Study | Participants | Interventions | N | Outcome | Follow-up | Main results (95% CI) | Conflict of interest | Risk 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:
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:
| None | 43% |
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:
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 Association | 79% |
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:
Mean difference in score, US-guided lavage vs ESWT at 12 months:
| None | 43% |
*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.