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Abstract
Background Rotator cuff calcific tendinopathy is characterised by the deposition of hydroxyapatite crystals in one of the rotator cuff tendons and can be managed by ultrasound-guided lavage. However, evidence regarding the efficacy of ultrasound-guided lavage for rotator cuff calcific tendinopathy remains inconclusive. The aim of this systematic review and meta-analysis is to update the available evidence on the efficacy of ultrasound-guided lavage in adults with rotator cuff calcific tendinopathy.
Methods A literature search was conducted up to April 2018 in four bibliographic databases to identify randomised control trials that compared ultrasound-guided lavage alone with other interventions to treat rotator cuff calcific tendinopathy. Randomised control trials were assessed with the Cochrane Risk of Bias Tool. Meta-analyses and/or qualitative synthesis of the evidence were performed.
Results Three randomised control trials were included. Pooled results for pain (n=226) indicated that ultrasound-guided lavage may significantly decrease pain when compared with shockwave therapy, with a mean difference of −1.98 out of 10 points (95% CI −2.52 to −1.45) in the short term and of −1.84 (95% CI −2.63 to −1.04) in the long term. Based on one trial (n=25), ultrasound-guided lavage significantly improved function when compared with shockwave therapy (p<0.05). Based on another trial (n=48), the addition of ultrasound-guided lavage to a corticosteroid injection significantly improves function in the long term (p<0.05).
Conclusion For individuals with rotator cuff calcific tendinopathy, low-quality evidence suggests that ultrasound-guided lavage is more effective than shockwave therapy or a corticosteroid injection alone. Future trials could modify the present conclusions.
Trial registration number CRD42018095858.
- shoulder
- rotator cuff
- tendinopathy
- hydroxyapatites and needling
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Footnotes
Contributors SL: designed the study protocol, performed the literature search, selected the articles of interest, performed the risk-of-bias analysis, extracted and analysed the data, and is the first author of the article. PD-C: assisted SL in the literature search and in the data analysis and reviewed the article. MS: performed the study selection and the risk-of-bias analysis with SL and reviewed the article. ML: assisted SL in the selection of the article especially regarding the ultrasound-guided lavage technique, assisted SL in the data analysis and reviewed the article. NJB: assisted SL in the selection of the article especially regarding the ultrasound-guided lavage technique, assisted SL in the data analysis and reviewed the article. J-OD: assisted SL to design the protocol and reviewed the article. J-SR: assisted SL to design the protocol and reviewed the article. FD: assisted SL in each step, managed the project and is the corresponding author.
Funding This article is part of a project supported by the Institut de recherche Robert-Sauvé en santé et sécurité au travail (IRSST). The grant number is 2016-0029. The project took place at Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center in Montreal, Quebec, Canada.
Competing interests All authors except NJB report grants from Institut de recherche Robert-Sauvé en santé et sécurité au travail (IRSST) during the conduct of the study which may be considered as a potential conflict of interest. However, since the IRSST is not a private company and does not have any financial interest in the treatment of shoulder disorders, this grant should not be considered as a conflict of interest. We still decided to declare this grant as a potential conflict of interest.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.