Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting.

Abstract

OBJECTIVES:

We performed a systematic review of current evidence regarding ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in the shoulder aimed to: assess different published techniques; evaluate clinical outcome in a large combined cohort; and propose suggestions for homogeneous future reporting.

METHODS:

Cochrane Collaboration for Systematic Reviews of Interventions Guidelines were followed. We searched MEDLINE/MEDLINE In-Process/EMBASE/Cochrane databases from 1992-2013 using the keywords 'ultrasound, shoulder, needling, calcification, lavage, rotator cuff' combined in appropriate algorithms. References of resulting papers were also screened. Risk of bias was assessed with a modified Newcastle-Ottawa Scale.

RESULTS:

Of 284 papers found, 15 were included, treating 1,450 shoulders in 1,403 patients (females, n = 838; mean age interval 40-63 years). There was no exclusion due to risk of bias.

CONCLUSIONS:

US-PICT of rotator cuff is a safe and effective procedure, with an estimated average 55% pain improvement at an average of 11 months, with a 10% minor complication rate. No evidence exists in favour of using a specific size/number of needles. Imaging follow-up should not be used routinely. Future studies should aim at structural uniformity, including the use of the Constant Score to assess outcomes and 1-year minimum follow-up. Alternatives to steroid injections should also be explored.

KEY POINTS:

• US-PICT of rotator cuff is a safe and effective procedure. • On average 55% pain improvement with 10% minor complication rate. • No evidence exists in favour of using a specific size/number of needles. • Future need to assess outcome using Constant Score with 1-year minimum follow-up.

• Authors: Ezio Lanza, Giuseppe Banfi, Giovanni Serafini, Francesca Lacelli, Davide Orlandi, Michele Bandirali, Francesco Sardanelli, Luca Maria Sconfienza
• Journal: European radiology (Eur Radiol) Vol. 25 Issue 7 Pg. 2176-83 (Jul 2015) ISSN: 1432-1084 [Electronic] Germany
• PMID: 25583182 (Publication Type: Journal Article, Review, Systematic Review)

Topics

• Adult
• Calcinosis (diagnostic imaging, therapy)
• Epidemiologic Methods
• Female
• Humans
• Male
• Middle Aged
• Needles
• Rotator Cuff
• Tendinopathy (diagnostic imaging, therapy)
• Therapeutic Irrigation (instrumentation, methods)
• Ultrasonography, Interventional (instrumentation, methods)