Table 1

Characteristics of included studies

StudyParticipantsInterventionsNOutcomeFollow-upMain results (95% CI)Conflict of interestRisk of bias
De Boer et al 201718 Adults with chronic shoulder pain (more than 6 months), confirmed calcification in the RC tendons on radiography, previously failed conservative treatment, mean age=53 (48% female)Intervention: US-guided lavage with aspiration and a corticosteroid injection (1 mL of Depo-Medrol 40 mg/mL and lidocaine 1%)
Control: RSWT (4 sessions over 4 weeks)
11
14
Pain (NRS)
OSS
CMS
6 weeks and
12 months
Mean difference in score, US-guided lavage vs RSWT at 6 weeks:
  • Pain (NRS): −1.60 (−3.75 to 0.55) p=0.14

  • OSS: 2.30 (−7.74 to 12.34) p=0.65

  • CMS: 11.70 (0.01 to 23.39) p=0.05*


Mixed model showed a significant interaction for CMS at 6 weeks in favour of US-guided lavage (p=0.02)*
Mean difference in score, US-guided lavage vs RSWT at 12 months:
  • Pain (NRS): −0.20 (−3.84 to 3.44) p=0.91

  • OSS: 4.10 (−15.01 to 23.21) p=0.67

None43%
de Witte et al 2013 and 201716 Adults (18 to 65 years old) with chronic shoulder pain (more than 3 months), confirmed calcification of more than 3 mm in the RC tendons on radiography, previously failed conservative treatment, mean age=52.0±7.3 (52% female)Intervention: US-guided lavage with aspiration and a corticosteroid injection (5 mL of bupivacaine 5 mg/mL, 1 mL of Depo-Medrol 40 mg/mL and lidocaine 1%)
Control: corticosteroid injection (same as group 1)
23
25
Calcification size
CMS
WORC
DASH
6 weeks,
3 months,
6 months,
12 months and
60 months
In mixed-model analysis, the mean overall effect of US-guided lavage on final score:
  • CMS: 17.9 (2.0 to 33.7)*

  • WORC: 33.1 (8.1 to 58.0)*

  • DASH: no significant effect


Mean difference in change-from-baseline US-guided lavage vs corticosteroid injection at 12 months:
Calcification size (mm): −6.50 (−9.94 to −3.06) p<0.01*
This study is part of a larger project funded by ZonMw, the Netherlands Organisation for Health Research and Development (NOW) and the Dutch Arthritis Association79%
Del Castillo-Gonzalez et al 201620 Adults with chronic shoulder pain (more than 6 months), confirmed calcification of at least 5 mm in the RC tendon by clinical examinations, radiography and ultrasound, mean age=49±7 (68% female)Intervention: US-guided lavage with aspiration and a corticosteroid injection (10 mL of mepivacaine 2% and 2+5 mL of triamcinolone)
Control: ESWT (8 sessions over 4 weeks)
121
80
Pain (VAS)
Calcification size
3 months,
6 months and
12 months
Mean difference in score, US-guided lavage vs ESWT at 3 months:
  • Pain (VAS): US-guided lavage: −2.01 (−2.56 to −1.46) p<0.01*

  • Calcification size (mm): −2.03 (−3.26 to −0.80) p<0.01*


Mean difference in score, US-guided lavage vs ESWT at 12 months:
  • Pain (VAS): −1.92 (−2.73 to −1.11) p<0.01*

  • Calcification size (mm): −3.11 (−4.53 to −1.69) p<0.01*

None43%
  • *Statistically significant p≤0.05.

  • CMS, Constant-Murley Score; DASH, Disability of the Arm, Shoulder and Hand; ESWT, extracorporeal shockwave therapy; NRS, numerical rating scale; OSS, Oxford Shoulder Score; RC, rotator cuff; RSWT, radial shockwave therapy; UGL, ultrasound-guided lavage; VAS, Visual analogue scale; WORC, Western Ontario Rotator Cuff.