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Ultrasound-guided percutaneous irrigation of calcific tendinopathy: redefining predictors of treatment outcome

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To identify prognostic factors affecting the clinical outcome in patients treated with rotator cuff ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT), by evaluating the degree of calcium removal, the size and consistency of calcific deposits, and baseline level of shoulder pain and functionality.

Methods

From January 2017 to December 2019, 79 patients (23 males, 56 females; mean age, 45.7 years) who underwent US-PICT were prospectively enrolled. The calcifications’ location, consistency, and size were evaluated. For US-PICT, local anesthesia, lavage of calcific material, and intrabursal steroid injection were performed. The degree of calcium removal was graded as total/partial. Shoulder pain and functionality were assessed with the visual analogue scale (VAS) in all and Constant score (CS) in a subset of patients, respectively, at 4 time-points. Mann-Whitney U test, Fisher’s test, and linear and binary logistic regression were utilized for analysis.

Results

Pain improvement correlated with the presence of larger calcifications and lower baseline VAS score, at 1 week (p = 0.001, p < 0.001, respectively) and 1 year (p < 0.001, p = 0.002, respectively). Improved functionality correlated with total calcification retrieval, higher baseline CS, and fluid/soft calcific consistency at 1 week (p = 0.013, p = 0.003, p = 0.019, respectively). Increased calcification size, cystic appearance, and lower baseline VAS scores independently predicted complete pain resolution at 1 year.

Conclusion

Large calcifications and low-grade pain at baseline correlated with short- and long-term pain improvement. The degree of calcium removal did not impact pain or functional improvement beyond 1 week. Increased calcification size, cystic appearance, and low-grade baseline pain predicted complete pain recovery at 1 year.

Key Points

• The presence of larger calcifications and lower-grade baseline pain appear to correlate with pain improvement at 1 week and 1 year after ultrasound-guided irrigation of rotator cuff calcific tendinopathy (US-PICT).

• Total calcification retrieval, less affected baseline shoulder functionality, and presence of fluid/soft consistency of calcific deposits appear to correlate with improved shoulder functionality at 1 week post-treatment.

• Baseline pain intensity and calcifications’ morphologic characteristics, but not the degree of calcium retrieval, represent predictors of complete pain recovery at 1 year after US-PICT.

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Abbreviations

CS:

Constant score

RC:

Rotator cuff

RCCT:

Rotator cuff calcific tendinopathy

SASD:

Subacromial-subdeltoid bursa

SD:

Standard deviation

US-PICT:

Ultrasound-guided percutaneous irrigation of calcific tendinopathy

VAS:

Visual analogue scale

References

  1. Speed CA, Hazleman BL (1999) Calcific tendinitis of the shoulder. N Engl J Med 340:1582–1584

    Article  CAS  Google Scholar 

  2. Merolla G, Bhat MG, Paladini P, Porcellini G (2015) Complications of calcific tendinitis of the shoulder: a concise review. J Orthop Traumatol 16:175–183

    Article  Google Scholar 

  3. Klontzas ME, Vassalou EE, Karantanas AH (2017) Calcific tendinopathy of the shoulder with intraosseous extension: outcomes of ultrasound-guided percutaneous irrigation. Skeletal Radiol 46:201–208

    Article  Google Scholar 

  4. Uhthoff HK, Loehr JW (1997) Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis, and management. J Am Acad Orthop Surg 5:183–191

    Article  CAS  Google Scholar 

  5. Gartner J, Heyer A (1995) Calcific tendinitis of the shoulder. Orthopade 24:284–302

    CAS  PubMed  Google Scholar 

  6. Louwerens JK, Sierevelt IN, van Hove RP, van den Bekerom MP, van Noort A (2015) Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. J Shoulder Elbow Surg 24:1588–1593

    Article  Google Scholar 

  7. Oliva F, Via AG, Maffulli N (2011) Calcific tendinopathy of the rotator cuff tendons. Sports Med Arthrosc Rev 19:237–243

    Article  Google Scholar 

  8. Bureau NJ (2013) Calcific tendinopathy of the shoulder. Semin Musculoskelet Radiol 17:80–84

    Article  Google Scholar 

  9. Sansone V, Maiorano E, Galluzzo A, Pascale V (2018) Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment. Orthop Res Rev 10:63–72

    PubMed  PubMed Central  Google Scholar 

  10. Chianca V, Albano D, Messina C et al (2018) Rotator cuff calcific tendinopathy: from diagnosis to treatment. Acta Biomed 89:186–196

    PubMed  PubMed Central  Google Scholar 

  11. Lanza E, Banfi G, Serafini G et al (2015) Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting. Eur Radiol 25:2176–2183

    Article  Google Scholar 

  12. Zhang T, Duan Y, Chen J, Chen X (2019) Efficacy of ultrasound-guided percutaneous lavage for rotator cuff calcific tendinopathy: a systematic review and meta-analysis. Medicine (Baltimore) 98:e15552

    Article  Google Scholar 

  13. Messina C, Banfi G, Orlandi D et al (2016) Ultrasound-guided interventional procedures around the shoulder. Br J Radiol 89:20150372

    Article  Google Scholar 

  14. Messina C, Sconfienza LM (2016) Ultrasound-guided percutaneous irrigation of calcific tendinopathy. Semin Musculoskelet Radiol 20:409–413

    Article  Google Scholar 

  15. Sconfienza LM, Adriaensen M, Albano D et al (2020) Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part I, shoulder. Eur Radiol 30:903–913

    Article  Google Scholar 

  16. Arirachakaran A, Boonard M, Yamaphai S, Prommahachai A, Kesprayura S, Kongtharvonskul J (2017) Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs. Eur J Orthop Surg Traumatol 27:381–390

