Best Practice Case Studies-Ultrasound Guided Lavage in the Shoulder

Pdf Summary

The systematic review conducted by Lafrance et al. examines the efficacy of ultrasound-guided lavage (UGL) as a treatment for rotator cuff calcific tendinopathy. This condition is characterized by the deposition of hydroxyapatite crystals in rotator cuff tendons, leading to shoulder pain and loss of function. The review analyzed three randomized controlled trials comparing the effects of UGL alone or with other interventions, against shockwave therapy or corticosteroid injections.<br /><br />Findings from the meta-analysis suggested that UGL combined with corticosteroid injections significantly reduced pain compared to shockwave therapy, both in the short and long term, showing clinically important effects. Moreover, one study indicated that UGL notably improved function when compared to shockwave therapy, specifically in the short term. Additionally, UGL also showed effectiveness in decreasing calcification size in affected tendons.<br /><br />Conversely, analysis of UGL versus corticosteroid injections showed that UGL was more beneficial in enhancing shoulder function, demonstrated through scores like the Western Ontario Rotator Cuff index and Constant-Murley Score, considered clinically meaningful. However, improvements in arm function, as measured by the Disability of the Arm, Shoulder, and Hand score, were insignificant.<br /><br />The review concluded that low-quality evidence supports UGL's superiority in managing rotator cuff calcific tendinopathy compared to shockwave therapy or corticosteroid injection alone. However, it emphasized the need for higher-quality trials to better ascertain UGL's benefits due to variations in study designs and the limited number of trials analyzed. Despite its limitations, UGL combined with corticosteroid injections has emerged as a promising treatment option, outperforming other therapies reviewed for chronic rotator cuff calcific tendinopathy.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 51

Topic Shoulder

Keywords

3rd Edition, CASE 51

3rd Edition

Shoulder

ultrasound-guided lavage

rotator cuff calcific tendinopathy

hydroxyapatite crystals

shoulder pain

corticosteroid injections

shockwave therapy

Western Ontario Rotator Cuff index

Constant-Murley Score

Disability of the Arm Shoulder and Hand score

meta-analysis