US-guided treatment of calcific rotator cuff tendonopathy

Abstract

Calcium hydroxyapatite crystal deposits in the rotator cuff are a common source of shoulder pain. Calcified tendinitis can lead to chronic disability and may interfere with daily living activities. Traditionally, the initial conservative therapeutic approach consists of oral nonsteroidal anti-inflammatory drugs, physical rehabilitation to prevent loss of joint mobility and local steroid injections. When conservative treatment fails, open surgical or arthroscopic excision of calcium deposits can be performed. Removal of the calcium deposits from the tendon significantly accelerates healing of the tendonopathy, however, the open surgical and even arthroscopic techniques are prone to prolonged post-operative disability and complications such as reflex sympathetic muscle dystrophy. Image-guided interventions to remove calcium deposits in the rotator cuff have been used as far back as 30 years ago. However, these procedures were mainly done under X-ray fluoroscopic guidance and utilized two large-bore needles, one to inject normal saline and the other to fragment the calcification and aspirate the fluid containing the calcium fragments. Use of these needles generally resulted in significant damage to the tendon. More recently, ultrasound (US) (figure 1) has been utilized to guide the intervention; this allows better visualization of smaller deposits, while avoiding radiation exposure to the patient and the performer.