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Is ultrasound-guided lavage an effective intervention for rotator cuff calcific tendinopathy? A systematic review with a meta-analysis of randomised controlled trials
  1. Simon Lafrance1,
  2. Patrick Doiron-Cadrin1,
  3. Marie Saulnier1,
  4. Martin Lamontagne2,3,
  5. Nathalie J Bureau3,4,
  6. Joseph-Omer Dyer5,
  7. Jean-Sébastien Roy6,7,
  8. François Desmeules1,5
  1. 1 Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Canada
  2. 2 Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Canada
  3. 3 University of Montreal Hospital Center Research Center (CRCHUM), Montreal, Canada
  4. 4 Department of Radiology, Oncology and Nuclear Medicine, Faculty of Medicine, University of Montreal, Montreal, Canada
  5. 5 School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada
  6. 6 Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
  7. 7 Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada
  1. Correspondence to Dr François Desmeules; f.desmeules{at}umontreal.ca

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.

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