Percutaneous steroid injection versus oral NSAIDs on treatment of symptomatic calcific rotator cuff tendinitis: a short-term retrospective clinical evaluation

Year 2023, Volume: 6 Issue: 3, 667 - 673, 31.05.2023

Ercan Hassa

https://doi.org/10.32322/jhsm.1287158

Abstract

Aim: Symptomatic calcific rotator cuff tendinopathies (CRCT) continue to be a significant health problem in the adult population because of intense pain and disability. Different clinical responses obtained with different treatment modalities show us the importance of determining the optimal method. The aim of this study is to compare short term pain and functional status improvements in adult patients diagnosed with CRCT and treated with oral non-steroid anti-inflammatory drugs (O-NSAID) or percutaneous steroid injections (PSI).
Material and Method: A retrospective examination was made of the clinical results of adult patients diagnosed with CRCT and treated with one of the two treatment methods. Whole study group was formed of 40 patients (20 male, 20 female) with a mean age of 42.35 ± 8.28 (range, 23-57) years. The clinical responses of the patients in a period of 3 months were compared between the two treatment groups O-NSAID, PSI using the Visual Analogue Scale (VAS) and the Quick Disability of the Arm, Shoulder, and Hand Scale (Q-DASH). The angular upper limit values of the active range of motion (ROM) of the shoulder joint (anteflexion and abduction angle) of patients also were compared in the study.
Results: In the PSI treatment group, in the 3rd week and 3rd month clinical evaluations, significant better responses were obtained in both the VAS and Q-DASH scores of the patients compared to O-NSAID treatment group (p=0.000, p=0.001, respectively). And significant greater shoulder anteflexion and abduction ROM upper limits were determined in the PSI treament group compared to O-NSAID treatment group at the end of the 3rd month (p=0.000, p=0.000, respectively).
Conclusion: The percutaneous steroid applications in treatment of CRCT can provide more pleasing short term results than O-NSAID treatments in terms of pain reduction and functional improvement.

