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Ultrasound-Guided Aspiration of Symptomatic Rotator Cuff Calcific Tendonitis

Cooper, Grant MD; Lutz, Gregory E. MD; Adler, Ronald S. MD

American Journal of Physical Medicine & Rehabilitation: January 2005 - Volume 84 - Issue 1 - p 81
doi: 10.1097/01.PHM.0000150821.55552.2C
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From the Department of Physical Medicine and Rehabilitation, New York-Presbyterian University Hospitals of Columbia and Cornell, New York, New York (GC); and the Departments of Physical Medicine and Rehabilitation (GEL) and Radiology (RSA), Hospital for Special Surgery, New York, New York.

All correspondence and requests for reprints should be addressed to Gregory E. Lutz, MD, Department of Physical Medicine and Rehabilitation, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.

Ultrasound-guided percutaneous needle puncture, aspiration, and lavage is a new, minimally invasive technique for the treatment of symptomatic rotator cuff calcific tendonitis. Approximately 10% of patients with chronic symptomatic rotator cuff calcific tendonitis are unresponsive to conservative medical management and require further intervention. In the past, either arthroscopically assisted or open-technique surgery has been the treatment of choice for these patients. Indeed, several research investigations have concluded that, in comparison with conservative therapy, surgery offers a significantly improved outcome for patients. However, surgery inevitably is accompanied by comorbidity and increased costs. Ultrasound-guided percutaneous needle puncture, aspiration, and lavage is an attractive alternative to surgery for these patients.

Ultrasound-guided percutaneous needle puncture, aspiration, and lavage easily locates and aspirates all soft calcifications in the shoulder (Figs. 1 and 2). It also fragments residual hard calcifications, which helps them to migrate to vascularized soft tissues. This fragmenting and migration accelerates the resorption process and makes it more complete. To date, five clinical studies investigating ultrasound-guided aspiration and lavage have been reported in the literature. The clinical success rates of these studies range from 60% to 74% and have follow-up times ranging from 2 wks to 1 yr.1–3 However, no controlled clinical trials have assessed the efficacy of this procedure. Future research will hopefully seek to fill this void.

Figure 1

Figure 1

Figure 2

Figure 2

In 1986, Bigliani et al.4 used supraspinatus outlet radiography to identify three distinct classifications of acromial morphology: type I (flat), type II (curved), and type III (hooked). The criteria of Bigliani et al.4 have become the most widely used criteria for acromion morphologic classification. It is a reasonable assumption that a patient’s acromion type may have a direct impact on the ability of a percutaneous needle approach to access an identified calcification in some shoulders, thus potentially affecting the efficacy of the ultrasound-guided percutaneous aspiration and lavage. Future research may investigate this potential causal relationship between Bigliani type and the efficacy of ultrasound-guided percutaneous aspiration and lavage.

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REFERENCES

1. Rima A, Cardinal E, Bureau NJ, et al: Calcific shoulder tendinitis: Treatment with modified us-guided fine-needle technique. Radiology 2001;221:455–61
2. Farin PU, Rasanen H, Jaroma H, et al: Rotator cuff calcifications: Treatment with ultrasound-guided percutaneous needle aspiration and lavage. Skeletal Radiol 1996;25:551–4
3. Aina R, Cardinal E, Beureau NJ, et al: Calcific shoulder tendinitis: Treatment with modified US-guided fine-needle technique. Radiology 2001;221:455–61
4. Bigliani LU, Morrison DS, April EW: The morphology of the acromion and its relationship to rotator cuff tears (abstract). Orthop Trans 1986;10:228
© 2005 Lippincott Williams & Wilkins, Inc.