Ultrasound-guided percutaneous irrigation of calcific tendinopathy: redefining predictors of treatment outcome

Objectives To identify prognostic factors affecting the clinical outcome in patients treated with rotator cuff ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT), by evaluating the degree of calcium removal, the size and consistency of calcific deposits, and baseline level of shoulder pain and functionality. Methods From January 2017 to December 2019, 79 patients (23 males, 56 females; mean age, 45.7 years) who underwent US-PICT were prospectively enrolled. The calcifications' location, consistency, and size were evaluated. For US-PICT, local anesthesia, lavage of calcific material, and intrabursal steroid injection were performed. The degree of calcium removal was graded as total/partial. Shoulder pain and functionality were assessed with the visual analogue scale (VAS) in all and Constant score (CS) in a subset of patients, respectively, at 4 time-points. Mann-WhitneyUtest, Fisher's test, and linear and binary logistic regression were utilized for analysis. Results Pain improvement correlated with the presence of larger calcifications and lower baseline VAS score, at 1 week (p= 0.001,p< 0.001, respectively) and 1 year (p< 0.001,p= 0.002, respectively). Improved functionality correlated with total calcification retrieval, higher baseline CS, and fluid/soft calcific consistency at 1 week (p= 0.013,p= 0.003,p= 0.019, respectively). Increased calcification size, cystic appearance, and lower baseline VAS scores independently predicted complete pain resolution at 1 year. Conclusion Large calcifications and low-grade pain at baseline correlated with short- and long-term pain improvement. The degree of calcium removal did not impact pain or functional improvement beyond 1 week. Increased calcification size, cystic appearance, and low-grade baseline pain predicted complete pain recovery at 1 year.

Automated summary

Prognostic factors affecting clinical outcome in rotator cuff ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) were evaluated in a study of 79 patients. Factors such as calcification size, consistency, and baseline pain levels were found to impact pain and functionality improvements, with large calcifications and low-grade pain correlating with short- and long-term pain improvement.