***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 determine the effectiveness of ultrasound-guided aspiration and lavage in the treatment of patients with calcific tendinosis of the shoulder . Material s and methods Retrospective chart review result ed in 44 patients who were identified as having received ultrasound-guided aspiration of calcific tendinosis of the shoulder between 2000 and 2003 . Of these , 36 patients were interviewed by telephone for pre- and posttreatment assessment of pain , shoulder function , prior shoulder surgery , injury , and prescribed treatment modalities with a follow-up time of 8 months to 3.1 years ( mean = 22.5 months ) . L’Insalata score , numeric rating scale ( NRS ) , and patient satisfaction score served as outcome measures . Results Our criteria for a successful outcome included ( 1 ) 12-point or greater improvement in the L’Insalata shoulder rating question naire , ( 2 ) 2-point or greater improvement in the NRS , ( 3 ) patient satisfaction rating of “ good ” , “ very good ” , or “ excellent ” , ( 4 ) patients ’ willingness to undergo the procedure again if they experienced recurrent symptoms , and ( 5 ) 1 month or less of analgesic medication use after the aspiration procedure . We determined that ultrasound-guided aspiration of calcific tendinosis of the shoulder result ed in a successful outcome for 75 % ( 27/36 ) of patients with a mean 20.2-point improvement in the L’Insalata shoulder rating question naire score and a mean 6.4-point improvement in the NRS ( p < 0.01 ) . Conclusion : This retrospective study suggests that ultrasound-guided aspiration and lavage of calcific shoulder deposits appears to be an efficacious therapeutic modality for treatment of calcific tendinosis . Further studies involving prospect i ve r and omized controlled trials would be helpful to further assess the long-term efficacy of this procedure as a minimally invasive treatment for calcific tendinosis of the shoulder A self-administered question naire was design ed to assess the severity of symptoms related to and the functional status of the shoulder . It includes domains of global assessment , pain , daily activities , recreational and athletic activities , work , satisfaction , and areas for improvement . Each domain is grade d separately and is weighted to arrive at the total score . The over-all scale and each domain were prospect ively tested for validity , reliability , and responsiveness to clinical change . One hundred patients who were seen for evaluation of the shoulder were enrolled in the study . The validity of the scale was demonstrated by moderate-to-high correlation of the domains and individual questions of the Shoulder Rating Question naire with those of the Arthritis Impact Measurement Scales 2 . Validity was supported further by significant correlation of the scores in each domain with the level of satisfaction in that domain and by significantly lower scores in domains that patients selected as areas important for improvement . The over-all scale and each domain were internally consistent ( Cronbach alpha , 0.71 to 0.90 ) . Reproducibility was evaluated by repeated administration of the question naire after a mean of three days to forty patients whose condition was clinical ly stable . Reproducibility of the over-all question naire and individual domains was excellent ( Spearman-Brown index , 0.94 to 0.98 ) . Individual questions were reproducible , with a weighted kappa value of more than 0.7 for each . Responsiveness was evaluated by comparison of the preoperative and postoperative scores of thirty patients who had a satisfactory result one year after an operation on the shoulder . The over-all Shoulder Rating Question naire and each domain were responsive to clinical change as demonstrated by favorable st and ardized response means ( range , 1.1 to 1.9 ) and indices of responsiveness ( range , 1.1 to 2.0 ) . Similar analysis performed for individual diagnostic groups supported the validity , reliability , and responsiveness of the question naire in each group . The self-administered shoulder question naire was found to be valid , reliable , and responsive to clinical change . These qualities should make it a useful instrument for the prospect i ve assessment of the outcome of treatment of disorders related to the shoulder CONTEXT Extracorporeal shock wave therapy ( ESWT ) has been used to treat calcific tendonitis of the shoulder , but trials of ESWT for this purpose have had method ological deficiencies and thus there is limited evidence for its effectiveness . OBJECTIVE To determine whether fluoroscopy-guided ESWT improves function , reduces pain , and diminishes the size of calcific deposits in patients with chronic calcific tendonitis of the shoulder . DESIGN , SETTING , AND PARTICIPANTS Double-blind , r and omized , placebo-controlled trial conducted between February 1997 and March 2001 among 144 patients ( of 164 screened ) recruited from referring primary care physicians , orthopedic surgeons , and sports physicians in 7 orthopedic departments in Germany and Austria . INTERVENTIONS Either high-energy ESWT , low-energy ESWT , or placebo ( sham treatment ) . The 2 ESWT groups received the same cumulative energy dose . Patients in all 3 groups received 2 treatment sessions approximately 2 weeks apart , followed by physical therapy . MAIN OUTCOME MEASURES The primary end point was the change in the mean Constant and Murley Scale ( CMS ) score from baseline to 6 months after the intervention . Secondary end points were changes in the mean CMS scores at 3 and 12 months , as well as changes in self-rated pain and radiographic change in size of calcific deposits at 3 , 6 , and 12 months . RESULTS Of 144 patients enrolled , all completed treatment as r and omized and 134 completed the 6-month follow-up . Both high-energy and low-energy ESWT result ed in significant improvement in the 6-month mean ( 95 % confidence interval [ CI ] ) CMS score compared with sham treatment ( high-energy ESWT : 31.0 [ 26.7 - 35.3 ] points ; low-energy ESWT : 15.0 [ 10.2 - 19.8 ] points ; sham treatment : 6.6 [ 1.4 - 11.8 ] points ; P<.001 for both comparisons ) . Patients who received high-energy ESWT also had significant 6-month CMS improvements compared with those who received low-energy ESWT ( P<.001 ) . We found similar results for both the 3-month and 12-month CMS comparisons , as well as for self-rated pain and radiographic changes at 3 , 6 , and 12 months . CONCLUSIONS Both high-energy and low-energy ESWT appeared to provide a beneficial effect on shoulder function , as well as on self-rated pain and diminished size of calcifications , compared with placebo . Furthermore , high-energy ESWT appeared to be superior to low-energy ESWT A prospect i ve quasir and omized study was performed to compare the effects of  surgical extirpation ( Group I , 29 patients ) 
    Output:
    
In all articles review ed , the authors reported a good clinical outcome , with many achieving marked improvement in clinical scores or overall satisfaction with the treatment .
Ultrasound-guided barbotage is a safe technique , with a high success rate and low complication rate .