Keywords

Calcific tendinopathy, rotator cuff, injection, steroid

References

• Luime JJ, Koes BW, Hendriksen IJ, et al. Prevalence and incidence of shoulder pain in the general population: a systematic review. Scand J Rheumatol 2004; 33: 73-81.
• Greenberg DL. Evaluation and treatment of shoulder pain. Med Clin North Am 2014; 98: 487-504.
• Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther 2016; 23: 57-68.
• Chianca V, Albano D, Messina C, et al. Rotator cuff calcific tendinopathy: from diagnosis to treatment. Acta Biomed 2018; 89:186-96.
• Leider JD, Derise OC, Bourdreaux KA, et al. Treatment of suprascapular nerve entrapment syndrome. Orthop Rev (Pavia) 2021; 13:25554.
• Osborne JD, Gowda AL, Wiater B, Wiater JM. Rotator cuff rehabilitation: current theories and practice. Phys Sportsmed 2016; 44: 85-92.
• Harrison AK, Flatow EL. Subacromial impingement syndrome. J Am Acad Orthop Surg 2011; 19: 701-8.
• Greis AC, Derrington SM, Mc Auliffe M. Evaluation and nonsurgical management of rotator cuff calcific tendinopathy. Orthop Clin North Am 2015; 46: 293-302.
• Darrieutort-Laffite C, Blanchard F, Le Goff B. Calcific tendonitis of the rotator cuff: From formation to resorption. Joint Bone Spine 2018; 85: 687-92.
• Gosens T, Hofstee DJ. Calcifying tendinitis of the shoulder: advances in imaging and management. Curr Rheumatol Rep 2009; 11:129-34.
• Umamahesvaran B, Sambandam SN, Mounasamy V, Gokulakrishnan PP, Ashraf M. Calcifying tendinitis of shoulder: A concise review. J Orthop 2018; 15: 776-82.
• Frassanito P, Cavalieri C, Maestri R, Felicetti G. Effectiveness of extracorporeal shock wave therapy and kinesio taping in calcific tendinopathy of the shoulder: a randomized controlled trial. Eur J Phys Rehabil Med 2018; 54:333-40.
• Bechay J, Lawrence C, Namdari S. Calcific tendinopathy of the rotator cuff: a review of operative versus nonoperative management. Phys Sportsmed 2020; 48: 241-6.
• Sánchez Lite I, Toribio Calvo B, Osorio Aira S, Romera de Blas C, Andrés García N. Treatment of calcific tendinopathy of the rotator cuff with ultrasound-guided puncture and aspiration. Tratamiento de la tendinopatía calcificante del manguito de los rotadores mediante punción-aspiración ecoguiada. Radiologia 2021: S0033-8338(21)00124-7.
• Zhang T, Duan Y, Chen J, Chen X. Efficacy of ultrasound-guided percutaneous lavage for rotator cuff calcific tendinopathy: a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98: e15552.
• Lanza E, Piccoli F, Intrieri C, et al. US-guided percutaneous irrigation of calcific tendinopathy of the rotator cuff in patients with or without previous external shockwave therapy. Radiol Med 2021; 126: 117-23.
• Messina C, Banfi G, Orlandi D, et al. Ultrasound-guided interventional procedures around the shoulder. Br J Radiol 2016; 89: 20150372.
• Porcellini G, Paladini P, Campi F, Paganelli M. Arthroscopic treatment of calcifying tendinitis of the shoulder: clinical and ultrasonographic follow-up findings at two to five years. J Shoulder Elbow Surg 2004; 13: 503-8.
• Molé D, Kempf JF, Gleyze P, Rio B, Bonnomet F, Walch G. Résultats du traitement arthroscipique des tendinopathies non rompues de la coiffe des rotateurs. 2e partie: les calcifications de la coiffe des rotateurs [Results of endoscopic treatment of non-broken tendinopathies of the rotator cuff. 2. Calcifications of the rotator cuff]. Rev Chir Orthop Reparatrice Appar Mot 1993; 79: 532-41.
• Gärtner J, Heyer A. Tendinosis calcarea der Schulter [Calcific tendinitis of the shoulder]. Orthopade 1995; 24: 284-302.
• Filippou G, Adinolfi A, Cimmino MA, et al. Diagnostic accuracy of ultrasound, conventional radiography and synovial fluid analysis in the diagnosis of calcium pyrophosphate dihydrate crystal deposition disease. Clin Exp Rheumatol 2016; 34: 254-60.
• Merolla G, Singh S, Paladini P, Porcellini G. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment. J Orthop Traumatol 2016; 17: 7-14.
• Darrieurtort-Laffite C, Bertrand-Vasseur A, Garraud T, Planche L, Le Goff B. Tolerance and effect of sodium thiosulfate in calcific tendinitis of the rotator cuff. Clin Rheumatol 2020; 39: 561-9.
• Lin KM, Wang D, Dines JS. Injection therapies for rotator cuff disease. Orthop Clin North Am 2018; 49: 231-9.
• Simpson M, Pizzari T, Cook T, Wildman S, Lewis J. Effectiveness of non-surgical interventions for rotator cuff calcific tendinopathy: A systematic review. J Rehabilb Med 2020; 52: jrm00119.
• Louwerens JKG, Sierevelt IN, Kramer ET, et al. Comparing ultrasound-guided needling combined with a subacromial corticosteroid injection versus high-energy extracorporeal shockwave therapy for calcific tendinitis of the rotator cuff: A randomized controlled trial. Arthroscopy 2020; 36: 1823-33.
• Dumoulin N, Cormier G, Varin S, et al. Factors associated with clinical improvement and the disappearance of calcifications after ultrasound-guided percutaneous lavage of rotator cuff calcific tendinopathy: A post hoc analysis of a randomized controlled trial. Am J Sports Med 2021; 49: 883-91.
• Azevedo S, Sousa-Neves J, Leite Silva J, et al. Shoulder pain: are there predictive factors of response to treatment and of ultrasound findings? Acta Reumatol Port 2020; 45: 39-45.