Comparative effectiveness of non-operative treatments for chronic calcific tendinitis of the shoulder: A systematic review and network meta-analysis of randomized-controlled trials

Publication date: Available online 8 April 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Yi-Cheng Wu, Wen-Chung Tsai, Yu-Kung Tu, Tung-Yang Yu
ObjectiveTo investigate the effectiveness of various non-operative treatments for chronic calcific tendinitis of the shoulder. A systematic review and network meta-analysis of randomized trials was performed to evaluate changes in pain reduction, functional improvements in patients with calcific tendinitis, and the ratio of complete resolution of calcific deposition.Data SourcesStudies were comprehensively searched, without language restrictions on PubMed, Embase, Cochrane Controlled Trials Register, the Cochrane and other databases. The reference lists of articles and reviews were cross-checked for possible studies.Study SelectionRandomized controlled trials from before August 2016 were included. Study selection was conducted by two reviewers independently.Data ExtractionThe quality of studies was assessed and data extracted by two independent reviewers. Disagreements were settled by consulting a third reviewer to reach a consensus.Data SynthesisFourteen studies with 1105 participants were included in the network meta-analysis that used a random-effect model to investigate the mean difference of pooled effect sizes of the visual analog scale, Constant-Murley score, and the ratio of complete resolution of calcific deposition on native radiographs.ConclusionsThe present network meta-analysis demonstrates that ultrasound-guided needling (UGN), radial extracorporeal shockwave (RSW), and high-energy focused extracorporeal shockwave therapy (H-FSW) alleviate pain and achieve complete resolution of calcium deposition. Compared with low-energy focused extracorporeal shockwave (L-FSW), transcutaneous electrical nerve stimulation (TENS), and ultrasound therapy, H-FSW is the best therapy for providing functional recovery. Physicians should consider UGN, RSW, and H-FSW as alternative effective therapies for chronic calcific tendinitis of the shoulder when initial conservative treatment fails.



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