Calcific tendinopathy of the shoulder: a cohort study of clinical management and scoping review of treatment options

Aim The James Lind Alliance (JLA) priority setting exercise for shoulder surgery identified a research need to define the role of early surgery in the management of newly diagnosed patients with calcific tendinopathy of the shoulder. This thesis will explore the current management of calcific tendinopathy in the shoulder within the National Health Service to inform design and delivery of a future trial to address this research priority. Method A multicentre retrospective cohort study has been used to establish the current management pathways and the treatment modalities that are in use. The cohort study also defined patient and disease characteristics and explored their relationship to treatment requirements. A systematic scoping review defines the primary evidence for treatment of calcific tendinopathy in the shoulder, and maps the use of outcome measures against core outcome domains in the assessment of treatment effectiveness. Results The cohort study demonstrated that following their introduction, musculoskeletal services now play a key role in managing these patients. Symptoms duration, size of calcium deposit, employment status at the time of treatment and concurrent diagnosis of malignancy may all influence treatment requirements. The scoping review has identified a sustained worldwide interest in the treatment of this condition, with a number of primary research studies published since 1990. There are a variety of published studies many of which have designs with a high risk of bias, and are conducted outside the United Kingdom (UK) with limitations in the generalisations of their conclusions to UK practice. Conclusions The JLA research priority question remains unanswered. The design of a future trial requires further work to define the detail of the study population and current nationwide practice, define the appropriate trial outcome measures and facilitate involvement of all healthcare settings and clinicians who currently contribute to the management of these patients.