High-Energy Extracorporeal Shock-Wave Therapy for Treating Chronic Calcific Tendinitis of the Shoulder

Bannuru, Raveendhara R.; Flavin, Nina E.; Vaysbrot, Elizaveta E.; Harvey, William; McAlindon, T.E.

doi:10.7326/m13-1982

Cited by 95 publications

(87 citation statements)

References 56 publications

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“…There is growing evidence that extracorporeal shock wave therapy and barbotage are effective treatment options for calcific tendonitis, and that corticosteroid injections can be harmful, [55][56][57][58] which emphasises the importance of evaluating these treatment options in general practice.…”

Section: Implications For Practice and Researchmentioning

confidence: 99%

Ultrasound imaging to tailor the treatment of acute shoulder pain: a randomised controlled trial in general practice

et al. 2016

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ObjectiveTo determine the clinical effectiveness of ultrasound tailored treatment in patients with acute subacromial disorders.DesignPragmatic randomised controlled trial.SettingDutch general practice.ParticipantsPatients aged 18–65 years with acute (duration <3 months) unilateral shoulder pain and no previous treatment, in whom the general practitioner suspected a subacromial disorder was enrolled.InterventionsAll patients underwent ultrasound imaging of the affected shoulder. Patients who were still symptomatic after a qualification period of 2 weeks with standard treatment were randomised to treatment tailored to ultrasound diagnosis (disclosure of the ultrasound diagnosis) or usual care (non-disclosure of the ultrasound diagnosis).Primary outcome measurePatient-perceived recovery using the Global Perceived Effect questionnaire at 1 year.Results129 patients were included. 18 patients recovered during the 2-week qualification period, resulting in 111 randomised patients; 56 were allocated to ultrasound tailored treatment and 55 to usual care. After 1 year, no statistically significant differences in recovery were found between the ultrasound tailored treatment group (72.5% (37/51)) and the usual care group (60% (30/50), OR 2.24 (95% CI 0.72 to 6.89; p=0.16)). Also, healthcare use was similar.ConclusionsThis study has shown no clinically significant difference in the primary outcome measure between the ultrasound tailored treatment and usual care groups. Furthermore, there was no overall difference in healthcare resources used between groups. Although no formal cost data are included, one can only assume that the ultrasound examinations are additional costs for the intervention group, which cannot be justified in routine practice based on this trial. Based on this study, no change in current pragmatic guidelines to incorporate early ultrasound imaging can be recommended.Trial registration numberNTR2403; Results.

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Section: Implications For Practice and Researchmentioning

confidence: 99%

Ultrasound imaging to tailor the treatment of acute shoulder pain: a randomised controlled trial in general practice

et al. 2016

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“…12 There are a number of conservative treatment options available: non-steroidal anti-inflammatory drugs and multiple modalities are often used to manage pain and inflammation; physical therapy can help improve scapular mechanics and decrease dynamic impingement; and corticosteroid injections. 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.…”

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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“…Several recent systematic reviews have shown the superiority of high-energy ESWT to low-energy ESWT in the treatment of calcific rotator cuff tendinopathy. 8,9,17 We therefore focused solely on high-energy ESWT.…”

Section: Methodsmentioning

confidence: 99%

“…Controversies exist, however, regarding the extent of calcification removal, the long-term impact on the rotator cuff tendons, and the use of subacromial decompression. 9,14 The recent focus on minimally invasive treatment modalities suggests that surgery is gradually being superseded by these new options in the management of chronic rotator cuff tendinopathy. The objectives of this study were to investigate if there is a sustainable positive effect in terms of functional outcome and resorption of calcific deposits after treatment with highenergy ESWT and US-guided needling and to compare these results with those of treatment with arthroscopic surgery.…”

mentioning

confidence: 99%

“…8 Several recent studies have shown the short-term effectiveness of these treatment options. [8][9][10] Treatment-resistant cases may, however, necessitate surgical removal of the calcific deposit, and surgery has long been the treatment of choice for patients with calcific rotator cuff tendinopathy. 4 Surgical management options include arthroscopic procedures to remove the calcified deposit and to perform subacromial decompression.…”

mentioning

confidence: 99%

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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

Louwerens

Veltman

Noort

et al. 2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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High-Energy Extracorporeal Shock-Wave Therapy for Treating Chronic Calcific Tendinitis of the Shoulder

Abstract: None.

Cited by 95 publications

References 56 publications

Ultrasound imaging to tailor the treatment of acute shoulder pain: a randomised controlled trial in general practice

Ultrasound imaging to tailor the treatment of acute shoulder pain: a randomised controlled trial in general practice

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

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

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