Rotator Cuff Calcific Tendinitis: Does Warm Saline Solution Improve the Short-term Outcome of Double-Needle US-guided Treatment?

Abstract

Purpose:To determine whether saline temperature infl uences procedure performance and outcome in patients undergoing ultrasonography (US)-guided lavage for the treatment of rotator cuff calcifi c tendinitis (RCCT). Materials and Methods:This study was approved by the institutional review board, and informed consent was obtained from all patients. , and analysis of variance tests. Results:Procedure duration was signifi cantly shorter ( P , .001) in patients treated with warm saline (mean, 576 seconds 6 121) than in those treated with room-temperature saline (mean, 777 seconds 6 151). Calcium dissolution was signifi cantly easier in patients treated with warm saline (median score, 1) than in those treated with roomtemperature saline (median score, 2). Subgroup analysis according to calcifi cation appearance at US showed a signifi cant difference between groups for both soft ( P = .003) and hard ( P , .001) calcifi cations. No overall signifi cant differences were found for VAS score (warm saline group: baseline = 8.9 6 0.6, 1 month = 4.7 6 0.6, 2 months = 4.0 6 0.7, 3 months = 3.4 6 0.4, 1 year = 3.0 6 0.7; roomtemperature saline group: baseline = 9.2 6 0.4, 1 month = 4.5 6 0.7, 2 months = 4.1 6 0.9, 3 months = 3.1 6 0.7, 1 year = 3.2 6 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 calcifi cation dissolution while reducing the frequency of postprocedural bursitis.q RSNA, 2011

Evaluation and Nonsurgical Management of Rotator Cuff Calcific Tendinopathy

“…They found shorter procedure time and easier dissolution of calcium deposits. 42 VAS was not different between saline temperature groups, but bursitis incidence was less in warm saline treated patients.…”

“…These techniques may utilize two needles 24,41,42 or one. [43][44][45][46][47][48] The technique is often performed as follows ( Fig.…”

“…24 The ability to aspirate calcium may be dependent on the phase of the calcification 24,43,44 , and deposit type might play a role in successful treatment. 47 The ability to remove more calcium during the procedure does not result in better pain relief 42 and a decrease in calcium deposit size is seen regardless of initial ability to remove all calcium from the deposit. 43,45 Removal of calcium may not even be necessary to provide pain relief.…”

Ultrasound-guided interventional procedures around the shoulder

“…12 According to the ultrasound appearance, calcific deposits can be classified as hard (hyper-reflexive nodule with a well-circumscribed dorsal acoustic shadow), soft (wellcircumscribed, homogeneous hyperechoic foci without posterior shadow) and fluid (hyperechoic peripheral rim with hypoechoic/anechoic centre). [15][16][17] Being a self-healing process, asymptomatic cases of calcific tendinopathy do not usually require treatment. In patients with mild symptoms, the disease can be managed conservatively with physical therapy and a short course of oral NSAIDs.…”

“…10,12 Percutaneous treatment is not indicated if the calcification is asymptomatic, is very small (,5 mm), has migrated into the bursal space or is eroding the humeral cortical bone. 26 Since the first study performed by Farin et al, different techniques and approaches have been reported in the literature 12,15,17,23,27,28 using one or two needles of different sizes to remove calcium. To date, no evidence exists in favour of using a specific size or number of needles.…”