Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Needling and Lavage Versus Subacromial Corticosteroids: Five-Year Outcomes of a Randomized Controlled Trial

Witte, Pieter Bas de; Kolk, Annemarie M.; Overes, Ferdinand; Nelissen, Rob G H H; Reijnierse, M.

doi:10.1177/0363546517721686

Cited by 50 publications

(66 citation statements)

References 36 publications

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“…Although it would have been ideal to have a control group to rule out that the outcome is because of the selflimiting history of RCCT, we believe that, for the purpose of identifying prognostic factors, a large prospective cohort study is of sufficient methodological quality. Finally, the follow-up term of this study was 1 year; this is comparable to other studies [16,17,24], but some long-term studies on RCCT show that a substantial part of patients still have persisting shoulder complaints in the long term [7,26]. More research is needed to gain insight in predictive factors for persisting shoulder complaints in the long term.…”

Section: Discussionsupporting

confidence: 76%

Prognostic factors for the outcome of needle aspiration of calcific deposits for rotator cuff calcific tendinitis

et al. 2020

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Objective To identify prognostic factors for the effectiveness of needle aspiration of calcific deposits (NACD) for rotator cuff calcific tendinitis (RCCT) Methods One hundred forty-nine patients with symptomatic RCCT were included in a prospective cohort study. Pain (VAS), shoulder function (SST and DASH), and quality of life (EQ-5D) were assessed at baseline and at 3, 6, and 12 months post-NACD. Univariate analyses (independent t tests or Mann-Whitney U tests depending on the distribution of data) were performed to build a multivariable linear regression model. Stepwise regression analysis through backward elimination was performed to evaluate the effect of predefined prognostic factors on the outcome. Results Patients who underwent multiple NACD procedures had less reduction of pain (p < 0.01). Furthermore, a larger reduction in VAS pain scores at 3 months post-NACD was associated with a larger reduction in VAS pain scores at 12 months (p < 0.01). More improvement of SST and DASH scores at 3 months was associated with better SST, DASH, and EQ-5D scores at 12 months (p < 0.01). Smaller-size calcific deposits were associated with less improvement of DASH (p = 0.03) and EQ-5D scores (p = 0.01). A longer duration of symptoms prior to NACD was associated with less improvement of EQ-5D scores (p = 0.01). Conclusions A good initial response after NACD is associated with better outcomes at 12 months. Patients with a longer duration of symptoms prior to NACD and patients who require multiple procedures showed inferior outcomes in terms of pain reduction and improvement of quality of life. Smaller-size calcific deposits are associated with a less favorable outcome of shoulder function and quality of life scores and might therefore be less susceptible for NACD. Key Points • A good initial response to NACD is associated with a better outcome in the longer term. • A longer duration of symptoms and the need for multiple NACD procedures are associated with inferior outcomes. • Smaller-size calcific deposits seem less susceptible for NACD.

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Section: Discussionsupporting

confidence: 76%

Prognostic factors for the outcome of needle aspiration of calcific deposits for rotator cuff calcific tendinitis

et al. 2020

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“…From the nine potentially relevant articles identified through titles and abstract review, three RCTs met the eligibility criteria after full-text review,16 18–20 one including the original publication and a 5-year follow-up16 19 (figure 1). Characteristics of included studies are presented in table 1.…”

Section: Resultsmentioning

confidence: 99%

“…In every RCT, the population was composed of adults with chronic RC calcific tendinopathy of at least 316 19 to 6 months’ duration 18 20. RC calcific tendinopathy was confirmed by radiography and/or ultrasound.…”

Section: Resultsmentioning

confidence: 99%

Is ultrasound-guided lavage an effective intervention for rotator cuff calcific tendinopathy? A systematic review with a meta-analysis of randomised controlled trials

