Efficacy of Conservative Approaches on Pain Relief and Function in Patients With Rotator Cuff Calcific Tendinopathy: Which Is the Best Option? A Systematic Review and Network Meta-Analysis.

Abstract

Objective: Rotator cuff calcific tendinopathy is a leading cause of nontraumatic shoulder pain, frequently leading to articular and functional impairments, depicting an adhesive capsulitis-like clinical presentation. To date, there is a lack of evidence on the impact of conservative approaches, and no gold standard has been established for managing rotator cuff calcific tendinopathy. This systematic review aimed to identify the most effective conservative approach for reducing pain and improving function in rotator cuff calcific tendinopathy patients.

Methods: PubMed, Scopus, and Cochrane Library databases were systematically searched from their inception until January 2, 2025, for English-language randomized clinical trials including adults affected by rotator cuff calcific tendinopathy undergoing conservative treatment. Data extraction was performed independently by two reviewers using a customized data extraction form, with consensus reached by a third reviewer. A network meta-analysis was subsequently carried out to compare the efficacy of different interventions. The risk of bias within the included randomized clinical trials was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials. The study has been registered with PROSPERO, registration number CRD420250650833.

Results: Nineteen articles were included. This study identified 1160 subjects affected by rotator cuff calcific tendinopathy. A pairwise comparison through a network meta-analysis indicated that platelet-rich plasma exhibited the highest probability (85%) of improving shoulder function, followed by disodium ethylenediamine tetra-acetic acid at 75%, aspiration techniques at 65%, and extracorporeal shockwave therapy at 57%. Regarding pain reduction, disodium ethylenediamine tetra-acetic acid showed the highest probability (66%), followed by kinesiotaping and needle aspiration, both at 61%.

Conclusion: This systematic review and network meta-analysis identified several interventional techniques, including platelet-rich plasma and disodium ethylenediamine tetra-acetic acid injections, extracorporeal shockwave therapy, and needle aspiration, as more effective strategies for reducing pain and improving function in subjects affected by rotator cuff calcific tendinopathy.

Level of evidence: I (systematic review of Level-I randomized controlled studies).