Poster 140: Ultrasound-guided needle aspiration and lavage for treatment of rotator cuff calcific tendonitis: a case report.

Abstract

Setting: Academic outpatient physiatric spine practice. Patient: A 57-year-old woman. Case Description: The patient was seen at our office with complaints of severe right shoulder and upper arm pain of 3 years in duration. Her pain was exacerbated by overhead activities, and sometimes woke her at night. Radiographs and magnetic resonance imaging confirmed a large calcific deposit in the supraspinatus tendon. There was no evidence of rotator cuff tear or labral pathology. She had been treated intermittently with physical therapy, chiropractic manipulations, and cortisone injections, none of which provided adequate symptom relief. She presented to our office for a nonsurgical treatment alternative. After examination, we diagnosed her with calcific tendonitis with impingement syndrome and treated her with ultrasound-guided needle aspiration and lavage. On postprocedure day 1, she reported 90% pain relief. 3 months postprocedure, she continued to report 90% pain relief. Radiographic examination at that time confirmed that the majority of her calcification had resolved. Results: The patient was diagnosed with calcific tendonitis and was treated with ultrasound-guided needle aspiration and lavage. On day 1 postprocedure she was 90% pain free. A year postprocedure, she continued to be primarily pain free and returned to playing tennis. Discussion: Approximately 10% of patients with chronic symptomatic calcific tendonitis are unresponsive to conservative management. Ultrasound-guided needle aspiration and lavage is a new minimally invasive procedure that offers patients an attractive alternative to the potential morbidity and costs of surgery. Few clinical studies, and none in the United States, have evaluated this procedure. Conclusion: Ultrasound-guided needle aspiration and lavage appears to be an effective minimally invasive option to treat chronic rotator cuff calcific tendonitis. More studies of this new procedure are needed.