title: Treatment of shoulder calcifications of the cuff: a controlled study.
abstract: OBJECTIVE
  About 1 in 10 patients with shoulder calcifications complains of chronic pain. Removal techniques have been developed. We carried out the first randomized study to validate bursoscopy (BS) and (needling fragmentation irrigation) (NFI) versus a control group (CT).
  
  
  METHODS
  102 shoulders (96 patients) with calcifications >5 mm whose medical treatment had failed (>4 months) were first injected using a corticosteroid; 49 shoulders improved by more than 70%. The other 53 shoulders were randomized in 3 groups: NFI (n=16), BS (n=20), and CT (n=17). All patients were reviewed at T 1-4-12-24 months.
  
  
  RESULTS
  After 4 months, we observed respectively in groups NFI-BS-CT: 62%, 65% and 29% patients showing global improvements >70% (NFI vs CT: p=0.03; BS vs CT: p=0.02); -37%, -29% and -11% pain VAS variation (ns), +16%, +12% and -15% Constant score variation (NFI vs CT: p=0.03; BS vs CT: p=0.02), and -58%, -77% and +4% area calcification variation (NFI vs CT: p=0.005; BS vs CT: p=0.0002; BS vs NFI: p=0.01). After 24 months, results were maintained in NFI and BS groups, and in the CT group only 6/17 patients were still improved. There were no significant differences between NFI and BS groups. Three partial tears of the cuff were found using MRI in failures, (1 in each group).
  
  
  CONCLUSIONS
  NFI and BS are now validated removal techniques of shoulder calcifications when there is chronic pain and other medical treatments have failed. Results were maintained after 24 months, and were similar between NFI and BS. However NFI could be preferred because of its simplicity and low cost.
authors.affiliation: Department of Rheumatology, University Hospital, Nantes, France. yves.maugars@chu-nantes.fr
authors.forename: Yves
authors.initials: Y
authors.lastname: Maugars
authors.forename: Stéphane
authors.initials: S
authors.lastname: Varin
authors.forename: François
authors.initials: F
authors.lastname: Gouin
authors.forename: Dominique
authors.initials: D
authors.lastname: Huguet
authors.forename: Denis
authors.initials: D
authors.lastname: Rodet
authors.forename: Julien
authors.initials: J
authors.lastname: Nizard
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: N'Guyen
authors.forename: Pascale
authors.initials: P
authors.lastname: Guillot
authors.forename: Joëlle
authors.initials: J
authors.lastname: Glémarec
authors.forename: Norbert
authors.initials: N
authors.lastname: Passutti
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Berthelot
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D002114:Calcinosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017006:Rotator Cuff / Q000503:physiopathology*; D012785:Shoulder Joint / Q000503:physiopathology*; D020069:Shoulder Pain / Q000209:etiology; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome