Effectiveness of non-surgical interventions for rotator cuff calcific tendinopathy: a systematic review

Abstract

Objective: To evaluate the effectiveness of non--surgical interventions for rotator cuff calcific tendinopathy. Data sources: Medline, EMBASE, CINAHL, Cochrane Register of Clinical Trials, PEDro and SPORTDiscus from inception to March 2018, and accompanying reference lists. Peer-reviewed randomized clinical trials of non-surgical interventions for adults with rotator cuff calcific tendinopathy were included. Data extraction: The same 2 reviewers independently evaluated eligibility, extracted data and evaluated risk of bias of the included randomized clinical trials. A system to resolve any disagreements was established a priori. Short-term, medium-term and long-term outcomes for pain, shoulder function and calcific morphology related to rotator cuff calcific tendinopathy were extracted. Due to diversity in outcome measures a meta-analyses was not conducted. Data synthesis: Of the 2,085 articles identified, 18 met the inclusion criteria, all of which had high risk of bias. Five non-surgical interventions were identified (extracorporeal shockwave therapy, ultrasound-guided percuta-neous intervention, pulsed ultrasound, acetic acid iontophoresis, and transcutaneous electrical nerve stimulat-ion). Conclusion: There was moderate evidence for the benefit of high energy extracorporeal shockwave therapy over low energy extracorporeal shockwave therapy for pain and function between 3 and 6 months follow-up, and benefit over placebo for improved function at up to 6 months follow-up. There was moderate evidence for the benefit of ultrasound-guided percutaneous intervention over medium/high-energy extracorporeal shockwave therapy for reduced pain and calcific morphology when followed up over a one-year period. Methodological concerns preclude definitive recommendations.