Mitchell Simpson, Tania Pizzari, Tim Cook, Stuart Wildman, Jeremy Lewis
Melbourne Medical School, University of Melbourne, , 3010 Parkville, Australia . E-mail: mitchell.simpson92@gmail.com
DOI: 10.2340/16501977-2725

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.

Calcific tendinopathy of the shoulder is a relatively common condition, characterized by the presence of calcium deposits in the shoulder tendons, which may be associated with shoulder pain and dysfunction. To help guide the most appropriate treatment and future research in the area, a thorough review of the best available research was conducted. Overall, it was found that there is a lack of high-quality research in this area. Based on the current research, high-energy shockwave therapy and ultra-sound-guided needling appear to be the best treatment options available for reducing shoulder pain, improving shoulder function and reducing the size of calcium deposits in the shoulder tendons. However, with-out further high-quality research in this area, it is not possible to inform people seeking care which is the best management option.

Appendix S1-S5