Minimally invasive rotator cuff treatment offers immediate relief of tendonitis

A minimally invasive procedure used to treat tendonitis in the rotator cuff can provide immediate symptom relief to patients, according to researchers at the University of Milan School of Medicine in Italy.

The study findings, published in the July issue of Radiology, suggest that ultrasound-guided nonsurgical therapy significantly reduces pain from calcific tendonitis of the rotator cuff and restores lasting mobility after treatment.

“With this treatment, we were able to establish a single inexpensive and effective treatment for calcific tendonitis of the rotator cuff. This has never happened before,” co-author Luca M. Sconfienza, MD, said in a press release. “Symptoms improved in patients treated with our procedure compared to nontreated patients.”

Calcific tendonitis

Calcific tendonitis is a condition that causes the formation of small calcium deposits within the tendons of the rotator cuff in the shoulder. It is most common in adults in their 40s. In most cases, the deposits become painful and can restrict mobility of the shoulder. In minor cases, physical therapy or anti-inflammatory medications may be sufficient to address the problem until the calcifications break apart spontaneously, according to the press release.

In severe cases, patients may require shock wave treatment or open surgery to remove the calcium. Open surgery requires a hospital stay and rehabilitation and, on rare occasions, may result in major complications such as tendon rupture, the authors wrote in their paper.

“This treatment could completely replace other treatments that are affected by several limitations and complications,” Sconfienza said in the press release.

A reduction in pain

For the 20-minute ultrasound-guided percutaneous therapy procedure, the shoulder is anesthetized and, with ultrasound guidance, a radiologist injects a saline solution into the rotator cuff to wash the area and break up the calcium. A second needle is used to aspirate, or withdraw, the calcium residue. Recovery time is about an hour.

For the study, Sconfienza — as well as senior author Giovanni Serafini, MD, from the radiology unit at Santa Corona Hospital in Pietra Ligure, Italy, and colleagues — used ultrasound-guided percutaneous therapy to treat 235 shoulders in 133 women and 86 men (mean age 42 years) with calcific tendonitis. An additional 68 patients (31 men and 37 women) did not receive treatment and acted as a control group.

All of the patients had shoulder pain that was unresponsive to previous medical treatment. The investigators conducted follow-ups after 1 month, 3 months, 1 year, 5 years and 10 years, according to the press release.

The results showed that treated patients exhibited a considerable reduction in pain and significant improvement in mobility of the affected limb after 1 month, 3 months and 1 year compared to nontreated patients. Five and 10 years after the procedure, the condition of nontreated patients had improved to the point that reported outcomes were similar to those of the treated group, according to the news release.

Although only a few institutions offer this therapy, Sconfienza said surgeons could theoretically perform the procedure in any hospital or clinic that has ultrasound equipment with a superficial probe, according to the press release.

Reference:
Serafini G, Sconfienza LM, Lacelli F, et al. Rotator cuff calcific tendonitis: Short-term and 10-year outcomes after two-needle US-guided percutaneous treatment — nonrandomized controlled trial. Radiology. 2009;252:157-164.