Background/Purpose: Rotator cuff calcific tendinopathy is a common condition causing up to 20% of the painful shoulder. Ultrasound guided percutaneous lavage (UGPL) is indicated after failure of conservative treatments. We have shown that this treatment led to clinical improvement and complete resorption of the calcification in 43 % of the patients at 3 months (1). However, it is currently unclear if the baseline characteristics of the calcification or the success of the procedure (withdrawal of calcium) are associated with the disappearance of the calcific deposit. The goal of this post-hoc analysis was to find characteristics associated with the resorption of the calcific deposit 3 months after UGPL.

Methods: This was a post-hoc analysis of a multicentric prospective double blinded randomized controlled study (1). Patients with shoulder pain for more than 3 months and a type A (dense) or B (split/separated with clear contours) calcification > 5 mm on X-Ray were included. Patients were treated with UGPL using a single needle technic. X-Ray was performed at 3 months and resorption of the calcific deposit defined as more than 90% of decrease of size or complete disappearance of the calcific deposit. Clinical, radiological and procedure characteristics was compared between patient with or without resorption. Multivariate logistic regression was performed to identify baseline and procedure characteristics associated with the disappearance of the calcific deposit.

Results: 134 patients were included in the study, mean age 49.8 (+/-9.7) years, 89 were females (67.4%). X-Ray at 3 months were available for 123 patients. At this time point 53 (43%) of the patients had more than 90% decrease or complete disappearance of their calcification. Baseline and procedure characteristics of the 2 groups are summarized in table 1. None of the baseline radiological characteristics were significantly different between the 2 groups (size of the calcific deposit (even calcification more than 2 cm wide) or radiologic type). Baseline pain at activity was the only clinical variable higher in patients that had resorption of their calcification. Consistence of the calcification during the procedure, the possibility of calcium extraction and the presence of a communication between the calcification and the sub-acromial bursa (SAB) at the end of the procedure were all associated with the calcific disappearance. However, no difference was found according to the amount of calcium extracted. Finally, blurred aspect of the calcification at 7 days but not pain at this time point was associated with resorption. In multivariate logistic regression, we found that only the pain during activity (p=0.046) at baseline and the communication between the subacromial bursa (p=0.046) remains significant.

Conclusion: Disappearance of the calcification after UGPL occurs more frequently in patients in which a communication can be created between the calcification and the SAB, leading to the migration of the calcium deposit and its resorption. Importantly nor the size of the calcification neither the radiological aspect seemed important showing that UGPL can be offered to any patients with symptomatic calcific tendonitis.

1. Darrieutort-Laffite at al., Ann Rheum Dis, 2019

Table 1

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-the-disappearance-of-calcifications-following-ultrasound-guided-percutaneous-lavage-of-rotator-cuff-calcific-tendinopathy-a-post-hoc-analysis-of-a-randomized-controlled-trial/