***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: We carried out a prospect i ve , r and omised controlled trial on two groups of 40 patients with painful calcific tendonitis and a mean age of 48.4 years ( 32.5 to 67.3 ) . All were to undergo arthroscopic removal of the calcific deposit within six months after r and omisation . The 40 patients in group I received ultrasound-guided needling followed by high-energy shock-wave therapy and the 40 in group II had shock-wave therapy alone . In both groups one treatment consisting of 2500 impulses of shock waves with an energy flux density of 0.36 mJ/mm(2 ) was applied . The clinical and radiological outcome was assessed using the 100-point Constant shoulder scoring system and st and ardised radiographs . The mean follow-up was 4.1 months and no patient was lost to follow-up . Both groups had significant improvement in their Constant shoulder score . Radiographs showed disappearance of the calcific deposit in 60.0 % of the shoulders in group I and in 32.5 % of group II ( p < 0.05 ) . Significantly better clinical and radiological results were obtained in group I than in group II . Arthroscopic removal of the deposit was avoided in 32 patients of group I and in 22 of group II . No severe side-effects were recorded . Ultrasound-guided needling in combination with high-energy shock-wave therapy is more effective than shock-wave therapy alone in patients with symptomatic calcific tendonitis , giving significantly higher rates of elimination of the calcium deposits , better clinical results and reduction in the need for surgery BACKGROUND Knowledge about Minimal Important Differences ( MIDs ) is essential for the interpretation of continuous outcomes , especially patient-reported outcome measures ( PROMS ) . OBJECTIVE The aim of this study was to estimate the MID for the Western Ontario Rotator Cuff Index ( WORC : score 0 ( best ) to 2100 ( worst disability ) ) in adults with shoulder pain associated with partial-thickness rotator cuff tears , ' symptomatic PTTs ' , undergoing conservative treatment with physiotherapy . DESIGN A prospect ively- design ed anchor-based MID analysis using data from a prospect i ve prognostic study with a three-month follow-up conducted within an outpatient care setting in Germany . METHODS The MID was estimated using data from 64 adults with atraumatic symptomatic PTTs who underwent three months of conservative treatment with physiotherapy .  The anchor was a seven-point Global Perceived Change ( GPC ) scale . RESULTS Based on a definition of the MID being the threshold of " being ( at least slightly ) improved " with a probability nearest to 0.90 ( i.e. 9 of 10 patients achieving the MID ) , the MID for the WORC was estimated as -300 for ' improved ' shoulder-related disability in 9 out of 10 patients ( 95 % CI 8 out of 10 patients to everyone ) undergoing three months of exercise-based physiotherapy for symptomatic PTTs . CONCLUSIONS This is the first published MID estimate for the WORC in adults with symptomatic PTTs of the rotator cuff undergoing typical treatment comprising conservative treatment with physiotherapy . The conceptual framework for interpretation facilitates its use in similar clinical context Background : Barbotage ( needling and lavage ) is often applied in the treatment of calcific tendinitis of the rotator cuff ( RCCT ) . In a previously published r and omized controlled trial , we reported superior clinical and radiological 1-year outcomes for barbotage combined with a corticosteroid injection in the subacromial bursa ( SAIC ) compared with an isolated SAIC . There are no trials with a midterm or long-term follow-up of barbotage available . Purpose : To compare the 5-year results of 2 regularly applied treatments of RCCT : ultrasound (US)–guided barbotage combined with a SAIC ( group 1 ) versus an isolated US-guided SAIC ( group 2 ) . