Cuff: A Randomized Controlled Trial of Ultrasound-Guided Needling and Lavage
Versus Subacromial Corticosteroids.
Nelissen RG, Reijnierse M. Am J Sports Med. 2013 May 21. [Epub ahead of print]
outcome measures and reabsorption of the calcific deposit in patients with
rotator cuff calcific tendinitis.
in patients between 30 to 50 years of age and can cause significant pain. There are several treatment options involving
injections or physical therapy; however, there is no consensus to a preferred
treatment; nor have there been any randomized controlled trails to evaluate the
current treatments. One treatment
gaining popularity is barbotage, which involves
flushing the calcific deposit with saline solution followed by repeatedly
perforating the deposit with an 18-gauge needle. The authors compared ultrasound-guided barbotage
and subacromial corticosteroids with just subacromial corticosteroids. Forty-eight patients with calcific tendinitis
were randomized into two groups and blinded to the treatment. Patients received standard radiographs and
completed a Constant shoulder score (CS), the Disabilities of the Arm, Shoulder and Hand questionnaire
(DASH), the Western Ontario Rotator Cuff Index (WORC), and a visual analog scale
(VAS) for pain prior to treatment. The
authors evaluated calcific deposits on radiographs with the Gartner classification.
Follow-up evaluations were performed at 6 weeks, 3 and 6 months, and 1
year. In the barbotage group 3 patients
required an additional barbotage treatment after 6 months and in the
corticosteroid-only group 9 patients required the barbotage after 6
months. In addition, 1 patient required
surgery after 6 months in the barbotage group and 2 patients required surgery
after 5 months in the corticosteroid only group. Therefore, the authors only compared 19
patients in the barbotage group and 14 patients in the corticosteroid-only
group. There were no significant
differences between groups at any of the timepoints for the VAS. At 1-year follow-up, the barbotage group had
better self-reported shoulder outcomes (CS and WORC) and better decreases in
calcific lesion size than patients that received corticosteroids only. .
the effectiveness of two ultrasound-guided injection treatments for calcific
tendinitis of the rotator cuff. The
results demonstrated that barbotage combined with corticosteroids provided the
best resolution of clinical disability and absorption of the calcific deposit. Although this treatment demonstrated enhanced
results, it is clearly more painful compared to the standard corticosteroid
treatment. Clinicians often use local anesthetics
to minimize the pain; however, patients may still be cautious due to the
potential pain associated with the treatment.
It seems that the barbotage treatment initiates the resorption of the
calcific deposit; however, the mechanism remains unknown. Due to the combination with a corticosteroid
it is unlikely due an inflammatory response.
It would be interesting to examine this treatment without a
corticosteroid to see if the effects are further enhanced or reduced.
discussion: What is your experience with
this treatment? Do you think this
treatment would be effective for other calcific deposits?
de Witte PB, Selten JW, Navas A, Nagels J, Visser CP, Nelissen RG, & Reijnierse M (2013). Calcific Tendinitis of the Rotator Cuff: A Randomized Controlled Trial of Ultrasound-Guided Needling and Lavage Versus Subacromial Corticosteroids. The American Journal of Sports Medicine PMID: 23696211