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Clinical outcomes of ultrasound-guided aspiration and lavage in calcific tendinosis of the shoulder.

ABSTRACT: OBJECTIVE: To determine the effectiveness of ultrasound-guided aspiration and lavage in the treatment of patients with calcific tendinosis of the shoulder. MATERIALS AND METHODS: Retrospective chart review resulted 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 questionnaire, (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 resulted in a successful outcome for 75% (27/36) of patients with a mean 20.2-point improvement in the L'Insalata shoulder rating questionnaire 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 prospective randomized 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.

SUBMITTER: Lin JT

PROVIDER: S-EPMC2504102 | biostudies-other | 2007 Feb

REPOSITORIES: biostudies-other

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Project description:Calcific tendinopathy of the shoulder (CTS) is the most common cause of shoulder pain. Conservative treatment is considered as the first therapeutic choice for CTS. The main objective of this study was to assess the effect of US-guided needling (UGN) compared to UGN plus Biocompatible Electrical Neurostimulation (BEN) in the treatment of the CTS. Pilot, prospective, non-interventional, monocentric, and observational study of patients treated for calcific rotator cuff tendinopathy and shoulder pain. Patients' selection, enrollment and interventions were conducted at the Chiparo Physical Medicine and Rehabilitation outpatient facility. Forty adult patients (aged 40-60 years) with a diagnosis of CTS in the acute and colliquative phase were recruited and enrolled into the study. Participants were assessed for self-perceived pain through the Numerical Rating Scale (NRS), and for functional limitation through the Shoulder Pain and Disability Index score (SPADI) at baseline (T0), after 15 days (T1), and after 40 days (T2). As a possible confounding factor between the two treatments' response, the dimension of the tendon calcification was also assessed by US-examination. Through the study, both groups improved their perceived functional performance of the arm (p-value < 0.001). AT T1, the SPADI score decreased by half in both groups, and the improvement remained stable at T2. A multiplicative effect (Time × Treatment) was demonstrated (p-value < 0.001). An improvement in the NRS score was measured at T1, and it remained stable at T2, a multiplicative effect was also reported (p-value < 0.001). The main results of this pilot study provide evidence that UGN plus BEN increases functional performance and reduces shoulder pain in individuals with CTS. Moreover, the tendon calcification dimension at the baseline and the percentage of drainage of the lesion were associated with a functional performance recovery and pain reduction detected after intervention.

Project description:BackgroundCalcific shoulder tendinitis (CST) is characterized by hydroxyapatite crystals deposition in the rotator cuff tendons. Therapeutic exercises have been the mainstay of CST treatment, and evidence for therapeutic ultrasound (T-US) utilization and efficacy is lacking.AimThis study aimed to determine whether 4500 J T-US combined with therapeutic exercises is superior to therapeutic exercises alone regarding calcification size reduction and symptom improvement in chronic symptomatic CST.DesignThis is a double-blind, placebo-controlled study.SettingThis study was conducted at a University Department for Rheumatic Diseases and Rehabilitation of a University Hospital.PopulationPatients with chronic CST were analyzed.MethodsAfter eligibility allocation, 46 patients with sonographically confirmed CST were divided into two groups (56 shoulders, 26 per group). Both groups performed the same therapeutic exercises for half an hour under physiotherapist supervision. In the treatment group T-US (4500 J, 10 minutes per session at a frequency of 1 MHz and an intensity of 1.5 W/cm2), and in the placebo group, sham T-US was applied for 4 weeks. Patients were assessed for: calcification size, shoulder pain, global health (GH), shoulder mobility (ROM), handgrip strength, Health Assessment Questionnaire Disability Index (HAQ-DI), Shoulder Pain and Disability Index (SPADI), and overall rehabilitation satisfaction.ResultsAll assessed variables improved in both groups. A significantly greater reduction in calcification size was recorded in the treatment group compared to placebo: -10.92% (IQR 4.61% to 19.38%) versus -5.04% (2.30% to 7.22%), P=0.008. There was a significantly greater decrease in HAQ-DI, reduction of VAS GH, and an increase in hand grip strength in the treatment group, while no significant differences were observed for other parameters between the groups.ConclusionsOur results showed that adding the 4500 J T-US to therapeutic exercises in chronic symptomatic CST therapy resulted in greater calcification size reduction immediately following the treatment, as well as hand grip strength, HAQ-DI, and VAS GH improvement.Clinical rehabilitation impact4500 J T-US combined with therapeutic exercises is more effective in reducing calcification size than therapeutic exercises alone in the treatment of chronic symptomatic CST.

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Clinical outcomes of ultrasound-guided aspiration and lavage in calcific tendinosis of the shoulder.

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