US-guided percutaneous treatment and physical therapy in rotator cuff calcific tendinopathy of the shoulder: outcome at 3 and 12 months

Pasquotti, Giulio; Faccinetto, Alex; Marchioro, U; Todisco, Matteo; Baldo, Vincenzo; Cocchio, Silvia; Conti, Giorgio

doi:10.1007/s00330-015-4102-8

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…When symptomatic, calcific tendinopathy can be treated with different approaches. Oral nonsteroidal anti-inflammatory drugs may be used to control low-grade symptoms, whereas extracorporeal shockwave therapy, surgery, or image-guided procedures can be used in advanced cases (35)(36)(37). Since its first description by Bradley et al in 1995 (15), US-guided percutaneous irrigation of calcific tendinopathy has been reported in several studies with slight variations among them (12,13).…”

Section: Treatment Results and Follow-upmentioning

confidence: 99%

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

Orlandi¹,

Mauri²,

Lacelli

et al. 2017

Radiology

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Purpose To determine whether the use of one or two needles influences procedure performance and patient outcomes for ultrasonography (US)-guided percutaneous irrigation of calcific tendinopathy. Materials and Methods Institutional review board approval and written informed patient consent were obtained. From February 2012 to December 2014, 211 patients (77 men and 134 women; mean age, 41.6 years ± 11.6; range, 24-69 years) with painful calcific tendinopathy diagnosed at US were prospectively enrolled and randomized. Operators subjectively graded calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous irrigation of calcific tendinopathy (local anesthesia, needle lavage, intrabursal steroid injection) was performed in 100 patients by using the single-needle procedure and in 111 patients by using the double-needle procedure. Calcium dissolution was subjectively scored (easy = 1; intermediate = 2; difficult = 3). Procedure duration was recorded. Clinical evaluation was performed by using the Constant score up to 1 year after the procedure. The occurrence of postprocedural bursitis was recorded. Mann-Whitney U, χ, and analysis of variance statistics were used. Results No difference in procedure duration was seen overall (P = .060). Procedure duration was shorter with the double-needle procedure in hard calcifications (P < .001) and with the single-needle procedure in fluid calcifications (P = .024). Ease of calcium dissolution was not different between single- and double-needle procedures, both overall and when considering calcification appearance (P > .089). No clinical differences were found (Constant scores for single-needle group: baseline, 55 ± 7; 1 month, 69 ± 7; 3 month, 90 ± 5; 1 year, 92 ± 4; double-needle group: 57 ± 6; 71 ± 9; 89 ± 7; 92 ± 4, respectively; P = .241). In the single-needle group, nine of 100 cases (9%) of postprocedural bursitis were seen, whereas four of 111 cases (3.6%) were seen in the double-needle group (P = .180). Conclusion The only difference between using the single- or double-needle procedure when performing US-guided percutaneous irrigation of calcific tendinopathy is procedure duration in hard and fluid calcifications. Clinical outcomes are similar up to 1 year. RSNA, 2017.

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Section: Treatment Results and Follow-upmentioning

confidence: 99%

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

Orlandi¹,

Mauri²,

Lacelli

et al. 2017

Radiology

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“…2 The choice of one needle is justified by the belief that using two needles may be risky to the tendon, but the safety and efficacy of the two-needle technique has been already shown up to 10 years. 9,20,25 Conversely, the twoneedle technique allows for creating a continuous inflow and outflow of saline solution to remove calcium and to control the saline pressure inside the calcification. This provides an escape for the fluid, avoiding possible disruption of the peripheral calcific rim.…”

