US-guided therapy of calcific tendinopathy: clinical and radiological outcome assessment in shoulder and non-shoulder tendons.
OBJECTIVE
To analyze the effectiveness and complication rate of ultrasound (US)-guided perforation and lavage using a two-needle technique with 16 - 18 G needles in the treatment of patients with calcific tendinopathy in the shoulder, elbow, hip, and knee by radiological and clinical follow-up.


METHODS
A retrospective chart review was performed and 40 patients (13 male, 27 female; mean age, 53.5 years; range 24 -74 years) were identified as having received US-guided perforation and lavage due to symptomatic calcific tendinopathy of the rotator cuff tendons, triceps, extensor and flexor tendons at the elbow, rectus femoris tendon and patellar tendons. The radiographic outcome was assessed by comparison of the size and quality of the calcification before and 6 weeks after the procedure. On US images, the quality of the acoustic shadow was assessed, together with other alterations of the tendon and surrounding tissue. Patients were interviewed by telephone to assess the clinical outcome regarding pre-treatment and post-treatment pain and tendon function.


RESULTS
34 shoulder tendons and 6 non-shoulder tendons were identified. The mean calcium reduction was 39.9 mm(2) (range, 0 - 215; p < 0.001), while 80 % of patient showed a resolution of more than 60 % resulting in good clinical improvement. A very low complication rate was found (1 partial tear).


CONCLUSIONS
The US-guided perforation and lavage technique is an effective and safe treatment for rotator cuff calcifications as well as for other body tendons. Although the two-needle technique and large needles were used in this study, a very low complication rate was detected.
De Zordo
T
T
Radiology, Medical University Innsbruck, Innsbruck, Austria. Tobias.De-Zordo@i-med.ac.at
Ahmad
N
N
Ødegaard
F
F
Girtler
M-T
MT
Jaschke
W
W
Klauser
A S
AS
Chhem
R K
RK
Romagnoli
C
C
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D011677:Punctures / Q000295:instrumentation; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000601:surgery; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging* / Q000601:surgery*; D052256:Tendinopathy / Q000000981:diagnostic imaging* / Q000601:surgery*; D013710:Tendons / Q000000981:diagnostic imaging / Q000601:surgery; D007507:Therapeutic Irrigation; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*