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Patients were r and omly assigned to group 1 or 2 and evaluated before and after treatment at regular time points until 12 months and also at 5 years using the Constant score ( CS ) , the Western Ontario Rotator Cuff Index ( WORC ) , and the Disabilities of the Arm , Shoulder and H and ( DASH ) . The calcification location and size and Gärtner classification were assessed on radiographs . The rotator cuff condition was evaluated with US . Results were analyzed using t tests , linear regression , and a mixed model for repeated measures . Results : Forty-eight patients were included ( mean age , 52.0 ± 7.3 years ; 25 [ 52 % ] female ) with a mean baseline CS of 68.7 ± 11.9 . After a mean follow-up of 5.1 ± 0.5 years , the mean CS was 90 ( 95 % CI , 83.0 - 95.9 ) in group 1 versus 87 ( 95 % CI , 80.5 - 93.5 ) in group 2 ( P = .58 ) . The mean improvement in the CS in group 1 was 18 ( 95 % CI , 12.3 - 23.0 ) versus 21 ( 95 % CI , 16.2 - 26.2 ) in group 2 ( P = .32 ) . There was total resorption in 62 % of group 1 and 73 % of group 2 ( P = .45 ) . The US evaluation of the rotator cuff condition showed no significant differences between the groups . With the mixed model for repeated measures , taking into account the baseline CS and Gärtner classification , the mean treatment effect for barbotage was 6 ( 95 % CI , –8.9 to 21.5 ) , but without statistical significance . Follow-up scores were significantly associated with baseline scores and the duration of follow-up . Results for the DASH and WORC were similar . There were no significant complications , but 4 patients in group 1 and 16 in group 2 underwent additional treatment during the follow-up period ( P < .001 ) . Conclusion : No more significant differences were found in the clinical and radiological outcomes between barbotage combined with a SAIC versus an isolated SAIC after 5 years of follow-up . Registration : NTR2282 ( Dutch Trial Registry ) OBJECTIVE Calcific tendonitis of rotator cuff is observed on plain radiographs in 10 % of adults , but remains asymptomatic in half these cases . We looked for differences on ultrasound ( US ) and power Doppler findings between symptomatic and asymptomatic cases of shoulder calcific tendonitis . METHODS US was performed in 62 patients ( 81 shoulders ) with symptomatic ( n=57 ) or asymptomatic ( n=24 ) calcific tendonitis . Calcific plaque morphology , power Doppler signaling , and widening of the subacromial-subdeltoid bursa ( SSB ) were recorded . US-guided steroid injection into the SSB ( n=21 ) or needle puncture of calcific deposits ( n=29 ) was performed at the end of US evaluation in 50 of the 57 patients , and a question naire was sent to each patient after 11+/-6 months . RESULTS Larger ( p=0.0015 ) and fragmented ( p=0.01 ) calcifications were associated with pain . A power Doppler signal and a widening of the SSB was identified in 21 and 17 of the 57 symptomatic calcification respectively , but in none of the cases of asymptomatic calcification ( p<0,005 ) . At least one of these signs was present in 31 of the 57 ( 54 % ) symptomatic shoulders ( p<0.001 ) . Long-term outcome was favourable for 60 % of our patients after steroid injection . The presence of a SSB widening before bursal steroid injection was associated with an improvement of the symptoms ( p=0.06 ) . CONCLUSION Positive power Doppler signal within the calcific deposit and SSB widening are US features strongly associated with pain . Moreover , larger calcifications are also more symptomatic . According to these results , US can help physicians to confirm that calcification is responsible for shoulder pain BACKGROUND Extracorporeal shockwave treatment ( ESWT ) and ultrasound-guided percutaneous lavage ( UGPL ) are two effective ways of treating rotator cuff calcific tendinopathy ( RCCT ) . AIM The aim of the present study was to compare the effectiveness of these techniques in the treatment of RCCT . DESIGN Prospect i ve , r and omized , controlled trial . SETTING Patients treated in our sports medicine and rehabilitation center ( Centro Médico Deyre , Madrid . Spain ) between January 2007 and December 2013 . METHODS This r and omized study compares the results achieved with these techniques over one year following their use to treat the above condition . Eighty patients received ESWT and 121 received UGPL .  