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, Jan K. G.; Veltman, Ewout S.; Noort, Arthur van; Bekerom, Michel P.J. van den

doi:10.1016/j.arthro.2015.06.049

Cited by 62 publications

(41 citation statements)

References 53 publications

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“…Third, it is feasible that mineralization does not contribute directly to tendon pain or fiber rupture but is an incidental change (a ‘bystander’). However, the improvement in patient comfort following surgical decompression of mineralized deposits in rotator cuff tendons suggests that mineralization can be an active contributor to tendon pain …”

Section: Discussionmentioning

confidence: 99%

Mineralization can be an incidental ultrasonographic finding in equine tendons and ligaments

O'Brien

Smith

2018

Vet Radiology Ultrasound

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Tendon/ligament mineralization is recognized in horses but information regarding its clinical significance is limited. The aims of this observational study were to report the structures most commonly affected by ultrasonographically detectable mineralization and, for these, determine frequency of diagnosis and key clinical features. Cases presented at our hospital in April 1999-April 2013 and September 2014-November 2015 were included: a total of 27 horses (22 retrospective, five prospective). Mineralizations were most common in deep digital flexor tendons (10) and suspensory ligament branches (eight), representing 10% and 7% (estimated), respectively, of horses diagnosed with injuries to these structures during the study. Two deep digital flexor tendon and three suspensory ligament branch cases showed bilateral mineralization. Deep digital flexor tendon mineralization was restricted to the digital flexor tendon sheath, most commonly in the proximal sheath (±sesamoidean canal), and seven of 10 cases involved hindlimbs. Suspensory ligament branch mineralization was visible in the same ultrasound window as the proximal sesamoid bones in 10/11 limbs and six of eight cases involved forelimbs. Previous corticosteroid medication was a feature of one deep digital flexor tendon and one suspensory ligament branch case. Mineralization was associated with lameness in some but not all limbs. Mineralized foci within the deep digital flexor tendon preceded hypoechoic lesion formation in two limbs. Of the cases with deep digital flexor tendon or suspensory ligament branch injury only, one of three and two of three cases, respectively, became sound. Findings indicated that tendon/ligament mineralization can be associated with lameness in some horses, but can also be an incidental finding.

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Section: Discussionmentioning

confidence: 99%

Mineralization can be an incidental ultrasonographic finding in equine tendons and ligaments

O'Brien

Smith

2018

Vet Radiology Ultrasound

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“…Iontophoresis with agents that dissolve mineral, such as acetic acid, has recently been shown to have little efficacy in calcific periarthritis [8]. A recent systematic review compared the effectiveness of high-energy extracorporeal shockwave (ESTW) therapy to barbotage and arthroscopic surgery [9■]. The authors identified 22 studies that satisfied their inclusion criteria, which included studies which followed patients for at least 6 months, eliminated other causes of shoulder pain such as full-thickness rotator cuff tears, and examined two relevant outcome measures based on shoulder function and size of the calcific deposit.…”

Section: Calcific Periarthritismentioning

confidence: 99%

Basic calcium phosphate crystal-associated musculoskeletal syndromes: an update

Rosenthal

2018

Current Opinion in Rheumatology

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Purpose of review Basic calcium phosphate (BCP) crystals are associated with two important musculoskeletal syndromes. Deposition of BCP crystals in tendons, bursae, and other soft tissues around joints causes calcific periarthritis, whereas intra-articular BCP crystals contribute to osteoarthritis and cause the highly destructive arthritis known as Milwaukee Shoulder Syndrome. The epidemiology and natural history of these syndromes are poorly understood, and because the pathogenesis remains unclear, few targeted therapies are available. I will review new developments in this field. Recent findings I will discuss a case collection of calcific periarthritis of the hip, and evidence-based management strategies for shoulder calcific periarthritis that might be applied to calcific periarthritis at other locations. I will summarize several recent articles addressing mechanisms of crystal formation and identifying pathways through which BCP crystals produce tissue damage and explore some newly identified risk factors for pathologic mineralization. Summary We are making slow, but steady progress in understanding the clinical presentation of calcific periarthritis in sites other than the shoulder. A growing appreciation of the mechanisms through which BCP crystals mediate tissue damage should lead to the development of novel management strategies for these common musculoskeletal syndromes.

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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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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

Cited by 62 publications

References 53 publications

Mineralization can be an incidental ultrasonographic finding in equine tendons and ligaments

Mineralization can be an incidental ultrasonographic finding in equine tendons and ligaments

Basic calcium phosphate crystal-associated musculoskeletal syndromes: an update

Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions

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