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

  • Musculoskeletal
  • Published:
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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.

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Acknowledgements

The scientific guarantor of this publication is Dr Luca Maria Sconfienza, MD PhD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because the review nature of the paper. Methodology: systematic review

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Authors and Affiliations

  1. Radiologia Oncologica ed Interventistica, Istituto Clinico Humanitas, Rozzano, Milano, Italy

    Ezio Lanza

  2. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Giuseppe Banfi

  3. Facoltà di Medicina e Chirurgia, Università Vita e Salute - San Raffaele, Milan, Italy

    Giuseppe Banfi

  4. Servizio di Radiologia, Ospedale Santa Corona, ASL 2 Savonese, Savona, Italy

    Giovanni Serafini & Francesca Lacelli

  5. Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Genoa, Italy

    Davide Orlandi

  6. Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Milano, Italy

    Michele Bandirali, Francesco Sardanelli & Luca Maria Sconfienza

  7. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy

    Francesco Sardanelli & Luca Maria Sconfienza

Authors
  1. Ezio Lanza
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  2. Giuseppe Banfi
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  3. Giovanni Serafini
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  4. Francesca Lacelli
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  5. Davide Orlandi
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  6. Michele Bandirali
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  7. Francesco Sardanelli
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  8. Luca Maria Sconfienza
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Correspondence to Luca Maria Sconfienza.

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Lanza, E., Banfi, G., Serafini, G. et al. Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting. Eur Radiol 25, 2176–2183 (2015). https://doi.org/10.1007/s00330-014-3567-1

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