, CSS increase at 1 month was estimated at 91.5 6 69.1%. CSS variations were significantly related to age of patients (better results between 30 and 40 years old), calcification size (more relevant improvement for middle-sized calcifications, 12-17 mm), sonographic and radiographic features of calcific deposits (softer calcifications) and thickening of subacromial/subdeltoid bursa walls. In the final model of stepwise regression for CSS variation, ultrasound score pre-treatment and posttreatment, the distance between bursa and calcification before treatment and the size of post-treatment calcification area were shown to be independently correlated to success. Numeric rating scale score for pain showed similar results. Pain at admission was also related to age, calcification size, ultrasound and Gärtner score, power Doppler positivity, bursal wall thickening and biceps tenosynovitis. Conclusion: The success of the procedure with quick improvement in function and symptoms is warranted in soft and middle-sized calcifications, in young adults. Advances in knowledge: Ultrasound-guided percutaneous procedures for RCCT must be safe, effective and with prompt pain relief and function restoration. This study shows which clinical picture is more favourable to this purpose and actual prognostic factors for DNL (soft and middle-sized calcifications, in young adults, are more favourable). INTRODUCTIONRotator cuff calcific tendinitis (RCCT) is a common condition, occurring in up to 20% of painful shoulders and even present in up to 7.5% of asymptomatic shoulders.

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confidence: 99%

Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome

Bazzocchi

Pelotti

Serraino

et al. 2016

BJR

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“…Five acceptable-quality reviews 36,38,47,49,50 and 1 high-quality review 35 addressed rotator cuff calcific tendinitis (RC-CT). The first SR included 20 individual studies (1544 participants).…”

Section: Rotator Cuff Calcific Tendinitismentioning

confidence: 99%

“…It found that high-energy ESWT is the most thoroughly investigated minimally invasive treatment option in the short term to midterm and has proven to be a safe and effective treatment. 35 The second review 36 by the same team found that with the 22 studies that were included (1258 shoulders), many patients can achieve good to excellent clinical outcomes after high-energy ESWT, US-guided needling, and arthroscopy for calcific tendinopathy of the shoulder. Two additional acceptable-quality reviews both found that ESWT was effective for RC-CT. 37,49 The other reviews in this category analyzed similar treatments and outcomes.…”

Section: Rotator Cuff Calcific Tendinitismentioning

confidence: 99%

Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions

Hawk

Minkalis

Khorsan

et al. 2017

Journal of Manipulative and Physiological Therapeutics

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Objective: The purpose of this review was to evaluate the effectiveness of conservative nondrug, nonsurgical interventions, either alone or in combination, for conditions of the shoulder. Methods: The review was conducted from March 2016 to November 2016 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and was registered with PROSPERO. Eligibility criteria included randomized controlled trials (RCTs), systematic reviews, or meta-analyses studying adult patients with a shoulder diagnosis. Interventions qualified if they did not involve prescription medication or surgical procedures, although these could be used in the comparison group or groups. At least 2 independent reviewers assessed the quality of each study using the Scottish Intercollegiate Guidelines Network checklists. Shoulder conditions addressed were shoulder impingement syndrome (SIS), rotator cuff-associated disorders (RCs), adhesive capsulitis (AC), and nonspecific shoulder pain. Results: Twenty-five systematic reviews and 44 RCTs met inclusion criteria. Low-to moderate-quality evidence supported the use of manual therapies for all 4 shoulder conditions. Exercise, particularly combined with physical therapy protocols, was beneficial for SIS and AC. For SIS, moderate evidence supported several passive modalities. For RC, physical therapy protocols were found beneficial but not superior to surgery in the long term. Moderate evidence supported extracorporeal shockwave therapy for calcific tendinitis RC. Low-level laser was the only modality for which there was moderate evidence supporting its use for all 4 conditions. Conclusion: The findings of this literature review may help inform practitioners who use conservative methods (eg, doctors of chiropractic, physical therapists, and other manual therapists) regarding the levels of evidence for modalities used for common shoulder conditions. (J Manipulative Physiol Ther 2017;40:293-319)

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“…Extracorporeal shockwaves have been used routinely, and a recent meta-analysis reported that they are safe and effective up to midterm. 34 An alternative procedure is to perform dry needling of the tendon. It simply consists of a number of punctures performed preferably under ultrasound guidance on the degenerated area of the tendon, with the purpose of local bleeding.…”

Section: Treatment Of Degenerative Tendinopathymentioning

confidence: 99%