• calcific tendinopathy
• extracorporeal shockwave therapy
• rotator cuff
• shoulder pain
• ultrasound-guided percutaneous irrigation

• rotator cuff
• therapeutic irrigation
• tendinopathy
• shoulder
• systematic review

• Humans
• Calcinosis/therapy
• Calcinosis/diagnostic imaging
• Randomized Controlled Trials as Topic
• Rotator Cuff/diagnostic imaging
• Tendinopathy/therapy
• Tendinopathy/diagnostic imaging
• Therapeutic Irrigation/methods
• Ultrasonography, Interventional/methods

• Calcific tendinopathy
• Rotator cuff
• Shoulder calcification
• Supraspinatus tendon
• Ultrasound-guided-needling (UGN)

• Bianchi Martinoli
• Exercise
• LLLT
• Shoulder pain
• Ultrasound

• extracorporeal shockwave therapy
• orthoregeneration
• photobiomodulation therapy
• prolotherapy
• pulsed electromagnetic field therapy
• regenerative medicine therapies
• ultrasound therapy

• Arthritis
• Chondrocalcinosis
• Gout
• Ultrasonography

• Humans
• Calcium Phosphates/analysis
• Calcium Pyrophosphate/analysis
• Chondrocalcinosis/diagnostic imaging
• Chondrocalcinosis/diagnosis
• Crystal Arthropathies/diagnostic imaging
• Gout/diagnostic imaging
• Practice Guidelines as Topic
• Radiography
• Sensitivity and Specificity
• Tomography, X-Ray Computed/standards
• Ultrasonography/methods
• Ultrasonography/standards

• extracorporeal shock wave therapy
• rotator cuff calcific tendinopathy

• Humans
• Extracorporeal Shockwave Therapy
• Tendinopathy/therapy
• Calcinosis/therapy
• Rotator Cuff
• Quality of Life
• Randomized Controlled Trials as Topic
• Treatment Outcome

• exercise therapy
• patellar tendinopathy
• soft-tissue therapy

• extracorporeal shock wave therapy
• musculoskeletal conditions
• musculoskeletal pain

• diagnostic accuracy studies
• expert clinical practice
• rotator cuff
• shoulder
• tendinopathy/tendinitis

• Shoulder pain
• extracorporeal shockwave therapy
• tendinitis
• ultrasonography

Hydroxyapatite crystal deposition disease (HADD) around the hip is typically described involving the gluteal tendons. However, HADD can occur in any location and result in varied clinical presentations. Even with small deposits, symptoms can be significant and imaging findings may appear aggressive, mimicking infection and malignancy particularly when in an atypical location.

We illustrate cases of both common and rare locations of HADD around the hip, in particular presenting as greater trochanteric pain syndrome, piriformis syndrome and ischiofemoral impingement. The latter two manifestations have not been previously described in the literature.

Low signal deposits were identified on MRI at the greater trochanter (gluteus medius tendon), proximal piriformis (adjacent to the sciatic nerve), and quadratus femoris (in the ischiofemoral space), respectively. Associated inflammatory changes with tendinopathy, bursitis and oedema were also demonstrated. The patient with piriformis syndrome underwent steroid injections and shockwave therapy with significant symptom improvement.

HADD should be within the differential diagnosis for hip pain and nerve compression syndromes. Knowledge of tendon anatomy and correlation with radiographs or CT, even after MRI, is crucial in recognising unusual manifestations and preventing unnecessary investigation. Therefore, we review the spectrum of imaging features of HADD, as well as the current evidence on its management, to confidently diagnose this condition.

• anterior cruciate ligament reconstruction
• graft incorporation
• knee functions
• shockwave

• calcific tendinopathy
• calcific tendonitis
• evaluation
• treatment
• ultrasound

Tendinopathy is a chronic degenerative musculoskeletal disorder that is common in both athletes and the general population. Exercise and extracorporeal shockwave therapy (ESWT) is among the most common treatments used to mediate tendon healing and regeneration. The review presents the current understanding of mechanisms of action of ESWT and exercise in isolation and briefly synthesises evidence of their effectiveness for various tendinopathies. The central purpose of the review is to synthesize research findings investigating the combination of ESWT and exercise for five common tendinopathies (plantar heel pain, rotator cuff, lateral elbow, Achilles, and patellar tendinopathy) and provide recommendations on clinical applicability. Collectively, the available evidence indicates that ESWT combined with exercise in the form of eccentric training, tissue-specific stretching, or heavy slow resistance training are effective for specific tendinopathies and can therefore be recommended in treatment. Whilst there are at present a limited number of studies investigating combined EWST and exercise approaches, there is evidence to suggest that the combination improves outcomes in the treatment of plantar heel pain, Achilles, lateral elbow, and rotator cuff tendinopathy. However, despite overall positive outcomes in patellar tendinopathy, the combined treatment has not been shown at present to offer additional benefit over eccentric exercise alone.

