Efficacy of triamcinolone acetate and methylprednisolone acetonide for intrabursal injection after ultrasound-guided percutaneous treatment in painful shoulder calcific tendonitis: a randomized controlled trial

Abstract

Background

Ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) with intrabursal steroid injection is an elective treatment for painful rotator cuff calcific tendinopathy.

Purpose

To compare the efficacy of post-US-PICT intrabursal 40 mg injection of triamcinolone acetonide (TA) versus methylprednisolone acetate (MA).

Material and Methods

Forty patients (22 women; mean age 48.7 ± 7.2 years) with painful shoulder calcific tendinopathy, treated with TA or MA injected intrabursally after US-PICT, were included in this randomized controlled trial. At baseline and after 1, 7, 15, 30, 45, and 180 days, patients underwent US and clinical examination, using Constant (CS) and VAS (VS) scores. Complications and analgesic use were also recorded.

Results

Compared to baseline, at the 45-day follow-up, TA and MA group showed a similar improvement (Δ) in CS (42 ± 10 versus 36 ± 9 points) and VS (−4.4 ± 1.3 versus −3.6 ± 1.3 points). At the 180-day follow-up, the improvement was higher in TA versus MA (ΔCS: 53 ± 7 versus 44 ± 7 points; ΔVS: −4.9 ± 1.1 versus −3.9 ± 1 points). Multivariate analysis showed a mean CS higher (P = 0.02) in TA versus MA group, while VS was similar. TA had a 5 × higher (P = 0.007) chance of reaching complete remission (CS = 100 points) than MA group. A progressive decrease in analgesic use, concomitant to a significant and similar reduction of bursitis and calcifications, was observed in both groups. No major complications occurred.

Conclusion

Two-needle US-PICT with intrabursal steroid injection is safe and effective. The chance of reaching better scores and, even more important for a clinical perspective, of functional recovery, is higher in patients treated with TA than MA.

Keywords

Tendinopathy rotator cuff ultrasound steroids pain measurement

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References

Oliva

Via

Maffulli

. Physiopathology of intratendinous calcific deposition. BMC Med 2012; 10: 95–95.

Speed

CAS

Hazleman

. Calcific tendinitis of the shoulder. N Engl J Med 2000; 340: 1582–1584.

Farin

Jaroma

Soimakallio

. Rotator cuff calcifications: treatment with US-guided technique. Radiology 1995; 195: 841–843.

Cho

Lee

Rhee

. Radiologic course of the calcific deposits in calcific tendinitis of the shoulder: Does the initial radiologic aspect affect the final results? J Shoulder Elb Surg 2010; 19: 267–272.

Uhthoff

Loehr

. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis and management. J Am Acad Orthop Surg 1997; 5: 183–191.

De Conti

Marchioro

Dorigo

. Percutaneous ultrasound-guided treatment of shoulder tendon calcifications: Clinical and radiological follow-up at 6 months. J Ultrasound 2010; 13: 188–198.

Fusaro

Orsini

Diani

. Functional results in calcific tendinitis of the shoulder treated with rehabilitation after ultrasonic-guided approach. Musculoskelet Surg 2011; 95(Supp.): 1–6.

Sconfienza

Viganò

Martini

. Double-needle ultrasound-guided percutaneous treatment of rotator cuff calcific tendinitis: Tips & tricks. Skeletal Radiol 2013; 42: 19–24.

Constant

Murley

. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987; 214: 160–164.

10.

Langley

Sheppeard

. The visual analogue scale: its use in pain measurement. Reum Int 1985; 5: 145–148.

11.

van Holsbeeck

. Sonography of the Shoulder: Evaluation of the subacromial subdeltoid Bursa. Am J Roentgenol 1993; 160: 561–564.

12.

Orlandi

Fabbro

Mauri

. RE: A simple technique to restore needle patency during percutaneous lavage and aspiration of calcific rotator cuff. PM&R 2013; 5: 633–633.

13.

Serafini

Sconfienza

Lacelli

. 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.

14.

Faul

Erdfelder

Lang

. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39: 175–191.

15.

Uhthoff

Sarkar

. Calcifying tendinitis. Bailieres Clin Rheumatol 1989; 3: 567–581.

16.

Weber

Abrams

Nottage

. Complications associated with arthroscopic shoulder surgery. Arthroscopy 2002; 18: 88–95.

17.

Seil

Litzenburger

Kohn

. Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy 2006; 22: 521–527.

18.

Leduc

Caya

Tremblay

. Treatment of calcifying tendinitis of the shoulder by acetic controlled trial: a double-blind randomized controlled trial. Arch Phys Med Rehabil 2003; 84: 1523–1527.

19.

Gerdesmeyer

Loew

Gassel

. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff. JAMA 2003; 290: 7–10.

20.

Rompe

Zoellner

Nafe

. Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder. Clin Orthop Relat Res 2001; 387: 72–82.

21.

Dietrich

Peterson

Brunner

. Imaging-guided subacromial therapeutic injections: prospective study comparing abnormalities on conventional radiography with patient outcomes. Am J Roentgenol 2013; 201: 865–871.

22.

Haake

Rautman

Wirth

. Assessment of the treatment costs of extracorporeal shock wave therapy versus surgical treatment for shoulder diseases. Int J Technol Assess Heal Care 2001; 17: 612–617.

23.

Aina

Cardinal

Bureau

. Calcific shoulder tendinitis: treatment with modified US-guided fine needle technique. Radiology 2001; 221: 455–461.

24.

Yoo

Koh

Park

. The outcome of ultrasound-guided needle decompression and steroid injection in calcific tendinitis. J Shoulder Elb Surg 2010; 19: 596–600.

25.

del Cura

Torre

Zabala

. Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results. Am J Roentgenol 2007; 189: 128–134.

26.

Lanza

Banfi

Serafini

. Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting. Eur Radiol 2015; 25: 2176–2183.

27.

Bazzocchi

Pelotti

Serraino

. Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome. Br J Radiol 2016; 89: 20150407–20150407.

28.

de Witte

Selten

Navas

. 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: 1665–1673.

29.

Sconfienza

Bandirali

Serafini

. Rotator cuff calcific tendinitis: does warm saline solution improve the short-term outcome of double-needle US-guided treatment? Radiology 2012; 262: 560–566.

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