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Reviewing the research: Treating calcific rotator cuff tendinitis

Ultrasound-guided management of calcific rotator cuff tendonitis is an effective treatment option

Serafini G, Sconfienza LM, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F.  Rotator Cuff Calcific Tendonitis:  Short-term and 10-year Outcomes After Two-Needle Ultrasound-guided Percutaneous Treatment.  Radiology. 252 (1), 2009;157-64.

 

Calcium deposits in the rotator cuff tendons of the shoulder are fairly common, occurring in about 5% of healthy shoulders.  70% of all cases involve women.  These deposits often occur in areas of the tendon where blood supply is not optimized, and it is thought that microinjury leads to abnormal tissue production, which triggers the calcification.  These deposits often eventually resolve – given enough time.  They sometimes become painful, however, ranging from aching at night to a gout-like reaction that limits any shoulder movement at all.  Patients with mild symptoms can be managed with anti-inflammatory medication or physical therapy.  Patients with more severe symptoms often require additional options.  In the past, treatment options for symptomatic calcific tendonitis have included dry needling under fluoroscopy, orthotripsy (use of high-intensity ultrasound to break up the deposits), steroid injection or surgery.  With the advent of office-based diagnostic ultrasound machines, the option of in-office tenotomy (injection of the tendon and retrieval of the calcium deposits) has become more feasible.  It has the potential advantage of less recovery time than surgery and greater treatment effectiveness than other conservative options.

This study looked at the effectiveness of ultrasound-guided tenotomy for the treatment of symptomatic calcific rotator cuff tendonitis in a group of 219 patients representing 235 treated shoulders.  Sixty-eight patients who presented for evaluation but declined to undergo the procedure served as controls.  Average patient age was 40.3 years.  Patients were excluded from the study if they presented with evidence of a rotator cuff tear or if they had previously been treated with orthotripsy, physical therapy or steroid injections.  Patient pain and function were assessed on validated shoulder symptom scores.

The treatment involved pre-procedure injection of local anesthetic for pain control, followed by advancement of needles into the calcified area under ultrasound guidance, with injection of local anesthetic into the deposit.  This serves to break up and dissolve the calcium, which can then be withdrawn through the syringe.  Because the escape of calcium crystals outside the wall of the calcium deposit can trigger a gout-like reaction, patients were given a steroid injection into the surrounding bursa to minimize the risk of developing this.  There were no immediate complications with the procedure.   About 11% of patients required a subsequent injection into the shoulder bursa – all within three months of the procedure.  The treatment itself did not cause any tearing in the rotator cuff.

Patients were followed for an average of 54 months, with pain score assessment at 1 month, 3 months, one year, five years and ten years.  Compared to controls, pain scores in the ultrasound-guided treatment group were better at one month, 3 months and one year follow-up.  There was no difference between groups at either five or ten years after the procedure.   Costs associated with ultrasound-guidance in this study were less than 5% of the costs for arthroscopic (surgical) treatment.

This study confirms the effectiveness of diagnostic ultrasound as a treatment approach that is comparable to arthroscopic surgery for painful calcific rotator cuff tendonitis.  Recovery time following this procedure is usually short, with a brief period of supervised physical therapy, followed by transition to a home-based rehab program.

If you are experiencing shoulder pain, call our office for an evaluation.  We’ll determine the appropriate treatment approach for you based on the diagnosis.

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