• Shoulder
• extracorporeal shock wave
• tendinopathy
• ultrasonography

• Espasticidad
• Myofascial pain syndrome, Pressure ulcers
• Ondas de choque
• Ondas de presión radial
• Radial pressure waves
• Rehabilitación
• Rehabilitation
• Shockwaves
• Spasticity
• Síndrome miofascial
• Tendinopathy
• Tendinopatía
• Úlceras por presión

• Extracorporeal Shockwave Therapy
• High-Energy Shock Waves
• Humans
• Treatment Outcome

To critically appraise the quality of published systematic reviews (SRs) of randomised controlled trials (RCTs) in tendinopathy with regard to handling and reporting of results with special emphasis on strength of evidence assessment.

Medline from inception to June 2020.

All SRs of RCTs assessing the effectiveness of any intervention(s) on any location of tendinopathy.

Included SRs were appraised with the use of a 12-item tool devised by the authors arising from the Preferred Reporting Items in Systematic Reviews and Meta-Analyses statement and other relevant guidance. Subgroup analyses were performed based on impact factor (IF) of publishing journals and date of publication.

A total of 57 SRs were included published in 38 journals between 2006 and 2020. The most commonly used risk-of-bias (RoB) assessment tool and strength of evidence assessment tool were the Cochrane Collaboration RoB tool and the Cochrane Collaboration Back Review Group tool, respectively. The mean score on the appraisal tool was 46.5% (range 0%–100%). SRs published in higher IF journals (>4.7) were associated with a higher mean score than those in lower IF journals (mean difference 26.4%±8.8%, p=0.004). The mean score of the 10 most recently published SRs was similar to that of the first 10 published SRs (mean difference 8.3%±13.7%, p=0.54). Only 23 SRs (40%) used the results of their RoB assessment in data synthesis and more than half (n=30; 50%) did not assess the strength of evidence of their results. Only 12 SRs (21%) assessed their strength of evidence appropriately.

In light of the poor presentation of evidence identified by our review, we provide recommendations to increase transparency and reproducibility in future SRs.

• evidence based review
• tendinopathy
• tendon

Calcific tendinopathy of the rotator cuff is a common cause of shoulder pain and debility. Minimally invasive treatment options have been employed for management; however, ultrasonic tenotomy has not been previously described for management of calcific tendinopathy of the shoulder. The purpose of the current case series was to provide preliminary evidence in support of a novel treatment modality for calcific tendinopathy of the rotator cuff. This descriptive pilot case series included a total of 8 patients with calcific tendinopathy of the supraspinatus that underwent ultrasound-guided ultrasonic debridement in the sports medicine clinic. All procedures were performed by the same physician (JLE). All patients had confirmation of the diagnosis with MRI and ultrasound imaging. Pain was measured pre-procedure and followed until 3-months post-procedure. Very large, statistically significant, reductions (P < .01) in pain scores were observed at 1 (ES = 1.93), 2 (ES = 1.84) and 3 (ES = 2.20) months post-procedure, respectively. All patients experienced a significant reduction in pain scores, regardless of hardness of the calcium deposit, at 1 month post-procedure with pain scores remaining lower than at baseline at 2 and 3 months post-procedure. No adverse events were noted in any patients. Ultrasonic tenotomy and debridement appears to be a safe and effective treatment option for patients with calcific tendinopathy of the supraspinatus.

• calcific tendinitis
• percutaneous
• rotator cuff
• tendinopathy
• ultrasound-guided

To aid the interpretation of clinical outcome scores, it is important to determine the measurement properties. The aim of this study was to establish the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the Constant-Murley score and Disabilities of the Arm, Shoulder and Hand score in patients with long-lasting rotator cuff calcific tendinitis treated with high-energy extracorporeal shockwave therapy and ultrasound guided needling. The secondary purpose was to assess the responsiveness of both questionnaires and to identify variables associated with achieving the MCID and SCB.

