***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    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 PURPOSE To evaluate clinical response to treatment of calcified tendinitis of the shoulder by using a modified percutaneous ultrasonography (US)-guided fine-needle technique . MATERIAL S AND METHODS Thirty shoulders of 30 consecutive patients ( 23 women , seven men ; mean age , 47.4 years ) with chronic shoulder pain ( average duration , 43.1 months ) refractory to medical treatment were treated percutaneously by using a fine needle and US guidance . Patients were prospect ively evaluated by using a shoulder pain and disability index consisting of 13 items and divided into two subcategories : pain and disability . The patient completed the question naire before the procedure and during the follow-up visit approximately 1 month later . A diagnostic US examination was also performed at that time . RESULTS There was a statistically significant improvement in the shoulder pain and disability index total score ( 27.0 % ) and the pain ( 30.5 % ) and disability ( 23.9 % ) scores . According to the index , these results indicate a significant clinical response . CONCLUSION This modified US-guided fine-needle technique for calcified tendinitis of the shoulder appears to be an effective therapy and was less aggressive than previously described percutaneous techniques PURPOSE To compare short- and long-term outcomes of patients with rotator cuff calcific tendonitis who did and did not undergo ultrasonographically (US)-guided percutaneous treatment .  MATERIAL S AND METHODS Institutional review board approval and informed patient consent were obtained . Of patients referred for US-guided treatment of rotator cuff calcific tendonitis , 219 ( 86 men , 133 women ; mean age , 40.3 years + /- 10.9 [ st and ard deviation ] ) were treated ; 68 ( 31 men , 37 women ; mean age , 40.2 years + /- 11.3 ) patients refused treatment and served as control subjects . After local anesthesia was induced , two 16-gauge needles were inserted into the calcific deposit . Saline solution was injected through one needle , and the dissolved calcium was extracted through the other needle . Shoulder joint function was assessed by using Constant scores , and pain was assessed by using visual analogue scale ( VAS ) scores . Mann-Whitney U and chi(2 ) tests were performed . RESULTS At baseline , no significant difference in age or sex distribution , Constant score , or VAS score was detected between treated and nontreated ( control ) patients . Compared with control subjects , treated patients reported a significant decrease in symptoms at 1 month ( mean Constant score , 73.2 + /- 6.2 vs 57.5 + /- 3.9 ; mean VAS score , 4.8 + /- 0.6 vs 9.1 + /- 0.5 ) , 3 months ( mean Constant score , 90.2 + /- 2.6 vs 62.6 + /- 7.2 ; mean VAS score , 3.3 + /- 0.4 vs 7.3 + /- 1.8 ) , and 1 year ( mean Constant score , 91.7 + /- 3.1 vs 78.4 + /- 9.5 ; mean VAS score , 2.7 + /- 0.5 vs 4.5 + /- 0.9 ) ( P < .001 ) . Symptom scores were not significantly different between the groups at 5 years ( mean Constant score , 90.9 + /- 3.6 vs 90.5 + /- 4.8 ; mean VAS score , 2.6 + /- 0.5 vs 2.8 + /- 0.7 ) ( P > or= .795 ) and 10 years ( mean Constant score , 91.8 + /- 5.0 vs 91.3 + /- 9.6 ; mean VAS score , 2.5 + /- 0.6 vs 2.7 + /- 0.6 ) ( P > or= .413 ) . CONCLUSION US-guided percutaneous treatment facilitated prompt shoulder function recovery and pain relief . Treated patients had better outcomes than did nontreated patients at 1 year . However , 5 and 10 years after the procedure , the nontreated group reported outcomes similar to those of the treated group OBJECTIVE The purpose of our study was to evaluate the short- and long-term effectiveness of sonographically guided percutaneous needle aspiration and lavage in calcific tendinitis of the shoulder and to study the progress of calcifications and symptoms in the first year after treatment . MATERIAL S AND METHODS Symptoms and radiologic findings after percutaneous aspiration of calcific tendinitis were prospect ively evaluated in the short and the long term using a shoulder pain and disability index , evaluation of shoulder motion , and a survey of the self-perception by the patients regarding the progress of their disease . RESULTS Sixty-seven consecutive shoulders were treated . A significant improvement was seen in shoulder motion , pain , and disability in the short term and in the long term ( p < 0.0001 ) . One year after treatment , 91 % of shoulders had substantially or completely improved , 64 % had perfect motion , and calcifications on radiography had resolved completely or nearly completely in 89 % . A transitory recurrence was observed approximately 15 weeks after treatment in 44.3 % of shoulders that improved . CONCLUSION Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder , with results similar to or better than those published for other techniques , and it is only slightly invasive and painful . Progress after treatment may include a transitory period of recurrence of the pain OBJECTIVE To define prognostic factors in chronically symptomatic patients with calcific tendinitis of the shoulder . METHODS We evaluated 420 patients ( 488 shoulders ) in the context of a prospect i ve cohort study . Epidemiologic data were assessed . The radiographic and sonographic appearance of the calcific deposits was classified . The mean period of nonoperative therapy was 4.4 years ( range 0.5 - 13.7 years ) . After referral to our institution , st and ardized nonoperative therapy was continued for a minimum of 3 months . Failure of nonoperative therapy was defined as the persistence of symptomatic calcific tendinitis of the shoulder after a minimum of 6 months . Prognostic factors ( determined at P < 0.05 by chi-square test ) were analyzed by logistic regression . RESULTS Of the 420 patients , 269 ( 64 % ) were women , 151 ( 36 % ) were men . The mean age of the patients was 51.3 years ( range 28 - 84 years ) .  