Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis.
BACKGROUND
This meta-analysis assessed the short-term to midterm effectiveness of minimally invasive treatments in the management of calcifying tendinopathy of the shoulder cuff, a common source of chronic shoulder pain that leads to pain, a decreased active range of motion, and loss of muscular strength. When conservative therapies fail, minimally invasive treatment options can be considered before resulting to surgery.


METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this review. A systematic literature search was conducted in May 2013 to identify all studies that examined the short-term to midterm effectiveness of minimally invasive treatments for chronic calcifying tendinopathy. The primary end points were identified as function, pain, and total resorption rates. Grades of Recommendation Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence.


RESULTS
Included were 20 studies (1544 participants). Common methodological flaws were related to randomization. In general, there is moderate-quality GRADE evidence that high-energy extracorporeal shockwave therapy has a significant effect on pain relief and functional status compared with other interventions. There is variable-quality GRADE evidence on the efficiency of other interventions.


CONCLUSIONS
High-energy extracorporeal shockwave therapy 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. Ultrasound-guided needling is safe but has not been proven to be more effective than an ultrasound-guided subacromial corticosteroid injection in recent level I research, and further research will have to prove its effectiveness.
Centre for Orthopaedic Research, Spaarne Ziekenhuis, Hoofddorp, The Netherlands. Electronic address: jlouwerens@spaarneziekenhuis.nl.
Jan K G
JK
Louwerens
Centre for Orthopaedic Research, Spaarne Ziekenhuis, Hoofddorp, The Netherlands.
Inger N
IN
Sierevelt
Department of Orthopaedic Surgery, Spaarne Ziekenhuis, Hoofddorp, The Netherlands.
Arthur
A
van Noort
Department of Orthopaedic Surgery, Onze Lieve Vrouwen Gasthuis, Amsterdam, The Netherlands.
Michel P J
MP
van den Bekerom
D002114:Calcinosis / Q000628:therapy*; D002908:Chronic Disease; D019220:High-Energy Shock Waves / Q000627:therapeutic use; D006801:Humans; D000070636:Rotator Cuff Injuries; D052256:Tendinopathy / Q000628:therapy*
Shoulder; calcific; evidence based; minimally invasive; rotator cuff; tendinopathy; treatment