Ultrasound guided interventions in rotator cuff calcific tendonitis

Purpose: To present our experience with treating rotator cuff calcific tendinitis and mild forms of shoulder impingement syndrome with ultrasound guided interventions.

Material and methods: Twenty-one (21) patients (27 shoulders), mean age 48 years (range 27 – 68 years) with shoulder impingement syndrome and concomitant rotator cuff calcific tendinitis (16 shoulders) were prospectively followed, after ultrasound guided interventions (dry needling and injections of local anaesthetic and corticosteroids in the subacromial space and in the acromioclavicular joint). A high frequency (12 MHz) probe was used. 7.5 ml of ropivacaine 0.5%, as local anaesthetic, and 2.5 ml of betamethasone sodium phosphate, as corticosteroid agent, were injected in each joint. The shoulder was at rest for 24 hours following the injection and each patient followed a strict rehabilitation program, consisting of analgesic exercises, and muscle relaxationstrengthening, for three (3) weeks. All patients were clinically evaluated before, and 1, 3, and 6 weeks and 6 months after the intra-articular injection. Patients were evaluated using Constant score.

Results: Patients showed a 75.4% improvement in Constant score, which was stable at the 3^rd and 6^th post injection month. Two (2) patients required second intervention at the 2^nd and 4^th post injection month. No severe adverse effects to the central nervous and cardiovascular systems were reported. Neither joint infections, nor skin irritation around the puncture were noticed. All patients followed constantly their rehabilitation program and reported a significant improvement in their daily activities.

Conclusions: Ultrasound guided interventions in mild forms of shoulder impingement syndrome consist a safe and effective minimal invasive alternative therapeutic option. Careful patient selection, precise planning of the procedure and close patient follow-up are significant parameters for the good final outcome.