CALCIFIC TENDONITIS OF THE SHOULDER; IS THERE A PLACE FOR ULTRASOUND GUIDED BARBOTAGE OR EXTRACORPORAL SHOCKWAVE THERAPY AS AN ALTERNATIVE TO SURGERY?

Abstract

The purpose of this study was to assess the clinical outcome of two non-invasive techniques used in the treatment of calcific tendinitis of the shoulder.

Over the eight month period April 2000 to November 2000 sixty patients who were referred to this hospital with symptomatic calcific tendonitis were treated either with extracorporeal shockwave therapy (ESWT) using the Storz Medical Minilith (Storz Medical AG, Kreuzlingen, Germany) or by barbotage (needle puncture, aspiration and lavage under ultrasound control). All the patients had a long history of shoulder pain (average 42 months), caused by a radiographically evident calcific deposit, that had been unresponsive to conservative treatment including physiotherapy, steroid injections and non-steroidal anti-inflammatory tablets.

15 patients were treated with ESWT and 45 with ultrasound guided barbotage. The patients undergoing ESWT had the application head positioned under real time ultrasound or flouroscopic control. Patients had from one to three treatments with up to 2,500 shocks per treatment at incremental energy levels from 0.1 to 0.2 mJ/ mm2. Patients undergoing real time ultrasound guided barbotage had a single treatment. Clinical outcome was evaluated after a three month period with a postal questionnaire.

Thirty-two of 45 patients (71%) in the barbotage group had a marked reduction in symptoms at three months compared to nine out of 15 (64%) of the ESWT group.

Shockwave therapy (ESWT) and ultrasound guided barbotage are simple non invasive outpatient procedures which are effective in 64% to 71% of patients. These simple outpatient techniques should be considered for chronic pain due to calcific deposits that have been unresponsive to conservative treatments, and surgery reserved for those who fail to benefit.