A prospective cohort of 80 patients with rotator cuff calcific tendinitis was analyzed. Two anchor-based methods were used to calculate the MCID and SCB. Effect sizes and standardized response means were calculated to assess the responsiveness. Additional univariate logistic regression analyses were performed to identify factors associated with the achievement of the MCID and SCB.

For the Constant-Murley score, we found an MCID and SCB of 9.8 and 19.9, respectively, based on the mean change method and 5.5 and 10.5, respectively, based on receiver operating characteristic analysis. For the Disabilities of the Arm, Shoulder and Hand score, we found an MCID and SCB of –8.2 and –19.6, respectively, with the former and –11.7 and –12.5, respectively, with the latter. The responsiveness of both outcome measures was good, with large effect sizes and standardized response means. The radiographic resorption after 6 weeks and after 6 months appeared to be the most important positive predictor for achieving the MCID and SCB after 6 months.

This study established the MCID, SCB, and responsiveness for patients with long-lasting rotator cuff calcific tendinitis who were treated with minimally invasive treatment options. With this information, physicians can distinguish between a statistically significant difference and a clinically relevant benefit. Successful radiographic resorption after 6 weeks and after 6 months was associated with achieving clinically significant improvement after treatment.

• Rotator cuff calcific tendinitis
• minimal clinically important difference
• minimally invasive treatment
• outcome measures
• prognostic factors
• substantial clinical benefit

• Calcific aspiration
• Corticosteroid shoulder injection
• Rotator cuff tendinopathy
• Shoulder calcific
• Ultrasound guided irrigation and lavage

Rotator cuff calcific tendinopathy is characterised by the deposition of hydroxyapatite crystals in one of the rotator cuff tendons and can be managed by ultrasound-guided lavage. However, evidence regarding the efficacy of ultrasound-guided lavage for rotator cuff calcific tendinopathy remains inconclusive. The aim of this systematic review and meta-analysis is to update the available evidence on the efficacy of ultrasound-guided lavage in adults with rotator cuff calcific tendinopathy.

A literature search was conducted up to April 2018 in four bibliographic databases to identify randomised control trials that compared ultrasound-guided lavage alone with other interventions to treat rotator cuff calcific tendinopathy. Randomised control trials were assessed with the Cochrane Risk of Bias Tool. Meta-analyses and/or qualitative synthesis of the evidence were performed.

Three randomised control trials were included. Pooled results for pain (n=226) indicated that ultrasound-guided lavage may significantly decrease pain when compared with shockwave therapy, with a mean difference of −1.98 out of 10 points (95% CI −2.52 to −1.45) in the short term and of −1.84 (95% CI −2.63 to −1.04) in the long term. Based on one trial (n=25), ultrasound-guided lavage significantly improved function when compared with shockwave therapy (p<0.05). Based on another trial (n=48), the addition of ultrasound-guided lavage to a corticosteroid injection significantly improves function in the long term (p<0.05).

For individuals with rotator cuff calcific tendinopathy, low-quality evidence suggests that ultrasound-guided lavage is more effective than shockwave therapy or a corticosteroid injection alone. Future trials could modify the present conclusions.

CRD42018095858.

• hydroxyapatites and needling
• rotator cuff
• shoulder
• tendinopathy

• Calcific tendonitis
• Electroacupuncture
• Electrotherapy

• calcific tendonitis
• electroacupuncture
• electrotherapy
• medical treatment

A retrospective single centre cohort analysis was performed to evaluate an individualised radial extracorporeal shock wave therapy (rESWT) protocol for treatment of symptomatic calcific shoulder tendinopathy.

67 patients (79 Shoulders) were identified with 76 shoulders included for analysis. rESWT treatment protocol was adapted according to individual response to treatment. Variables included number of sessions, shockwave impulses, pressure and frequency. Success rate was estimated as the percentage of patients having ≥60% visual analogue score (VAS) pain decrease at follow-up. Recurrence at 1 year was recorded.

