title: Comparative Effectiveness of Nonoperative Treatments for Chronic Calcific Tendinitis of the Shoulder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.
abstract: To investigate the effectiveness of various nonoperative treatments for chronic calcific tendinitis of the shoulder, a systematic review and network meta-analysis of randomized trials was performed to evaluate changes in pain reduction, functional improvements in patients with calcific tendinitis, and the ratio of complete resolution of calcific deposition.
  
  
  
  Studies were comprehensively searched, without language restrictions, on PubMed, Embase, Cochrane Controlled Trials Register, the Cochrane, and other databases. The reference lists of articles and reviews were cross-checked for possible studies.
  
  
  
  Randomized controlled trials from before August 2016 were included. Study selection was conducted by 2 reviewers independently.
  
  
  
  The quality of studies was assessed and data extracted by 2 independent reviewers. Disagreements were settled by consulting a third reviewer to reach a consensus.
  
  
  
  Fourteen studies with 1105 participants were included in the network meta-analysis that used a random-effect model to investigate the mean difference of pooled effect sizes of the visual analog scale, Constant-Murley score, and the ratio of complete resolution of calcific deposition on native radiographs.
  
  
  
  The present network meta-analysis demonstrates that ultrasound-guided needling (UGN), radial extracorporeal shockwave therapy (RSW), and high-energy focused extracorporeal shockwave therapy (H-FSW) alleviate pain and achieve complete resolution of calcium deposition. Compared with low-energy focused extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and ultrasound therapy, H-FSW is the best therapy for providing functional recovery. Physicians should consider UGN, RSW, and H-FSW as alternative effective therapies for chronic calcific tendinitis of the shoulder when initial conservative treatment fails.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Wu
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
authors.forename: Wen-Chung
authors.initials: WC
authors.lastname: Tsai
authors.affiliation: Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Kung
authors.initials: YK
authors.lastname: Tu
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan. Electronic address: mr3964@cgmh.org.tw.
authors.forename: Tung-Yang
authors.initials: TY
authors.lastname: Yu
mesh_terms: D002114:Calcinosis / Q000534:rehabilitation*; D019220:High-Energy Shock Waves / Q000627:therapeutic use; D006801:Humans; D009339:Needles; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D020069:Shoulder Pain / Q000534:rehabilitation*; D052256:Tendinopathy / Q000534:rehabilitation*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods; D014464:Ultrasonic Therapy / Q000379:methods; D018084:Ultrasonography, Interventional
keywords: High energy shock waves; Interventional; Rehabilitation; Shoulder; Tendinopathy; Ultrasonography