title: Efficacy of triamcinolone acetate and methylprednisolone acetonide for intrabursal injection after ultrasound-guided percutaneous treatment in painful shoulder calcific tendonitis: a randomized controlled trial.
abstract: Background Ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) with intrabursal steroid injection is an elective treatment for painful rotator cuff calcific tendinopathy. Purpose To compare the efficacy of post-US-PICT intrabursal 40 mg injection of triamcinolone acetonide (TA) versus methylprednisolone acetate (MA). Material and Methods Forty patients (22 women; mean age 48.7 ± 7.2 years) with painful shoulder calcific tendinopathy, treated with TA or MA injected intrabursally after US-PICT, were included in this randomized controlled trial. At baseline and after 1, 7, 15, 30, 45, and 180 days, patients underwent US and clinical examination, using Constant (CS) and VAS (VS) scores. Complications and analgesic use were also recorded. Results Compared to baseline, at the 45-day follow-up, TA and MA group showed a similar improvement (Δ) in CS (42 ± 10 versus 36 ± 9 points) and VS (-4.4 ± 1.3 versus -3.6 ± 1.3 points). At the 180-day follow-up, the improvement was higher in TA versus MA (ΔCS: 53 ± 7 versus 44 ± 7 points; ΔVS: -4.9 ± 1.1 versus -3.9 ± 1 points). Multivariate analysis showed a mean CS higher ( P = 0.02) in TA versus MA group, while VS was similar. TA had a 5 × higher ( P = 0.007) chance of reaching complete remission (CS = 100 points) than MA group. A progressive decrease in analgesic use, concomitant to a significant and similar reduction of bursitis and calcifications, was observed in both groups. No major complications occurred. Conclusion Two-needle US-PICT with intrabursal steroid injection is safe and effective. The chance of reaching better scores and, even more important for a clinical perspective, of functional recovery, is higher in patients treated with TA than MA.
authors.affiliation: 1 Diagnostic and Interventional Radiology, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Milva
authors.initials: M
authors.lastname: Battaglia
authors.affiliation: 2 Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Guaraldi
authors.affiliation: 3 Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gori
authors.affiliation: 4 Department of Prosthetic Surgery and Revision of Hip and Knee Implants, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Castiello
authors.affiliation: 2 Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Arvat
authors.affiliation: 4 Department of Prosthetic Surgery and Revision of Hip and Knee Implants, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sudanese
mesh_terms: D002114:Calcinosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D020069:Shoulder Pain / Q000000981:diagnostic imaging / Q000188:drug therapy*; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage / Q000627:therapeutic use*; D018084:Ultrasonography, Interventional
chemical_list: D005938:Glucocorticoids; D014221:Triamcinolone; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone
keywords: Tendinopathy; pain measurement; rotator cuff; steroids; ultrasound