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US-guided percutaneous irrigation of calcific tendinopathy of the rotator cuff in patients with or without previous external shockwave therapy

  • MUSCULOSKELETAL RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Objectives

To compare the outcome of US-guided percutaneous irrigation of calcific tendinopathy (US-PICT) of the rotator cuff in patients with or without previous external shockwave therapy (ESWT).

Methods

We analyzed all patients treated with US-PICT from March 1, 2016, to October 1, 2019, with shoulder pain refractory to conservative management for rotator cuff calcific tendinopathy, diagnosed with ultrasound. Each patient was examined using the Constant–Murley Score (CMS) questionnaire (score 0–100) before and after treatment. We tested CMS differences using the Mann–Whitney U (Wilcoxon rank-sum) test in the two groups. US-PICT was performed placing two or multiple 14G needles, according to the calcification size, inserted under US guidance to create a circuit of irrigation in the calcified tendon. NaCl solution at 38 °C was then injected from the entry needle in a variable amount to hydrate and fragment the calcification, finally allowing for its expulsion through the exit needle. All patients also received an intrabursal steroid injection.

Results

From 2016 to 2019, 72 US-PICT treatments were performed on 70 patients (females = 46; males = 26) with a mean age of 49.7 years (SD = 8.7. Thirty-three (47%) underwent previous ESWT, while thirty-seven (53%) had no previous treatments. No treatment-related complications were observed. Follow-up was averagely 14.4 months (median = 11.6, SD = 11.9, range 1–45); 37 patients had a follow-up shorter than 12 months (1–11.6); 35 patients were visited after more than 1 year (12.2–45.6, Table W). Before treatment, the mean CMS was 35 (SD = 21); after treatment, it reached 75.4, with an average CMS improvement of 40.3 points (SD = 23.7, p < 0.001). The comparison of improvement between the ESWT and non-ESWT group yielded no significant difference (p = 0.3).

Conclusions

US-PICT of the rotator cuff is an effective procedure to reduce shoulder pain and increase mobility in patients with calcific tendinopathy, both in short- and long-term time intervals. Previous unsuccessful ESWT does not affect the outcome of US-PICT.

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Authors and Affiliations

  1. Radiology Department, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy

    Ezio Lanza & Letterio Salvatore Politi

  2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

    Francesca Piccoli, Cristina Intrieri, Riccardo Muglia, Letterio Salvatore Politi & Alessandro Castagna

  3. Shoulder and Elbow Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy

    Mario Borroni & Alessandro Castagna

  4. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Luca Maria Sconfienza

  5. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Luca Maria Sconfienza

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  1. Ezio Lanza
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  2. Francesca Piccoli
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  3. Cristina Intrieri
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  8. Luca Maria Sconfienza
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Correspondence to Ezio Lanza.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Lanza, E., Piccoli, F., Intrieri, C. et al. US-guided percutaneous irrigation of calcific tendinopathy of the rotator cuff in patients with or without previous external shockwave therapy. Radiol med 126, 117–123 (2021). https://doi.org/10.1007/s11547-020-01229-4

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  • DOI: https://doi.org/10.1007/s11547-020-01229-4

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