A visual analogue scale was used to measure pain , and ultrasound to determine the extent of calcification , at 3 , 6 , and 12 months after treatment . RESULTS Pain and the amount of calcification were significantly reduced by both techniques at 3 , 6 and 12 months ( P<0.001 for each ) , but significantly more so by UGPL ( P<0.001 ) . CONCLUSIONS Both techniques are valid for the treatment of RCCT , although UGPL is associated with a greater reduction of calcification and greater reduction in pain . CLINICAL REHABILITATION IMPACT The results obtained applying UGPL , the low cost and the lack of complications should therefore make the treatment of choice in centers that are appropriately equipped and staffed HYPOTHESIS Ultrasound (US)-guided needling with subacromial corticosteroid injection is more effective than extracorporeal shock wave therapy ( ESWT ) for function restoration and pain relief in patients with calcific tendinitis of the shoulder . METHODS Fifty-four patients diagnosed with unilateral painful calcific tendinitis were r and omly allocated to a US needling or ESWT group . The US needling group underwent US-guided needling and received a subacromial corticosteroid injection . The ESWT group received ESWT 3 times a week . All patients were prospect ively evaluated ; American Shoulder and Elbow Surgeons , Simple Shoulder Test , and visual analog scale for pain scores were recorded before the procedure and at 6 weeks , 12 weeks , 6 months , 12 months , and the last follow-up . The size and morphology of the deposits were evaluated by radiography . RESULTS The average follow-up period was 23.0 months . At last follow-up , the mean size of the deposits was significantly different between the 2 groups ( P = .001 ) ; it decreased to 0.5 mm from 14.8 mm in the US needling group and to 5.6 mm from 11.0 mm in the ESWT group . There were also significant improvements in clinical outcomes in both groups after treatment ( P < .05 ) . At 1-year follow-up , the US needling group had significantly better scores than the ESWT group with regard to the American Shoulder and Elbow Surgeons assessment ( 90.3 and 74.6 , respectively ; P = .001 ) , Simple Shoulder Test ( 83.3 and 70.8 , respectively ; P = .015 ) , and visual analog scale for pain ( 1.4 and 3.3 , respectively ; P = .003).The initial calcium deposit sizes and clinical outcomes were weakly correlated in both groups ( P > .05 ) . CONCLUSION Both treatment modalities for calcific tendinitis improved clinical outcomes and eliminated calcium deposits . US-guided needling treatment , however , was more effective in function restoration and pain relief in the short term BACKGROUND The minimal clinical ly important difference ( MCID ) is increasingly used to evaluate treatment effectiveness . The MCID for the Constant score has not been previously reported . MATERIAL S AND METHODS A prospect ively collected cohort of 802 consecutive shoulders with arthroscopically treated partial- or full-thickness rotator cuff tears was analyzed . The Constant score was measured preoperatively and at 3 months and 1 year postoperatively . At follow-up visits , the patients were asked a simple 2-stage question : Is the shoulder better or worse after the operation compared with the preoperative state ? This single 2-level question was used as an indicator of patient satisfaction and as an anchor to calculate the  MCID  for the Constant score . RESULTS At 1 year , 781 ( 97.4 % ) patients ( 474 men , 307 women ) were available for follow-up . The preoperative Constant score was 53.1 ( SD 17.2 ) in all patients , 56.2 ( SD 17.4 ) in male patients , and 48.2 ( SD 15.6 ) in female patients . Postoperatively at 3 months , the scores were 61.7 ( SD 16.4 ) in all patients , 65.1 ( SD 16.1 ) in male patients , and 56.8 ( SD 15.5 ) in female patients . At 1 year , the scores were 75.9 ( SD 15.2 ) in all patients , 79.0 ( SD 14.9 ) in male patients , and 71.0 ( SD 14.3 ) in female patients . At 3 months postoperatively , 92.2 % of male patients and 87.2 % of female patients were satisfied with the outcome ( P = .027 ) ; at 1 year , the satisfaction was 93.2 % and 89.5 % , respectively ( P = .067 ) . Five different statistical approaches yielded 5 different MCID estimates ( range , 2 - 16 ) . The 3-month mean change estimate of MCID was 10.4 points . CONCLUSION Our study demonstrates an MCID estimate of 10.4 points as the 
    Output:
    
Conclusion For individuals with rotator cuff calcific tendinopathy , low- quality evidence suggests that ultrasound-guided lavage is more effective than shockwave therapy or a corticosteroid injection alone .