Background Shoulder calcified tendinitis can be a very disabling condition in some patients. Conservative pharmacological treatment with NSAIDs and steroid injections can be ineffective, and some patients can require surgery.
Objectives To evaluate the short- and long-term efficacy of percutaneous ultrasound-guided percutaneous aspiration or fragmentation in patients with shoulder calcified tendinitis, that had failed to NSAIDs and corticosteroid injections.
Methods From October 2009 to October 2014 all consecutive patients with shoulder calcification (≥1 cm) by X-ray who have chronic shoulder pain (VAS ≥5), and that had failed to treatment with NSAIDs and at least 1 local steroid injection were included. All included patients were treated by ultrasound-guided percutaneous aspiration or fragmentation of the calcification.
For this technique the patient was placed lying on his back on a stretcher, with his shoulder in neutral position or mild internal rotation. With a high-frequency probe (5-13 Mhz) of a Siemens Acuson Antares ultrasound, we localized the calcification, and after a local anaesthetic injection, we arbitrarily decided to perform aspiration or fragmentation of the calcification. Finally steroids were injected in the subdeltoid bursa in all patients. The efficacy on patient shoulder pain was assessed by VAS at baseline, 1, 3, 6, 12 and 24 months. A shoulder X-ray was performed before and 2-3 months after the technique.
Results Fifty-eight patients (39 women) were included. Mean age 49.2±8.7 years (range 29-66). Main duration of symptoms was 50.9±43.1 months. The baseline shoulder pain was 8.0±1.2. One month after the procedure 88% (51/58) of the patients had improved (VAS 2.0±2.3), and 19 patients had VAS=0, without any differences between the 2 techniques. Just 4 patients had not improved, and 3 patients had worsened. A complete disappearance of calcification was seen in 53% of the cases by X-ray. In 38% of the cases the calcification was markedly reduced, and less than 10% showed no changes in the size of the calcification.
At 3, 6, 12 and 24 months 52% (31/58), 37.5% (21/56), 30% (17/56) and 25% (14/55) of patients remained asymptomatic or just had minimal symptoms, without requiring other treatments.
We didn't observe any case of tendon rupture or other complications excepting self-limited local pain at 48-72 hours after the technique.
Conclusions Ultrasound-guided percutaneous aspiration or fragmentation seems to be an effective and safe option in patients with refractory shoulder calcified tendinitis.
Disclosure of Interest None declared