title: Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids.
abstract: BACKGROUND
  Calcific tendinitis of the rotator cuff (RCCT) is frequently diagnosed in patients with shoulder pain, but there is no consensus on its treatment.
  
  
  OBJECTIVE
  To compare 2 regularly applied RCCT treatments: ultrasound (US)-guided needling and lavage (barbotage) combined with a US-guided corticosteroid injection in the subacromial bursa (subacromial bursa injection [SAI]) (group 1) versus an isolated SAI (group 2).
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 1.
  
  
  METHODS
  Patients were randomly assigned to the 2 groups. Shoulder function was assessed before treatment and at regular follow-up intervals (6 weeks and 3, 6, and 12 months) using the Constant shoulder score (CS, primary outcome), the Western Ontario Rotator Cuff Index (WORC), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Additionally, calcification location, size, and Gärtner classification were assessed on radiographs. Results were analyzed using the t test, linear regression, and a mixed model for repeated measures.
  
  
  RESULTS
  This study included 48 patients (25 female, 52.1%; mean age, 52.0 ± 7.3 years; 23 patients in group 1) with a mean baseline CS of 68.7 ± 11.9. No patients were lost to follow-up. Four patients in group 1 and 11 in group 2 (P = .06) had an additional barbotage procedure or surgery during the follow-up period because of persisting symptoms and no resorption. At 1-year follow-up, the mean CS in group 1 was 86.0 (95% CI, 80.3-91.6) versus 73.9 (95% CI, 67.7-80.1) in group 2 (P = .005). The mean calcification size decreased by 11.6 ± 6.4 mm in group 1 and 5.1 ± 5.7 mm in group 2 (P = .001). There was total resorption in 13 patients in group 1 and 6 patients in group 2 (P = .07). With regression analyses, correcting for baseline CS and Gärtner type, the mean treatment effect was 20.5 points (P = .05) in favor of barbotage. Follow-up scores were significantly influenced by baseline scores. Results for the DASH and WORC were similar.
  
  
  CONCLUSIONS
  On average, there was improvement at 1-year follow-up in both treatment groups, but clinical and radiographic results were significantly better in the barbotage group.
authors.affiliation: Department of Orthopaedics, Leiden University Medical Center, Postzone J11R, Postbus 9600, 2300 RC Leiden, the Netherlands. p.b.de_witte@lumc.nl
authors.forename: Pieter Bas
authors.initials: PB
authors.lastname: de Witte
authors.forename: Jasmijn W
authors.initials: JW
authors.lastname: Selten
authors.forename: Ana
authors.initials: A
authors.lastname: Navas
authors.forename: Jochem
authors.initials: J
authors.lastname: Nagels
authors.forename: Cornelis P J
authors.initials: CP
authors.lastname: Visser
authors.forename: Rob G H H
authors.initials: RG
authors.lastname: Nelissen
authors.forename: Monique
authors.initials: M
authors.lastname: Reijnierse
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D011859:Radiography; D012044:Regression Analysis; D020069:Shoulder Pain / Q000000981:diagnostic imaging / Q000628:therapy*; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000628:therapy*; D007507:Therapeutic Irrigation; D018084:Ultrasonography, Interventional
chemical_list: D000893:Anti-Inflammatory Agents; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone
keywords: barbotage; calcific tendinitis; needling; randomized controlled trial; rotator cuff; treatment