Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study

Abstract

Background: to evaluate the short and long term effectiveness of ultrasonography (US)-guided percutaneous needle lavage in calcific tendinopathy of the rotator cuff. To study the evolution of the size of calcifications and pain in the two years after treatment. Methods: study design: A 2 year longitudinal prospective study is carried out after applying the UGPL technique on a number of patients diagnosed with calcific tendinitis of the rotator cuff. Clinical, ultrasound and radiology follow-up controls were performed, 3 months, 6 months, one year and two years after the treatment. The Visual Analog Scale (VAS) was used to assess the pain. The degree and point of pain is selected on a 10 cm line, arranged horizontally or vertically. The "0" represents no pain and "10" represents worst pain. The population studied was made up of 121 patients that required our service as a result of suffering from a painful shoulder. Results: the pain (VAS) and the size of the calcification significantly decreased with the application of the technique (p< 0,001 in both cases) and regardless of the sex (p: 0.384 for pain and p: 0.578 for the size of the calcification). This occurred from the first checkup (3 months) and was maintained for two year. Conclusions: we consider this technique to be a valid alternative as a first-choice treatment of calcific tendinitis of the shoulder. The intervention is simple, cost-effective, does not require hospitalization , involves no complications, rehabilitation treatment is not required and it shows very few side effects without sequelae, significantly reducing the size of the calcification and pain in the majority of patients.

Rotator Cuff Calcific Tendinopathy: Randomized Comparison of US-guided Percutaneous Treatments by Using One or Two Needles

“…We acknowledge that forces exerted on calcifications with needles and syringes of different size are not equal; thus, this may be viewed as a limitation. However, 16-gauge needles were already used in conjunction with 20-mL syringes (2,5,28); similarly, 10-mL syringes were also used (26). Some authors used 20-22-gauge needles (15,17,21,25,26).…”

“…However, 16-gauge needles were already used in conjunction with 20-mL syringes (2,5,28); similarly, 10-mL syringes were also used (26). Some authors used 20-22-gauge needles (15,17,21,25,26). However, we chose to use an 18-gauge needle as a good compromise between 20-gauge and 16-gauge needles, because in our clinical experience (unpublished data), 20-22-gauge needles frequently get obstructed and remarkably increase procedure duration.…”

“…After clinical evaluation, to define the exact location and consistency of the to dissolve calcific deposits before aspiration. The main difference among procedures is the use of one needle (11,13,(15)(16)(17)(20)(21)(22)(23)(24)(25)(26) or two needles (2,5,12,18,19,27,28) to inject fluid and remove calcium, mainly based on authors' personal preference or on the idea that two needles may cause more damage to tendons than one. To date, to our knowledge, a direct comparison between the use of one or two needles has never been performed.…”

Outcomes of surgical repair of partial thickness rotator cuff tears in patients with calcific tendinitis

“…No statistically significant differences in outcomes of our series were found between the groups but patients of the suture repair group showed higher scores measured with patient-reported outcomes. Indications to rotator cuff tendon repair remain obscure: suture repair is advocated either for full thickness tear [15] or for Ellman grade 3 tears [1]. Suture repair in our series was produced for Ellman grades 2 and 3 tears.…”

“…9 % of deposits are reported to spontaneously resolve within 3 years [12], with resolution rate of 3 % of deposits per year [13]. About 90 % of patients with calcific tendinitis can be treated successfully nonoperatively using physical therapy, systematic NSAIDs, glucocorticoid injections and a variety of minimally invasive procedures [8,13,14,15,16,17,18].…”