Using this individualised symptom guided protocol, patients underwent a mean of 7 ± 1.5 rESWT sessions, with mean pressure of 1.7 ± 0.2 bar, mean frequency of 5 ± 0.3 Hz and 2175 ± 266 impulses. The mean pre-treatment VAS score of 6.7 ± 1.1 was significantly decreased to 3.2 ± 0.8 immediately post-treatment, 2.6 ± 0.9 at 1 month, 1.7 ± 1.0 at 3 months and 0.8 ± 1.0 at 1 year follow up (α = 0.05). One-year success rate was estimated at 92% and 1-year recurrence rate was 7%.

We conclude that in this retrospective study an individualised rESWT protocol resulted in a high success rate with low number of recurrences. Randomised controlled trials to support these findings are recommended.

• ESWT
• Radial extracorporeal shockwave therapy
• Recurrence rate
• Symptomatic shoulder calcifying tendinopathy
• Treatment

For the treatment of calcific tendinitis of the shoulder a variety of treatment regimes exist. Commonly used treatment measures include medication with oral analgesics, corticosteroid injections, extracorporeal shockwave therapy, ultrasound guided needling and lavage, and surgical treatment. Earlier cohort studies suggest that patients may benefit from these treatments, but there are few randomized studies and conflicting evidence about the effectiveness of the various treatments. In the present study we aim to compare the effectiveness of ultrasound guided needling and lavage (barbotage) together with a steroid injection to sham barbotage with and without an additional steroid injection.

The study will be performed in six secondary-care institutions in Norway and Sweden. It is designed as a pragmatic, randomized, three-arm, parallel group, double-blinded, sham-controlled clinical trial with a 2-year follow-up. It will be performed on 210 patients, aged 30 years or older, presenting with painful arc, positive impingement sign and a calcium deposit > 5 mm. Randomization to one of the three treatment options will be performed by using an online central randomization system. The three treatment groups are barbotage together with a subacromial steroid injection (the barbotage group), sham barbotage together with a subacromial steroid injection (the steroid group) or sham barbotage without a subacromial steroid injection (the placebo group). In the placebo group the steroid injection will be replaced by a short-acting local anaesthetic. Standardized home-based post-treatment physiotherapy will be performed by all patients for 8 weeks. Follow-ups are at 2 and 6 weeks, 4, 8, 12 and 24 months after treatment was given and will be performed with the patients and the outcome assessors blinded for group assignment. Primary outcome will be the Oxford shoulder score at 4 month follow-up. Secondary outcome measures are the QuickDASH upper extremity score, the EQ-5D-5L general health score and visual analogue scales for pain at rest, during activity, and at night.

The scientific evidence from this placebo-controlled trial will be of importance for future treatment recommendations in patients with calcific tendinitis.

ClinicalTrials.gov: NCT02419040, registered 10 April 2015

EudraCT: 2015-002343-34, registered 23 September 2015 (retrospectively registered)

The online version of this article (doi:10.1186/s12891-017-1501-9) contains supplementary material, which is available to authorized users.

• Barbotage
• Calcific tendinitis
• Corticosteroids
• Placebo
• Sham treatment
• Ultrasound guided lavage

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Physical Examination/methods
• Prospective Studies
• Radiography/methods
• Rotator Cuff/diagnostic imaging
• Rotator Cuff Injuries/diagnostic imaging
• Shoulder/diagnostic imaging
• Shoulder Pain/diagnostic imaging
• Ultrasonography/methods
• Young Adult

• Health Research Council of New Zealand
• New Zealand Manipulative Physiotherapists Association
• Physiotherapy New Zealand

• arthroscopy
• athletes
• calcifying tendinitis
• return to sports
• rotator cuff

• CS
• Calcific tendinitis
• ESWT
• Extracorporeal shock wave therapy
• UGPL
• Ultrasound guide

• chronic non-cancer pain
• steroid injections
• nerve blocks
• epidurals
• intra-articular
• local anesthetic
• systematic review
• meta-analysis

• Adrenal Cortex Hormones
• Anesthetics, Local
• Chronic Pain/drug therapy
• Humans
• Randomized Controlled Trials as Topic
• Systematic Reviews as Topic
• Meta-Analysis as Topic

• Calcific tendenitis
• Classification
• Clinical picture
• Imaging
• Natural history
• Pathogenesis
• Prevalence
• Rotator cuff
• Treatment

• Calcific tendinopathy
• epidemiology
• prevalence
• risk factors
• subacromial pain syndrome