Comparative Effectiveness of Nonoperative Treatments for Chronic Calcific Tendinitis of the Shoulder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

  • Yi-Cheng Wu
    Affiliations
    Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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  • Wen-Chung Tsai
    Affiliations
    Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

    College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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  • Author Footnotes
    ∗ Tu and Yu contributed equally to this work.
    Yu-Kung Tu
    Footnotes
    ∗ Tu and Yu contributed equally to this work.
    Affiliations
    Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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  • Author Footnotes
    ∗ Tu and Yu contributed equally to this work.
    Tung-Yang Yu
    Correspondence
    Corresponding author Tung-Yang Yu, MD, No. 5, Fuxing St, Guishan Dist, Taoyuan City 333, Taiwan.
    Footnotes
    ∗ Tu and Yu contributed equally to this work.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

    Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
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  • Author Footnotes
    ∗ Tu and Yu contributed equally to this work.
Published:April 08, 2017DOI:https://doi.org/10.1016/j.apmr.2017.02.030

      Abstract

      Objective

      To investigate the effectiveness of various nonoperative 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 Sources

      Studies 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 Selection

      Randomized controlled trials from before August 2016 were included. Study selection was conducted by 2 reviewers independently.

      Data Extraction

      The quality of studies was assessed and data extracted by 2 independent reviewers. Disagreements were settled by consulting a third reviewer to reach a consensus.

      Data Synthesis

      Fourteen 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.

      Conclusions

      The present network meta-analysis demonstrates that ultrasound-guided needling (UGN), radial extracorporeal shockwave therapy (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 therapy, transcutaneous electrical nerve stimulation, 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.

      Keywords

      List of abbreviations:

      CI ( confidence interval), CMS ( Constant-Murley Score), CrI ( credible interval), ESWT ( extracorporeal shockwave therapy), FSW ( focused extracorporeal shockwave therapy), H-FSW ( high-energy focused extracorporeal shockwave therapy), L-FSW ( low-energy focused extracorporeal shockwave therapy), RSW ( radial extracorporeal shockwave therapy), TENS ( transcutaneous electrical nerve stimulation), UGN ( ultrasound-guided needling), VAS ( visual analog scale)
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