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. Steroids injections in the subacromial bursa (SAB) are usually performed after the lavage to prevent the pain induced by the procedure. However, some suggested that this injection could prevent the inflammatory reaction leading to the disappearance of the calcific deposit. Moreover, its efficacy to prevent post-procedure pain has never been demonstrated.

The purpose of the study was to evaluate the effect of a steroid injection in the SAB after UGPL on the pain and the radiographic evolution of the calcification.

Methods: This was a multicentric prospective double-blind randomized controlled study. We included patients with shoulder pain for more than 3 months and a type A or B calcification > 5 mm on X-Ray. Patients were treated with UGPL and, at the end of the procedure, they received a blind injection of either 2 mL of methylprednisolone acetate or 2 mL of serum saline (placebo group). The primary outcome was the maximal VAS pain (0-100) the first week following UGPL. Secondary outcomes were the evolution of VAS pain at 7 days, 6 weeks, 3 months, 6 months and 12 months and the radiographic changes of the calcification during the follow-up.

Results: We included 132 patients: mean age was 49.8 (+/-9.7) years and 89 were females (67.4%). Mean size of the calcification was 1.5 cm (+/- 0.5) and calcifications mainly involved the supraspinatus (86%). Backflow of calcific material was obtained in 107 patients (81.1%). Maximum pain during the first week following UGPL was 71.5 [CI95%:63.9-79.20] in the serum saline group versus 59.8 [CI95%:52.2-67.41] in the steroid group with a mean difference of 11.7 [CI95%:3.7-19.7]. More patients in the placebo group needed to take NSAID (12.1% versus 6.1%) and paracetamol (16.7% versus 9.1%) during the first week. VAS pain during activities decreased significantly more in the steroid group compared to the placebo between the baseline and 3 months while VAS pain was similar at 6 and 12 months (Figure1). At 12 months, no difference was found in the radiographic evolution: 61.9% of the patients treated with steroid and 65% treated with placebo had more than 50% of resorption of their calcification and complete disappearance of the calcification was obtained in 46% of the steroid group versus 40% of the placebo group.

Conclusion: Our study shows that steroid injection in the SAB leads to a significant decrease of maximal pain during the following week. This treatment also decreases significantly the pain during the 3 first months after UGPL. Importantly, we found no difference between the 2 groups in the radiographic evolution of the calcification at 12 months. Overall, steroids injections in the SAB can be recommended after UGPL.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/calcific-tendonitis-of-the-rotator-cuff-do-we-need-steroid-injection-after-ultrasound-guided-percutaneous-lavage-results-of-a-12-months-double-blind-randomized-controlled-study/