title: Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs.
abstract: Treatment of calcific tendinitis using extracorporeal shock wave therapy (ESWT), ultrasound-guided percutaneous lavage (UGPL or barbotage), subacromial corticosteroid injection (SAI) and combined treatment is still controversial. This systematic review and meta-regression aimed to compare clinical outcomes between treatments. Relevant RCTs were identified using PubMed and Scopus search engines to date of September 23, 2015. Seven of 920 studies identified were eligible. Compared to the other treatments, the results of this study indicate that ESWT significantly improved CMS and VAS when compared to placebo. Barbotage plus ESWT significantly improved CMS, VAS and decreased size of calcium deposit when compared to ESWT, while barbotage plus SAI significantly improved CMS and decreased size of calcium deposit when compared to SAI. There have no different adverse effects of all treatment groups. Multiple active treatment comparisons indicated that barbotage plus SAI significantly improved VAS and size of calcium deposit when compared to other groups, while barbotage plus SAI improved CMS when compared to other groups. But there was no significant difference. The network meta-analysis suggested that combined US-guided needling and subacromial corticosteroid injection significantly decreased shoulder pain VAS, improved CMS score and decreased the size of calcium deposits, while also lowering risks of adverse event when compared to barbotage plus ESWT, ESWT and subacromial corticosteroid injection; therefore, the evidence points to UGPL as being the treatment of choice for nonsurgical options of treatment in calcific tendinitis of the shoulder. Level of evidence I.
authors.affiliation: Orthopedics Department, Police General Hospital, Bangkok, Thailand.
authors.forename: Alisara
authors.initials: A
authors.lastname: Arirachakaran
authors.affiliation: Orthopedics Department, Srinakarin Hospital, Khonkan, Thailand.
authors.forename: Manusuk
authors.initials: M
authors.lastname: Boonard
authors.affiliation: Orthopaedic Department, Saint Louis Hospital, Bangkok, Thailand.
authors.forename: Sarunpong
authors.initials: S
authors.lastname: Yamaphai
authors.affiliation: Orthopedic Department, Aek Udon International Hospital, Udontani, Thailand.
authors.forename: Akom
authors.initials: A
authors.lastname: Prommahachai
authors.affiliation: Orthopedics Department, Police General Hospital, Bangkok, Thailand.
authors.forename: Suraphol
authors.initials: S
authors.lastname: Kesprayura
authors.affiliation: Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand. Jatupon_kong@hotmail.com.
authors.forename: Jatupon
authors.initials: J
authors.lastname: Kongtharvonskul
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D002114:Calcinosis / Q000628:therapy*; D003131:Combined Modality Therapy / Q000009:adverse effects; D019220:High-Energy Shock Waves / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D016032:Randomized Controlled Trials as Topic; D000070636:Rotator Cuff Injuries / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000009:adverse effects; D018084:Ultrasonography, Interventional
chemical_list: D000305:Adrenal Cortex Hormones
keywords: CS; Calcific tendinitis; ESWT; Extracorporeal shock wave therapy; UGPL; Ultrasound guide