J Shoulder Elbow Surg (2015) 24, e104-e105
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Ultrasound-guided needling versus extracorporeal shock wave therapy Dear Editors: We appreciate the work done by Kim et al3 to evaluate the clinical and radiologic outcomes in their recent article, ‘‘Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy.’’ Kim et al published their paper in a time when there is an urgent need for high-level research comparing these 2 major treatment modalities, as advised in the conclusion of recently published systematic reviews.2,4 Previously, promising results after 1-year follow-up were published,1 but Kim et al provide Level I evidence with 2-year follow-up that ultrasound (US)-guided needling is a safe and effective way of restoring function and relieving pain in patients with calcific tendinopathy of the rotator cuff. The inclusion criteria of Kim et al were, however, less strict as it was not stated that all patients had a maximum conservative treatment (e.g., physiotherapy, subacromial infiltration, nonsteroidal anti-inflammatory drugs) before US-guided needling. Because there are patients in this group who would have responded well to any treatment (e.g., subacromial infiltration alone), not excluding these patients might have resulted in a better treatment response in the US-guided needling group. In the other group, extracorporeal shock wave therapy (ESWT) was administered for 3 sessions, 1 week apart, with 1000 impulses at an energy flux density of 0.36 mJ/ mm2, aiming for the maximum point of tenderness. The intensity of 0.36 mJ/mm2 is according to the current available evidence since the conclusion of recent metaanalyses4,6 is that, although there is no universal agreement concerning the thresholds of these subdivisions, high-level energy ESWT (>0.28 mJ/mm2) is more effective than lowlevel energy ESWT (
www.elsevier.com/locate/ymse
Ultrasound-guided needling versus extracorporeal shock wave therapy Dear Editors: We appreciate the work done by Kim et al3 to evaluate the clinical and radiologic outcomes in their recent article, ‘‘Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy.’’ Kim et al published their paper in a time when there is an urgent need for high-level research comparing these 2 major treatment modalities, as advised in the conclusion of recently published systematic reviews.2,4 Previously, promising results after 1-year follow-up were published,1 but Kim et al provide Level I evidence with 2-year follow-up that ultrasound (US)-guided needling is a safe and effective way of restoring function and relieving pain in patients with calcific tendinopathy of the rotator cuff. The inclusion criteria of Kim et al were, however, less strict as it was not stated that all patients had a maximum conservative treatment (e.g., physiotherapy, subacromial infiltration, nonsteroidal anti-inflammatory drugs) before US-guided needling. Because there are patients in this group who would have responded well to any treatment (e.g., subacromial infiltration alone), not excluding these patients might have resulted in a better treatment response in the US-guided needling group. In the other group, extracorporeal shock wave therapy (ESWT) was administered for 3 sessions, 1 week apart, with 1000 impulses at an energy flux density of 0.36 mJ/ mm2, aiming for the maximum point of tenderness. The intensity of 0.36 mJ/mm2 is according to the current available evidence since the conclusion of recent metaanalyses4,6 is that, although there is no universal agreement concerning the thresholds of these subdivisions, high-level energy ESWT (>0.28 mJ/mm2) is more effective than lowlevel energy ESWT (
