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Purpose To determine whether the use of one or two needles influences procedure performance and patient outcomes for ultrasonography (US)-guided percutaneous irrigation of calcific tendinopathy. Materials and Methods Institutional review board approval and written informed patient consent were obtained. From February 2012 to December 2014, 211 patients (77 men and 134 women; mean age, 41.6 years ± 11.6; range, 24-69 years) with painful calcific tendinopathy diagnosed at US were prospectively enrolled and randomized. Operators subjectively graded calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous irrigation of calcific tendinopathy (local anesthesia, needle lavage, intrabursal steroid injection) was performed in 100 patients by using the single-needle procedure and in 111 patients by using the double-needle procedure. Calcium dissolution was subjectively scored (easy = 1; intermediate = 2; difficult = 3). Procedure duration was recorded. Clinical evaluation was performed by using the Constant score up to 1 year after the procedure. The occurrence of postprocedural bursitis was recorded. Mann-Whitney U, χ 2 , and analysis of variance statistics were used. Results No difference in procedure duration was seen overall (P = .060). Procedure duration was shorter with the double-needle procedure in hard calcifications (P < .001) and with the single-needle procedure in fluid calcifications (P = .024). Ease of calcium dissolution was not different between single- and double-needle procedures, both overall and when considering calcification appearance (P > .089). No clinical differences were found (Constant scores for single-needle group: baseline, 55 ± 7; 1 month, 69 ± 7; 3 month, 90 ± 5; 1 year, 92 ± 4; double-needle group: 57 ± 6; 71 ± 9; 89 ± 7; 92 ± 4, respectively; P = .241). In the single-needle group, nine of 100 cases (9%) of postprocedural bursitis were seen, whereas four of 111 cases (3.6%) were seen in the double-needle group (P = .180). Conclusion The only difference between using the single- or double-needle procedure when performing US-guided percutaneous irrigation of calcific tendinopathy is procedure duration in hard and fluid calcifications. Clinical outcomes are similar up to 1 year. © RSNA, 2017.

Objectives: We performed a systematic review of current evidence regarding ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in the shoulder aimed to: assess different published techniques; evaluate clinical outcome in a large combined cohort; and propose suggestions for homogeneous future reporting., Methods: Cochrane Collaboration for Systematic Reviews of Interventions Guidelines were followed. We searched MEDLINE/MEDLINE In-Process/EMBASE/Cochrane databases from 1992-2013 using the keywords 'ultrasound, shoulder, needling, calcification, lavage, rotator cuff' combined in appropriate algorithms. References of resulting papers were also screened. Risk of bias was assessed with a modified Newcastle-Ottawa Scale., Results: Of 284 papers found, 15 were included, treating 1,450 shoulders in 1,403 patients (females, n = 838; mean age interval 40-63 years). There was no exclusion due to risk of bias., Conclusions: US-PICT of rotator cuff is a safe and effective procedure, with an estimated average 55% pain improvement at an average of 11 months, with a 10% minor complication rate. No evidence exists in favour of using a specific size/number of needles. Imaging follow-up should not be used routinely. Future studies should aim at structural uniformity, including the use of the Constant Score to assess outcomes and 1-year minimum follow-up. Alternatives to steroid injections should also be explored., Key Points: • US-PICT of rotator cuff is a safe and effective procedure. • On average 55% pain improvement with 10% minor complication rate. • No evidence exists in favour of using a specific size/number of needles. • Future need to assess outcome using Constant Score with 1-year minimum follow-up.