Occurrence of calcific tendinitis of the shoulder was unilateral in 84 % and bilateral in 16 % . Gärtner type I calcific deposits were found in 37 % , type II in 32 % , and type III in 31 % . Failure of nonoperative therapy was observed in 114 patients ( 27 % ) . Negative prognostic factors were bilateral occurrence of calcific tendinitis of the shoulder , localization to the anterior portion of the acromion , medial ( subacromial ) extension , and high volume of the calcific deposit . Positive prognostic factors were a Gärtner type III deposit and a lack of sonographic sound extinction of the calcific deposit . CONCLUSION Our findings demonstrate the existence of prognostic factors in the nonoperative treatment of chronic symptomatic calcific tendinitis of the shoulder . Guidelines for optimal treatment can be implemented according to these factors to avoid a long-term symptomatic disease course PURPOSE To determine whether saline temperature influences procedure performance and outcome in patients undergoing ultrasonography (US)-guided lavage for the treatment of rotator cuff calcific tendinitis ( RCCT ) . MATERIAL S AND METHODS This study was approved by the institutional review board , and informed consent was obtained from all patients . From December 2009 to May 2011 , 462 patients ( 191 men and 271 women ; mean age , 39.7 years ) with painful RCCT diagnosed at US were prospect ively enrolled and r and omized into two groups . Operators subjectively classified calcifications as hard , soft , or fluid according to their appearance at US . US-guided percutaneous treatment of RCCT ( local anesthesia , double-needle lavage , intrabursal steroid injection ) was performed with warm saline ( 42 ° C , 107 ° F ) in 229 patients and with room-temperature saline in 233 . Operators and patients were not blinded to saline temperature . The ease of calcium dissolution was subjectively scored ( easy=1 , intermediate=2 , difficult=3 ) . Procedure duration was recorded . Patient discomfort was assessed by using a visual analog scale ( VAS ) . The occurrence of postprocedure bursitis was recorded . Statistical analyses were performed with Mann-Whitney U , χ2 , and analysis of variance tests . RESULTS Procedure duration was significantly shorter ( P<.001 ) in patients treated with warm saline ( mean , 576 seconds±121 ) than in those treated with room-temperature saline ( mean , 777 seconds±151 ) . Calcium dissolution was significantly easier in patients treated with warm saline ( median score , 1 ) than in those treated with room-temperature saline ( median score , 2 ) . Subgroup analysis according to calcification appearance at US showed a significant difference between groups for both soft ( P=.003 ) and hard ( P<.001 ) calcifications . No overall significant differences were found for VAS score  ( warm saline group : baseline=8.9±0.6 , 1 month=4.7±0.6 , 2 months=4.0±0.7 , 3 months=3.4±0.4 , 1 year=3.0±0.7 ; room-temperature saline group : baseline=9.2±0.4 , 1 month=4.5±0.7 , 2 months=4.1±0.9 , 3 months=3.1±0.7 , 1 year=3.2±0.8 ; P=.491 ) . Postprocedural bursitis was observed in eight patients in the warm saline group and 20 in the room-temperature saline group ( P<.022 ) . CONCLUSION In the treatment of RCCT , warm saline appears to reduce procedure duration and improve calcification dissolution while reducing the frequency of postprocedural bursitis HYPOTHESIS Needle lavage is frequently performed before consideration of surgical removal in shoulders with calcific tendinitis because this may avoid surgery . However , its role in nonoperative treatment has not been fully investigated in terms of clinical and radiographic response . We hypothesized that needle decompression and subacromial steroid injection would show good clinical results in chronic calcific tendinitis patients . MATERIAL S AND METHODS Thirty-five shoulders in 30 consecutive patients with painful calcific tendinitis were treated by ultrasound-guided needle decompression and subacromial corticosteroid injection . Patients were prospect ively evaluated using American Shoulder and Elbow Surgeons ( ASES ) and Constant scores at 1 , 3 , and 6 months after the intervention . Size and morphology of the calcific deposits were compared with those in baseline radiographs at each visit . RESULTS At 6 months after the index procedure , 25 shoulders ( 71.4 % ) showed ASES and Constant score improvements from 48.0 and 53.7 to 84.6 and 87.9 , respectively ( P < .01 ) . Ten shoulders ( 28.6 % ) showed no symptom relief at the last follow-up . In shoulders with pain improvement , the mean size of calcific deposits reduced from 13.6 to 5.6 mm ( P < .01 ) , and in shoulders with no pain improvement or that underwent operation , mean size was 13.1 mm at initial visits and 12.7 mm at final visits ( P = .75 ) . DISCUSSION Shoulders showing little evidence of deposit size reduction at 6 months after needle decompression are less likely to achieve symptomatic improvement and may be considered as c and i date s for surgical removal . CONCLUSION Needle decompression with subacromial steroid injection is effective in 71.4 % of calcific tendinitis within 6 months . The size of calcific deposits in patients that achieved symptom relief was reduced 
    Output:
    
Additional high- quality evidence is required to determine the relative efficacy of ultrasound-guided needle lavage in the management of calcific tendinitis of the rotator cuff