Lafrance

Doiron-Cadrin

Saulnier

et al. 2019

BMJ Open Sport Exerc Med

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BackgroundRotator cuff calcific tendinopathy is characterised by the deposition of hydroxyapatite crystals in one of the rotator cuff tendons and can be managed by ultrasound-guided lavage. However, evidence regarding the efficacy of ultrasound-guided lavage for rotator cuff calcific tendinopathy remains inconclusive. The aim of this systematic review and meta-analysis is to update the available evidence on the efficacy of ultrasound-guided lavage in adults with rotator cuff calcific tendinopathy.MethodsA literature search was conducted up to April 2018 in four bibliographic databases to identify randomised control trials that compared ultrasound-guided lavage alone with other interventions to treat rotator cuff calcific tendinopathy. Randomised control trials were assessed with the Cochrane Risk of Bias Tool. Meta-analyses and/or qualitative synthesis of the evidence were performed.ResultsThree randomised control trials were included. Pooled results for pain (n=226) indicated that ultrasound-guided lavage may significantly decrease pain when compared with shockwave therapy, with a mean difference of −1.98 out of 10 points (95% CI −2.52 to −1.45) in the short term and of −1.84 (95% CI −2.63 to −1.04) in the long term. Based on one trial (n=25), ultrasound-guided lavage significantly improved function when compared with shockwave therapy (p<0.05). Based on another trial (n=48), the addition of ultrasound-guided lavage to a corticosteroid injection significantly improves function in the long term (p<0.05).ConclusionFor individuals with rotator cuff calcific tendinopathy, low-quality evidence suggests that ultrasound-guided lavage is more effective than shockwave therapy or a corticosteroid injection alone. Future trials could modify the present conclusions.Trial registration numberCRD42018095858.

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“…Another review by Louwerens al. [39] indicated good to excellent clinical outcomes in high-energy ESWT and US-guided needling, but the side effects and posttreatment complications for each individual patient should be taken into account [17,21,24,25]. Cho et al [27] showed that at least 28% of the patients included in their study did not fully recover after nonoperative treatments, and surgical treatment may be needed for these patients.…”

Section: Discussionmentioning

confidence: 99%

“…guided percutaneous lavage (UGPL) [21] have also yielded good results, but might lead to complications such as vagus nerve stimulation, pain [1,22] and even skin disinfection [23]. Many patients even experience pain and discomfort, followed by recurring symptoms of the involved shoulder [17,21,24,25], and some of them require surgery nally. Nevertheless, more than 25% of patients who are resistant to conservative treatment and patients with severe symptoms persisting for more than six months need to undergo surgery [26,27].…”

mentioning

confidence: 99%

The Clinical Results of Arthroscopic Treatment for Calcified Tendinitis of Rotator Cuff—— A Retrospective Study With No Less Than 2 Years Follow Up

Li¹,

Yan²,

Qing³

et al. 2020

Preprint

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Background The treatment of CT remains controversial. The aim of this study was to retrospectively evaluate the pain and functional outcomes of arthroscopic excision with or without rotator cuff repair for treating calcified tendinitis of the rotator cuff.Methods Between Jan 2015 and Apr 2018, a total of 38 patients with 39 shoulders CT of the rotator cuff underwent arthroscopic surgery and were followed for at least two years. The clinical outcomes were evaluated at intervals of 2, 4, and 8 weeks and 3, 6，12 and 24 months after the surgery and annually thereafter. The efficacy measures included the visual analogue scale (VAS) score, University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score and radiographic outcomes.Results All patients underwent follow-ups, and the mean follow-up time was 45.38 months. The VAS score significantly decreased from 73.59±11.35 mm before the surgery to 26.41±10.63 mm at 6 months after surgery and continued to decrease to 5.64±5.02 mm at the end of the follow-up period (all p < 0.01). This result was supported by a significant increase in both the UCLA score and ASES score (all p<0.01) after surgery. Plain radiographs after surgery revealed complete calcification removal in all patients. No recurrence was observed during the follow-up period.Conclusions Arthroscopic excision can relieve pain and improve shoulder joint function in patients with CT. Additional randomized controlled studies need to be conducted to confirm our findings.

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Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Needling and Lavage Versus Subacromial Corticosteroids: Five-Year Outcomes of a Randomized Controlled Trial

Abstract: No more significant differences were found in the clinical and radiological outcomes between barbotage combined with a SAIC versus an isolated SAIC after 5 years of follow-up. Registration: NTR2282 (Dutch Trial Registry).

Cited by 50 publications

References 36 publications

Prognostic factors for the outcome of needle aspiration of calcific deposits for rotator cuff calcific tendinitis

Prognostic factors for the outcome of needle aspiration of calcific deposits for rotator cuff calcific tendinitis

Is ultrasound-guided lavage an effective intervention for rotator cuff calcific tendinopathy? A systematic review with a meta-analysis of randomised controlled trials

The Clinical Results of Arthroscopic Treatment for Calcified Tendinitis of Rotator Cuff—— A Retrospective Study With No Less Than 2 Years Follow Up

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