title: Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting.
abstract: OBJECTIVE
  We performed a systematic review of current evidence regarding ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in the shoulder aimed to: assess different published techniques; evaluate clinical outcome in a large combined cohort; and propose suggestions for homogeneous future reporting.
  
  
  METHODS
  Cochrane Collaboration for Systematic Reviews of Interventions Guidelines were followed. We searched MEDLINE/MEDLINE In-Process/EMBASE/Cochrane databases from 1992-2013 using the keywords 'ultrasound, shoulder, needling, calcification, lavage, rotator cuff' combined in appropriate algorithms. References of resulting papers were also screened. Risk of bias was assessed with a modified Newcastle-Ottawa Scale.
  
  
  RESULTS
  Of 284 papers found, 15 were included, treating 1,450 shoulders in 1,403 patients (females, n = 838; mean age interval 40-63 years). There was no exclusion due to risk of bias.
  
  
  CONCLUSIONS
  US-PICT of rotator cuff is a safe and effective procedure, with an estimated average 55% pain improvement at an average of 11 months, with a 10% minor complication rate. No evidence exists in favour of using a specific size/number of needles. Imaging follow-up should not be used routinely. Future studies should aim at structural uniformity, including the use of the Constant Score to assess outcomes and 1-year minimum follow-up. Alternatives to steroid injections should also be explored.
  
  
  CONCLUSIONS
  • US-PICT of rotator cuff is a safe and effective procedure. • On average 55% pain improvement with 10% minor complication rate. • No evidence exists in favour of using a specific size/number of needles. • Future need to assess outcome using Constant Score with 1-year minimum follow-up.
authors.affiliation: Radiologia Oncologica ed Interventistica, Istituto Clinico Humanitas, Rozzano, Milano, Italy.
authors.forename: Ezio
authors.initials: E
authors.lastname: Lanza
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Banfi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Serafini
authors.forename: Francesca
authors.initials: F
authors.lastname: Lacelli
authors.forename: Davide
authors.initials: D
authors.lastname: Orlandi
authors.forename: Michele
authors.initials: M
authors.lastname: Bandirali
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
mesh_terms: D000328:Adult; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000628:therapy*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D017006:Rotator Cuff; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000295:instrumentation / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods