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EFFICIENCY OF TREATMENT OF CALCIFIC TENDINOPATHY OF A ROTATOR CUFF WITH ULTRASOUND GUIDED PERCUTANEUS TREATMENT - PRELIMINARY RESULTS
Calcific tendinopathy is a disease characterized by the occurrence of calcium hydroxyapatite crystals within the tendon. The prevalence of the disease is 2.7-22%. Disease mainly affect active working population, most often women between ages of 30 and 50 (1,2). Clinically, it can be expressed with severe pain and decreased shoulder joint mobility and reduced functionality. Usually it can be managed with non-steroidal anti-inflammatory drugs and physiotherapy. In some patients, conservative treatment is unsuccessful and the disease significantly impairs their quality of life. In this case one of the possible treatment methods is ultrasound guided needle lavage (3). Firstly we use the ultrasound to guide needle into calcium deposits, deposit is punctured and then flushed out the area with saline. There is no guidelines for this kind of treatment, due to lack of systematic clinical research. The purpose of this study is to determine the success of percutaneous ultrasound-guided lavage calcification as a method of treatment for calcific tendinopathy when conservative treatment fails.
Methods: In this study were included patiens who met the inclusion criteria (failed conservative treatment of calcific tendinosis lasting at least 6 months, size of calcification at least 7 mm and age between 20 and 70 years). The first group of patients was treated with combination of ultrasound guided needle lavage and corticosteroid injection into the subacromial bursa. The second group was only administered corticosteroid injection into the subacromial bursa. For the evaluation of the clinical condition and function of the shoulder joint, the Constant score scale (CS) by the European Society of Shoulder and Elbow Surgery(4) has been used and for the assessment of pain, the visual analogue scale (VAL) (5).
Results: Preliminary results indicate that ultrasound-guided needle lavage and corticosteroid injection into the subacromial bursa are more effective than only corticosteroid injection in managing of pain and improving function. In both groups, there was a comparable and statistically significant improvement in upper limb functionality one month after the intervention, but after 6 months functionality was significantly better in group one (MCS1=76,6±6,6; MCS2=63,4±6,5; p= 0,01). Combination of ultrasound-guided needle lavage and corticosteroid injection has also proven to be more effective in reducing pain. Both groups reported less (but comparable) pain 1 month after treatment, but after 6 months, patients in the first group experienced significantly less pain than patients in the second group (MVAL1=1,62±0,75; MVAL2=2,75±0,71; p= 0,008).
Discussion: Preliminary results indicate that both groups have experienced improvement in functionality and pain reduction. However group which was treated with combination of ultrasound-guided needle lavage and corticosteroid injection functional improvement after 6 months was significantly better and these patients also report significantly lower levels of pain. Similar results were found by de Witte et al, describing improvement after one year in both groups, and functional outcomes were significantly better in the group where patients were treated with combination of ultrasound-guided needle lavage and corticosteroid injection into the subacromial bursa.
CONCLUSION Current preliminary results confirm the efficacy of both therapies and at the same time confirm that the long-term success (6 months) was better with combination of ultrasound-guided needle lavage and corticosteroid injection into the subacromial bursa.