Ultrasound guided steroid injection of subacromial bursa: morphologic and clinical effects on patients with supraspinatus tendon calcifications

Year 2021, , 152 - 156, 31.05.2021

Nurten Andac Baltacıoglu Canan Sanal Toprak Efe Soydemır Mehmet Mithat Dokur

https://doi.org/10.5472/marumj.942790

Abstract

Objective: Subacromial injection (SAI), due to its ease of application and increased patient tolerability, is one of the preferred invasive
therapies. In this study, we aimed to evaluate effectiveness of ultrasound-guided SAI in patients with supraspinatus calcific tendinitis
by assessment of roentgenograms and clinical appraisal.
Patients and Methods: Thirty-five patients with supraspinatus tendon calcifications as revealed by the roentgenography underwent
ultrasound-guided SAI. Pre-treatment the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) scores and
Gartner’s Classification of calcific tendinitis were obtained. Clinical follow-up was scheduled at 1st, 3rd and 6th months posttreatment
along with a single roentgenogram planned at 6th month.
Results: A total of 53 SAIs were performed on 36 shoulders, 21 female and 14 male patients. Mean size of calcifications were 12.3
and 7.1 mm, pre-treatment and at 6th month, respectively. Pre and post-injection calcification mean sizes in the group with clinical
improvement were 13.6 and 5.7 mm; whereas, in group without diminished symptoms, they were 11.8 and 9.4 mm demonstrating a
statistically significant intergroup difference (p<0.05). Pre-injection QuickDASH mean score was 52.2; this showed improvement at
1st, 3rd and 6th months post-treatment; 20.7, 22.2 and 19.5, respectively.
Conclusion: Subacromial injection is a well-tolerated, easily applicable, safe and effective treatment for pain alleviation in supraspinatus
calcific tendinitis.

Keywords

Calcific tendinitis, Shoulder joint, Subacromial bursa, Sonography guided injection, Steroid injection

References

• Siegal DS, Wu JS, Newman JS, del Cura JL, Hochman MG. Calcific tendinitis: a pictorial review. Can Assoc Radiol J 2009; 60: 263-72. doi: 10.1016/j.carj.2009.06.008
• Albert J-D, Meadeb J, Guggenbuhl P, Marin F, et al. High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial. Bone Joint J British volume 2007; 89: 335-41. doi: 10.1302/0301-620X.89B3.18249
• Merolla G, Singh S, Paladini P, Porcellini G. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment. J Orthop Traumatol 2016; 17: 7-14. doi: 10.1007/ s10195.015.0367-6
• Ogon P, Südkamp NP, Jaeger M, Izadpanah K, Koestler W, Maier D. Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulder. Arthritis Rheum 2009; 60: 2978-84. doi: 10.1002/art.24845
• de Witte PB, Kolk A, Overes F, Nelissen RG, Reijnierse M. Rotator cuff calcific tendinitis: ultrasound-guided needling and lavage versus subacromial corticosteroids: five-year outcomes of a randomized controlled trial. Am J Sports Med 2017; 45: 3305-14. doi:10.1177/036.354.6517721686
• Oudelaar BW, Huis R, Schepers-Bok R, Ooms EM, Nelissen RG, Vochteloo AJ. Prognostic factors for the outcome of needle aspiration of calcific deposits for rotator cuff calcific tendinitis. Eur Radiol 2020; 30: 4082-90. doi: 10.1007/ s00330.020.06669-0.
• Arirachakaran A, Boonard M, Yamaphai S, Prommahachai A, Kesprayura S, Kongtharvonskul J. Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs. Eur J Orthop Surg Traumatol 2017; 27: 381-90. doi: 10.1007/s00590.016.1839-y
• Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (Quick DASH): validity and reliability based on responses within the fulllength DASH. BMC Musculoskelet Disord 2006; 7: 1-7. doi: 10.1186/1471-2474-7-44 dash
• Gärtner J, Simons B. Analysis of calcific deposits in calcifying tendinitis. Clin Orthop Relat Res 1990: 254:111-20.
• Arroll B, Goodyear-Smith F. Corticosteroid injections for painful shoulder: a meta-analysis. Br J Gen Pract 2005; 55: 224-8.
• Serafini G, Sconfienza LM, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F. Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle US-guided percutaneous treatment—nonrandomized controlled trial. Radiology 2009; 252: 157-64. doi: 10.1148/radiol.252.108.1816
• de Witte PB, Selten JW, Navas A, et al. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med 2013; 41: 1665-73. doi: 10.1177/036.354.6513487066
• Cho NS, Lee BG, Rhee YG. Radiologic course of the calcific deposits in calcific tendinitis of the shoulder: does the initial radiologic aspect affect the final results? J Shoulder Elbow Surg 2010; 19: 267-72. doi: 10.1016/j.jse.2009.07.008
• Kim Y-S, Lee H-J, Kim Y-V, Kong C-G. Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasoundguided needling and extracorporeal shock wave therapy. J Shoulder Elbow Surg 2014; 23: 1640-6. doi:10.1016/j. jse.2014.06.036
• Cacchio A, Paoloni M, Barile A, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther 2006; 86: 672-82. doi: 10.1093/ptj/86.5.672
• Darrieutort-Laffite C, Varin S, Coiffier G, et al. Are corticosteroid injections needed after needling and lavage of calcific tendinitis? Randomised, double-blind, non-inferiority trial. Ann Rheum Dis 2019; 78: 837-43. doi: 10.1136/ annrheumdis-2018-214971