title: Needle aspiration of calcific deposits (NACD) for calcific tendinitis is safe and effective: Six months follow-up of clinical results and complications in a series of 431 patients.
abstract: BACKGROUND
  Although needle aspiration of calcific deposits (NACD) has proven to be an effective treatment for calcific tendinitis of the rotator cuff (CTRC) in patients who are resistant to conservative treatment, little is known about the effectiveness of NACD in terms of complete relief of symptoms and the effectiveness of repeated NACD procedures. Furthermore, analyses of complications of the procedure in large series are scarce.
  
  
  METHODS
  431 consecutive patients with symptomatic CTRC treated by NACD were included in this retrospective cohort study. Short-term effects were assessed at two weeks post-treatment by using an 11-point numeric rating scale (NRS). The six months outcome was determined on a dichotomous symptom scale (symptom free or persistence of symptoms). NACD procedures performed within six months of a previous NACD procedure were considered repeated procedures. All complications that occurred within six months of the NACD procedure were registered.
  
  
  RESULTS
  At two weeks post-treatment, a significant improvement of pain scores was noted (mean reduction of NRS: 4.4 points; p<0.001). 74% of patients had complete relief of symptoms at six months post-treatment. 143 (33.2%) patients required multiple treatments. These repeated procedures were equally effective as the primary procedure. Complications of the NACD procedure were seen in 31 (7.2%) patients: 21 patients (4.9%) developed a subacromial bursitis, seven patients (1.6%) a frozen shoulder and three patients (0.7%) developed a septic bursitis.
  
  
  CONCLUSIONS
  Needle aspiration of calcific deposits (NACD) is an effective treatment for calcific tendinitis of the rotator cuff in the majority of patients. Approximately one third of the patients will require multiple treatments, which were equally effective as the primary procedure. Based on this, patients should not be withheld a second or even a third treatment in case of persistent symptoms. Furthermore, NACD has a low complication rate, the risk of infection should, however, always be accounted for.
  
  
  METHODS
  Retrospective study, level IV.
authors.affiliation: Centre for Orthopaedic Surgery OCON, Shoulder Unit, P.O. Box 546, 7550 AM Hengelo, The Netherlands.
authors.forename: Bart W
authors.initials: BW
authors.lastname: Oudelaar
authors.affiliation: Department of Radiology, Ziekenhuisgroep Twente, P.O. Box 546, 7550 AM Hengelo, The Netherlands.
authors.forename: Relinde
authors.initials: R
authors.lastname: Schepers-Bok
authors.affiliation: Centre for Orthopaedic Surgery OCON, Shoulder Unit, P.O. Box 546, 7550 AM Hengelo, The Netherlands.
authors.forename: Edwin M
authors.initials: EM
authors.lastname: Ooms
authors.affiliation: Centre for Orthopaedic Surgery OCON, Shoulder Unit, P.O. Box 546, 7550 AM Hengelo, The Netherlands. Electronic address: r.huisintveld@ocon.nl.
authors.forename: Rianne
authors.initials: R
authors.lastname: Huis In 't Veld
authors.affiliation: Centre for Orthopaedic Surgery OCON, Shoulder Unit, P.O. Box 546, 7550 AM Hengelo, The Netherlands.
authors.forename: Anne J H
authors.initials: AJ
authors.lastname: Vochteloo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002062:Bursitis / Q000209:etiology; D002114:Calcinosis / Q000150:complications* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D010146:Pain / Q000209:etiology*; D059408:Pain Management / Q000379:methods*; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000473:pathology; D013396:Suction; D013585:Synovitis / Q000209:etiology; D052256:Tendinopathy / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Calcific tendinitis; Complications; Needle aspiration of calcific deposits; Outcome; Rotator cuff; Treatment