Purpose: To determine whether saline temperature influences procedure performance and outcome in patients undergoing ultrasonography (US)-guided lavage for the treatment of rotator cuff calcific tendinitis (RCCT)., Materials and Methods: This study was approved by the institutional review board, and informed consent was obtained from all patients. From December 2009 to May 2011, 462 patients (191 men and 271 women; mean age, 39.7 years) with painful RCCT diagnosed at US were prospectively enrolled and randomized into two groups. Operators subjectively classified calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous treatment of RCCT (local anesthesia, double-needle lavage, intrabursal steroid injection) was performed with warm saline (42°C, 107°F) in 229 patients and with room-temperature saline in 233. Operators and patients were not blinded to saline temperature. The ease of calcium dissolution was subjectively scored (easy=1, intermediate=2, difficult=3). Procedure duration was recorded. Patient discomfort was assessed by using a visual analog scale (VAS). The occurrence of postprocedure bursitis was recorded. Statistical analyses were performed with Mann-Whitney U, χ2, and analysis of variance tests., Results: Procedure duration was significantly shorter (P<.001) in patients treated with warm saline (mean, 576 seconds±121) than in those treated with room-temperature saline (mean, 777 seconds±151). Calcium dissolution was significantly easier in patients treated with warm saline (median score, 1) than in those treated with room-temperature saline (median score, 2). Subgroup analysis according to calcification appearance at US showed a significant difference between groups for both soft (P=.003) and hard (P<.001) calcifications. No overall significant differences were found for VAS score (warm saline group: baseline=8.9±0.6, 1 month=4.7±0.6, 2 months=4.0±0.7, 3 months=3.4±0.4, 1 year=3.0±0.7; room-temperature saline group: baseline=9.2±0.4, 1 month=4.5±0.7, 2 months=4.1±0.9, 3 months=3.1±0.7, 1 year=3.2±0.8; P=.491). Postprocedural bursitis was observed in eight patients in the warm saline group and 20 in the room-temperature saline group (P<.022)., Conclusion: In the treatment of RCCT, warm saline appears to reduce procedure duration and improve calcification dissolution while reducing the frequency of postprocedural bursitis., (© RSNA, 2011)

Purpose: To compare short- and long-term outcomes of patients with rotator cuff calcific tendonitis who did and did not undergo ultrasonographically (US)-guided percutaneous treatment., Materials and Methods: Institutional review board approval and informed patient consent were obtained. Of patients referred for US-guided treatment of rotator cuff calcific tendonitis, 219 (86 men, 133 women; mean age, 40.3 years +/- 10.9 [standard deviation]) were treated; 68 (31 men, 37 women; mean age, 40.2 years +/- 11.3) patients refused treatment and served as control subjects. After local anesthesia was induced, two 16-gauge needles were inserted into the calcific deposit. Saline solution was injected through one needle, and the dissolved calcium was extracted through the other needle. Shoulder joint function was assessed by using Constant scores, and pain was assessed by using visual analogue scale (VAS) scores. Mann-Whitney U and chi(2) tests were performed., Results: At baseline, no significant difference in age or sex distribution, Constant score, or VAS score was detected between treated and nontreated (control) patients. Compared with control subjects, treated patients reported a significant decrease in symptoms at 1 month (mean Constant score, 73.2 +/- 6.2 vs 57.5 +/- 3.9; mean VAS score, 4.8 +/- 0.6 vs 9.1 +/- 0.5), 3 months (mean Constant score, 90.2 +/- 2.6 vs 62.6 +/- 7.2; mean VAS score, 3.3 +/- 0.4 vs 7.3 +/- 1.8), and 1 year (mean Constant score, 91.7 +/- 3.1 vs 78.4 +/- 9.5; mean VAS score, 2.7 +/- 0.5 vs 4.5 +/- 0.9) (P < .001). Symptom scores were not significantly different between the groups at 5 years (mean Constant score, 90.9 +/- 3.6 vs 90.5 +/- 4.8; mean VAS score, 2.6 +/- 0.5 vs 2.8 +/- 0.7) (P >or= .795) and 10 years (mean Constant score, 91.8 +/- 5.0 vs 91.3 +/- 9.6; mean VAS score, 2.5 +/- 0.6 vs 2.7 +/- 0.6) (P >or= .413)., Conclusion: US-guided percutaneous treatment facilitated prompt shoulder function recovery and pain relief. Treated patients had better outcomes than did nontreated patients at 1 year. However, 5 and 10 years after the procedure, the nontreated group reported outcomes similar to those of the treated group., ((c) RSNA, 2009.)