title: 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.
abstract: OBJECTIVE
  The objectives of this comprehensive quantitative review of the treatment of calcific tendinopathy of the rotator cuff were to investigate if there is a sustainable positive effect on outcomes after treatment with high-energy extracorporeal shockwave therapy (ESWT) or ultrasound (US)-guided needling and to compare these results with those of treatment with arthroscopic surgery.
  
  
  METHODS
  The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this review. A systematic literature search was conducted in December 2014 to identify relevant clinical articles in peer-reviewed journals with at least 6 months' follow-up. Each article was scored using the Coleman Methodology Score. The primary endpoints were functional outcome and radiologic change in the size of the calcific deposit.
  
  
  RESULTS
  Twenty-two studies were included (1,258 shoulders). The mean Coleman Methodology Score for the included studies was 77.1 ± 9.1. Overall, good to excellent clinical outcomes were achieved after treatment with either high-energy ESWT, US-guided needling, or arthroscopic surgery, with an improvement in the Constant-Murley score ranging between 26.3 and 41.5 points after 1 year. No severe side effects or long-term complications were encountered.
  
  
  CONCLUSIONS
  Patients can achieve good to excellent clinical outcomes after high-energy ESWT, US-guided needling, and arthroscopy for calcific tendinopathy of the shoulder. Side effects and post-treatment complications should be taken into account when a decision is being made for each individual patient. Physicians should consider high-energy ESWT and US-guided needling as minimally invasive treatment options when primary conservative treatment fails. Arthroscopy can safely be used as a very effective but more invasive secondary option, although the extent of deposit removal and the additional benefit of subacromial decompression remain unclear.
  
  
  METHODS
  Level IV, systematic review of Level I, II, and IV studies.
authors.affiliation: Research Center Linnaeus Institute, Spaarne Hospital, Hoofddorp, Netherlands; Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands. Electronic address: jlouwerens@spaarneziekenhuis.nl.
authors.forename: Jan K G
authors.initials: JK
authors.lastname: Louwerens
authors.affiliation: Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands.
authors.forename: Ewout S
authors.initials: ES
authors.lastname: Veltman
authors.affiliation: Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands.
authors.forename: Arthur
authors.initials: A
authors.lastname: van Noort
authors.affiliation: Department of Orthopaedic Surgery, Onze Lieve Vrouwen Gasthuis, Amsterdam, Netherlands.
authors.forename: Michel P J
authors.initials: MP
authors.lastname: van den Bekerom
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D002114:Calcinosis / Q000628:therapy*; D002908:Chronic Disease; D019299:Decompression, Surgical; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D009339:Needles; D017006:Rotator Cuff / Q000601:surgery*; D012782:Shoulder / Q000503:physiopathology; D052256:Tendinopathy / Q000628:therapy*; D016896:Treatment Outcome