title: Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome.
abstract: OBJECTIVE
  Rotator cuff calcific tendinitis (RCCT) is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. Between non-surgical and surgical treatment options, today a few minimal invasive techniques are available to remove the calcific deposit, and they represent a cornerstone in the management of this painful clinical condition. The aim of the work was a retrospective evaluation of double-needle ultrasound-guided percutaneous fragmentation and lavage (DNL), focused on understanding the factors which are of major importance in determining a quick and good response at 1 month.
  
  
  METHODS
  A series of 147 patients affected by RCCT and suitable for DNL were evaluated. A systematic review of anamnestic, clinical and imaging data was performed in 144 shoulders treated in a single-centre setting. Clinical reports and imaging examinations were revisited. The inclusion criteria were submission to DNL, therefore fitness for the percutaneous procedure, and following 1-month follow-up. There was no exclusion owing to risk of bias. The treatment was defined as successful for constant shoulder modified score (CSS) improvement of >50% at 1 month.
  
  
  RESULTS
  In 70% of shoulders, the treatment resulted in a quick and significant reduction of symptoms (successful). On the whole, CSS increase at 1 month was estimated at 91.5 ± 69.1%. CSS variations were significantly related to age of patients (better results between 30 and 40 years old), calcification size (more relevant improvement for middle-sized calcifications, 12-17 mm), sonographic and radiographic features of calcific deposits (softer calcifications) and thickening of subacromial/subdeltoid bursa walls. In the final model of stepwise regression for CSS variation, ultrasound score pre-treatment and post-treatment, the distance between bursa and calcification before treatment and the size of post-treatment calcification area were shown to be independently correlated to success. Numeric rating scale score for pain showed similar results. Pain at admission was also related to age, calcification size, ultrasound and Gärtner score, power Doppler positivity, bursal wall thickening and biceps tenosynovitis.
  
  
  CONCLUSIONS
  The success of the procedure with quick improvement in function and symptoms is warranted in soft and middle-sized calcifications, in young adults.
  
  
  CONCLUSIONS
  Ultrasound-guided percutaneous procedures for RCCT must be safe, effective and with prompt pain relief and function restoration. This study shows which clinical picture is more favourable to this purpose and actual prognostic factors for DNL (soft and middle-sized calcifications, in young adults, are more favourable).
authors.affiliation: 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bazzocchi
authors.affiliation: 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pelotti
authors.affiliation: 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Serraino
authors.affiliation: 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy.
authors.forename: Milva
authors.initials: M
authors.lastname: Battaglia
authors.affiliation: 2 Shoulder and Elbow Surgery Unit, The "Rizzoli" Orthopaedic Institute, Bologna, Italy.
authors.forename: Graziano
authors.initials: G
authors.lastname: Bettelli
authors.affiliation: 3 Physical Therapy and Rehabilitation Unit, The "Rizzoli" Orthopaedic Institute, Bologna, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Fusaro
authors.affiliation: 4 Department of Radiology, University of Foggia, Foggia, Italy.|5 Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guglielmi
authors.affiliation: 2 Shoulder and Elbow Surgery Unit, The "Rizzoli" Orthopaedic Institute, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rotini
authors.affiliation: 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Albisinni
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging*; D020069:Shoulder Pain / Q000209:etiology; D052256:Tendinopathy / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional