Study: No gain to ultrasound-guided lavage, steroids for calcific tendinopathy in shoulder
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Key takeaways:
- Ultrasound-guided lavage with steroid injection yielded no clinical benefit for patients with calcific tendinopathy of the shoulder.
- Results were not superior to sham treatment alone at 4 months and 2 years.
Compared with sham treatment, ultrasound-guided lavage with corticosteroid injection yielded no clinical benefit for patients with calcific tendinopathy of the shoulder, according to published results.
“This study shows no benefit from ultrasound-guided lavage along with a steroid injection or from a steroid injection alone over sham treatment in the treatment of patients suffering from chronic calcific tendinopathy of the shoulder,” Stefan Moosmayer, MD, PhD, told Healio. “Our results challenge the clinical utility of these commonly used interventions in the treatment of this condition.”
Moosmayer and colleagues performed a three-arm, double-blinded, randomized controlled trial of 218 patients with calcific tendinopathy of the shoulder who presented to six hospitals in Norway and Sweden between April 24, 2015, and March 3, 2020. Outcomes included Oxford Shoulder Score (OSS) at 4 months, as well as QuickDASH upper extremity scores and pain intensity at 2 years.
The first cohort consisted of 73 patients randomized to ultrasound-guided deposit lavage plus subacromial injection of 20 mg of triamcinolone acetonide and 9 mL of 1% lidocaine hydrochloride (lavage plus steroid group). The second cohort consisted of 74 patients randomized to sham lavage plus subacromial injection of 20 mg of triamcinolone acetonide and 9 mL of 1% lidocaine hydrochloride (sham lavage plus steroid group). The third cohort consisted of 71 patients randomized to sham lavage plus subacromial injection of 10 mL of 1% lidocaine hydrochloride (sham group).
At 4 months, mean improvements in OSS were 3.9 for the lavage plus steroid group, 5.7 for the sham lavage plus steroid group and 3.2 for the sham group. Linear mixed model analysis revealed no significant between group differences for mean improvements in OSS.
Researchers concluded neither lavage plus steroid nor sham lavage plus steroid was superior to sham treatment alone.
“The finding of this study will lead to a change of guidelines for the treatment of calcific tendinopathy,” Moosmayer said. “Practitioners and patients can be informed that there is good evidence for a wait-and-see approach together with non-invasive, symptom-relieving methods in the treatment of these patients.”
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