Comparing Ultrasound -Guided Needling Combined With a Subacromial Corticosteroid Injection Versus High -Energy Extracorporeal Shockwave Therapy for Calci fi c Tendinitis of the Rotator Cuff: A Randomized Controlled Trial

Purpose: To compare clinical and radiographic outcomes after treatment with standardized high-energy extracorporeal shock wave therapy (ESWT) and ultrasound-guided needling (UGN) in patients with symptomatic calci fic tendinitis of the rotator cuff who were nonresponsive to conservative treatment. Methods: The study was designed as a randomized controlled trial. The ESWT group received ESWT (2000 pulses, energy flux density 0.35 mJ/mm 2 ) in 4 sessions with 1- week intervals. UGN was combined with a corticosteroid ultrasound-guided subacromial bursa injection. Shoulder function was assessed at standardized follow-up intervals (6 weeks and 3, 6, and 12 months) using the Constant Murley Score (CMS), the Disabilities of the Arm, Shoulder, and Hand questionnaire, and visual analog scale for pain and satis- faction. The size, location, and morphology of the deposits were evaluated on radiographs. The a priori sample size calculation computed that 44 participants randomized in each treatment group was required to achieve a power of 80%. Results: Eighty-two patients were treated (56 female, 65%; mean age 52.1 +/- 9 years) with a mean baseline CMS of 66.8 ?12 and mean calci fication size of 15.1 +/- 4.7 mm. One patient was lost to follow-up. At 1-year follow-up, the UGN group showed similar results as the ESWT group with regard to the change from baseline CMS (20.9 vs 15.7; P = .23), Disabilities of the Arm, Shoulder, and Hand questionnaire (-20.1 vs-20.7; P = .78), and visual analog scale for pain (-3.9 and-2.6; P = .12). The mean calci fication size decreased by 13 +/- 3.9 mm in the UGN group and 6.7 +/- 8.2 mm in the ESWT group (