Ultrasound-guided needling combined with shock-wave therapy for the treatment of calcifying tendonitis of the shoulder.
We carried out a prospective, randomised controlled trial on two groups of 40 patients with painful calcific tendonitis and a mean age of 48.4 years (32.5 to 67.3). All were to undergo arthroscopic removal of the calcific deposit within six months after randomisation. The 40 patients in group I received ultrasound-guided needling followed by high-energy shock-wave therapy and the 40 in group II had shock-wave therapy alone. In both groups one treatment consisting of 2500 impulses of shock waves with an energy flux density of 0.36 mJ/mm(2) was applied. The clinical and radiological outcome was assessed using the 100-point Constant shoulder scoring system and standardised radiographs. The mean follow-up was 4.1 months and no patient was lost to follow-up. Both groups had significant improvement in their Constant shoulder score. Radiographs showed disappearance of the calcific deposit in 60.0% of the shoulders in group I and in 32.5% of group II (p < 0.05). Significantly better clinical and radiological results were obtained in group I than in group II. Arthroscopic removal of the deposit was avoided in 32 patients of group I and in 22 of group II. No severe side-effects were recorded.Ultrasound-guided needling in combination with high-energy shock-wave therapy is more effective than shock-wave therapy alone in patients with symptomatic calcific tendonitis, giving significantly higher rates of elimination of the calcium deposits, better clinical results and reduction in the need for surgery.
Krasny
C
C
1st Department of Orthopaedic Surgery, Orthopaedic Hospital, Vienna-Speising, Speisingerstrasse 109, A-1134 Vienna, Austria. christian.krasny@oss.at
Enenkel
M
M
Aigner
N
N
Wlk
M
M
Landsiedl
F
F
D000328:Adult; D000368:Aged; D001182:Arthroscopy; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000000981:diagnostic imaging; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography