Ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a systematic review with meta-analysis of randomized controlled trials.
Cristiano Sconza, Valentina Palloni, Domenico Lorusso and 5 others
PMID 39382530WHAT IT FOUND
Ultrasound-guided lavage beats shock-wave therapy for pain at one year but not earlier, and clears calcium faster.
It is safe but not clearly superior to steroid injections or sham procedures. Evidence is very low, so do not expect this to resolve your patient's symptoms definitively.
Key findings
01Pooled analysis showed ultrasound-guided lavage was significantly better than extracorporeal shock-wave therapy for pain at 52 weeks, but there was no significant difference at 12 or 26 weeks.
02Ultrasound-guided lavage resulted in a significantly higher rate of complete calcification resorption compared to extracorporeal shock-wave therapy at less than 52 weeks.
03When compared to subacromial corticosteroid injection alone, adding lavage did not significantly improve pain at rest or in motion, nor did it improve function or quality of life at 52 weeks or 5 years.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The certainty of evidence for all pooled outcomes was rated as very low. High heterogeneity existed between studies, particularly regarding the timing of steroid injections (before or after lavage) and the specific protocols for ESWT. Several studies used multimodal approaches (UGL plus SCI), making it impossible to isolate the effect of the lavage alone. Risk of bias was high in several studies, particularly concerning outcome measurement and selection of reported outcomes. No data were available on range of motion or time to recovery, which are critical functional outcomes for therapists. Sample sizes for some comparisons were very small (e.g., only three studies pooled for pain).
Declared interests
The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
The easy way to misread this
Do not assume that faster calcification resorption leads to better pain or function. One study found that clinical benefit did not differ between patients whose calcium disappeared and those whose deposit remained unchanged, and UGL did not show clear superiority over steroid injections or sham procedures for symptom relief.