    Article  Google Scholar 

  17. Kim YS, Lee HJ, Kim YV, Kong CG (2014) Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. J Shoulder Elbow Surg 23:1640–1646

    Article  Google Scholar 

  18. Orlandi D, Mauri G, Lacelli F et al (2017) Rotator cuff calcific tendinopathy: randomized comparison of US-guided percutaneous treatments by using one or two needles. Radiology 285:518–527.15

    Article  Google Scholar 

  19. Sconfienza LM, Bandirali M, Serafini G et al (2012) Rotator cuff calcific tendinitis: does warm saline solution improve the short-term outcome of double-needle US-guided treatment? Radiology 262:560–566

    Article  Google Scholar 

  20. Bazzocchi A, Pelotti P, Serraino S et al (2016) Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome. Br J Radiol 89:20150407

    Article  Google Scholar 

  21. del Cura JL, Torre I, Zabala R, Legórburu A (2007) Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results. AJR Am J Roentgenol 189:W128–W134

    Article  Google Scholar 

  22. Oudelaar BW, Huis In ‘t Veld R, Schepers-Bok R, Ooms EM, Nelissen RGHH, Vochteloo AJH (2020) Prognostic factors for the outcome of needle aspiration of calcific deposits for rotator cuff calcific tendinitis. Eur Radiol 30:4082–4090

    Article  Google Scholar 

  23. de Witte PB, van Adrichem RA, Selten JW, Nagels J, Reijnierse M, Nelissen RG (2016) Radiological and clinical predictors of long-term outcome in rotator cuff calcific tendinitis. Eur Radiol 26:3401–3411

    Article  Google Scholar 

  24. Pasquotti G, Faccinetto A, Marchioro U et al (2016) US-guided percutaneous treatment and physical therapy in rotator cuff calcific tendinopathy of the shoulder: outcome at 3 and 12 months. Eur Radiol 26:2819–2827

    Article  Google Scholar 

  25. Beggs I, Bianchi S, Bueno A et al (2016) Musculoskeletal ultrasound technical guidelines. I. Shoulder. https://essr.org/content-essr/uploads/2016/10/shoulder.pdf

  26. Martinoli C (2010) Musculoskeletal ultrasound: technical guidelines. Insights Imaging 1:99–141

    Article  Google Scholar 

  27. Orlandi D, Fabbro E, Mauri G, Savarino E, Serafini G, Sconfienza LM (2013) RE: a simple technique to restore needle patency during percutaneous lavage and aspiration of calcific rotator cuff tendinopathy. PM R 5:633

    Article  Google Scholar 

  28. Diercks R, Bron C, Dorrestijn O et al (2014) Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop 85:314–322

    Article  Google Scholar 

  29. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Google Scholar 

  30. Tashjian RZ, Deloach J, Porucznik CA, Powell AP (2009) Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg 18:927–932

    Article  Google Scholar 

  31. Aina R, Cardinal E, Bureau NJ, Aubin B, Brassard P (2001) Calcific shoulder tendinitis: treatment with modified US-guided fine-needle technique. Radiology 221:455–461

  32. Bradley M, Bhamna MS, Robson MJ (1995) Ultrasound guided aspiration of symptomatic supratendinous calcific deposits. Br J Radiol 68:716–719

    Article  CAS  Google Scholar 

  33. Rizzello G, Franceschi F, Longo UG et al (2009) Arthroscopic management of calcific tendinopathy of the shoulder–do we need to remove all the deposit? Bull NYU Hosp Jt Dis 67:330–333

    PubMed  Google Scholar 

  34. Serafini G, Sconfienza LM, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F (2009) Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial. Radiology 252:157–164

    Article  Google Scholar 

  35. Kirkley A, Griffin S, Dainty K (2003) Scoring systems for the functional assessment of the shoulder. Arthroscopy 19:1109–1120

    Article  Google Scholar 

  36. Chiou HJ, Hung SC, Lin SY, Wei YS, Li MJ (2010) Correlations among mineral components, progressive calcification process and clinical symptoms of calcific tendonitis. Rheumatology (Oxford) 49:548–555

    Article  CAS  Google Scholar 

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Medical Imaging, University of Crete, University Hospital of Heraklion, Voutes 71110, Heraklion, Crete, Greece

    Evangelia E. Vassalou, Michail E. Klontzas, Athena P. Plagou & Apostolos H. Karantanas

  2. Department of Medical Imaging, General Hospital of Sitia, Sitia, Crete, Greece

    Evangelia E. Vassalou

  3. Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece

    Michail E. Klontzas & Apostolos H. Karantanas

  4. Ultrasound Unit, Private Radiological Institution, Athens, Greece

    Athena P. Plagou

  5. Department of Radiology, Medical School-University of Crete, Heraklion, Greece

    Apostolos H. Karantanas

Authors
  1. Evangelia E. Vassalou
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  2. Michail E. Klontzas
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  3. Athena P. Plagou
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  4. Apostolos H. Karantanas
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Correspondence to Apostolos H. Karantanas.

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The scientific guarantor of this publication is Prof. Apostolos H. Karantanas.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• prospective

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• multicenter study

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Vassalou, E.E., Klontzas, M.E., Plagou, A.P. et al. Ultrasound-guided percutaneous irrigation of calcific tendinopathy: redefining predictors of treatment outcome. Eur Radiol 31, 2634–2643 (2021). https://doi.org/10.1007/s00330-020-07334-2

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  • DOI: https://doi.org/10.1007/s00330-020-07334-2

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