Section: Needle Positioning and Irrigation Proceduresmentioning

confidence: 99%

“…Currently, ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) is accepted as the first-line safe and effective treatment for RCCT, with significant pain improvement and a very low rate of minor complications (vasovagal reaction, bursitis). [8][9][10] Compared with arthroscopy, US-PICT is less expensive and invasive, and it requires no hospitalization and little rehabilitation. 6 Keywords ► shoulder ► calcific tendinopathy ► rotator cuff ► ultrasound-guided procedures ► ultrasound-guided percutaneous irrigation…”

mentioning

confidence: 99%

Ultrasound-Guided Percutaneous Irrigation of Calcific Tendinopathy

Messina

Sconfienza

2016

Semin Musculoskelet Radiol

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Rotator cuff calcific tendinopathy (RCCT) is a common disease that may cause highly disabling shoulder pain. No treatment is required for asymptomatic calcifications; mild symptoms may be treated conservatively. Among several therapeutic options, ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) is currently accepted as the first-line safe and effective treatment for RCCT, with significant pain improvement and a very low rate of minor complications. Different approaches have been reported to dissolve calcified deposits, all including the use of a fluid (local anesthetic or saline solution) and the use of one or two needles to inject and retrieve the fluid/dissolved calcium. This review describes both one-needle and two-needle US-PICT techniques, providing technical and practical information that can improve daily clinical practice.

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“…Radiological characteristics of RCCT, including the number, size, appearance (Gärtner classification) and location of calcifications, have been associated with clinical outcome by some [ 3 , 23 ], but this association has been disputed by others [ 16 , 23 , 46 – 49 ]. There is also little knowledge of radiological calcification characteristics in large patient groups and their measurement properties, including reliability.…”

Section: Introductionmentioning

confidence: 99%

Radiological and clinical predictors of long-term outcome in rotator cuff calcific tendinitis

et al. 2016

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ObjectivesKnowledge on the epidemiology and long-term course of rotator cuff calcific tendinitis (RCCT) is scarce. We assessed demographics, radiological characteristics, and their association with long-term outcomes in a large patient group.MethodsBaseline demographics, radiological characteristics and treatment were recorded in 342 patients. Interobserver agreement of radiological measures was analyzed. Long-term outcome was evaluated with questionnaires (WORC, DASH). The association of baseline characteristics with outcome was assessed.ResultsMean age was 49.0 (SD = 10.0), and 59.5 % were female. The dominant arm was affected in 66.0 %, and 21.3 % had bilateral disease. Calcifications were on average 18.7 mm (SD = 10.1, ICC = 0.84 (p < 0.001)) and located 10.1 mm (SD = 11.8) medially to the acromion (ICC = 0.77 (p < 0.001)). Gärtner type I calcifications were found in 32.1 % (Kappa = 0.47 (p < 0.001)). After 14 years (SD = 7.1) of follow-up, median WORC was 72.5 (range, 3.0-100.0; WORC < 60 in 42 %) and median DASH 17.0 (range, 0.0-82.0). Female gender, dominant arm involvement, bilateral disease, longer duration of symptoms, and multiple calcifications were associated with inferior WORC. DASH results were similar.ConclusionsMany subjects have persisting shoulder complaints years after diagnosis, regardless of treatment. Female gender, dominant arm involvement, bilateral disease, longer duration of symptoms, and multiple calcifications were associated with inferior outcome. Radiological measures had moderate-to-good reliability and no prognostic value.Key Points• Most RCCT studies report on short-term outcome and/or small patients groups.• In this large, long-term observational study, RCCT appeared to not be self-limiting in many subjects.• Negative prognostic factors included female gender, more calcifications, dominant arm affected, and longer duration of symptoms.• Interobserver agreement of general radiological RCCT measures is moderate to good.• More rigorous diagnostics and treatment might be needed in specific RCCT cases.Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-016-4224-7) contains supplementary material, which is available to authorized users.

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US-guided percutaneous treatment and physical therapy in rotator cuff calcific tendinopathy of the shoulder: outcome at 3 and 12 months

Abstract: • US-guided tcreatment of shoulder calcific tendinopathy is an excellent therapeutic option • Long-term results seem greatly affected by patients' features and needs in everyday life • No proven pre- or intra-procedural parameters emerged that might predict the outcome.

Cited by 9 publications

References 20 publications

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

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

Ultrasound-Guided Percutaneous Irrigation of Calcific Tendinopathy

Radiological and clinical predictors of long-term outcome in rotator cuff calcific tendinitis

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