Rotator cuff calcifications: treatment with ultrasound-guided percutaneous needle aspiration and lavage

Abstract

 Objective. To analyze the results of ultrasound (US)-guided needle puncture, aspiration and lavage in the treatment of symptomatic calcific tendinitis of the rotator cuff. Design and patients. Atraumatic pain in 61 shoulders of 58 patients was resistant to conservative therapy. The average age of the treated patients was 42 years (range 26–49 years), follow-up was 12 months, and the mean diameter of the calcifications was 1.6 cm (range 1.1–2.9 cm). With US guidance and local anesthesia, two needles were placed within each calcification. The calcification was punctured 10–15 times and saline solution injected and aspirated using the needles until the aspirate was free of calcific particles. Results and conclusions. Based on radiographs at 1 year follow-up, 74% (45 of 61) of the calcifications decreased, including 28% (17 of 61) which disappeared totally, and 26% (16 of 61) were unchanged. Calcifications with a faint or absent shadow on US proved to be nearly liquid (slurry calcification in 93% (14 of 15) of cases and could be aspirated. Clinical results were excellent in 74% (45 of 61), moderate in 16% (10 of 61) and poor in 10% (6 of 61) of cases. US offers technical advantages over fluoroscopy, and the typical US image of a slurry calcification helps to select the most suitable patients for aspiration treatment. The results are comparable with those using fluoroscopic guidance.