Clinical outcomes of combined focused shock wave and ultrasound-guided percutaneous irrigation of rotator cuff calcific tendinopathy therapy

Background: Various conservative treatments have been reported for refractory calcific tendinitis of the shoulder. This study aimed to evaluate the clinical outcomes of a combined therapy of focused shock wave (FSW) and ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT).

Methods: A total of 229 patients (246 shoulders) who experienced shoulder pain for over six months due to calcific tendinitis were included. The mean age of the patients was 55.0 years, and the mean disease duration was 30.0 months. FSW was performed monthly with ultrasonography. US-PICT was performed before FSW until the symptoms or calcium deposits disappeared. The resorption rate, number of treatments, and clinical scores (the University of California at Los Angeles [UCLA] and Constant scores) were evaluated at the final follow-up. Radiological characteristics of the calcium deposits before treatment were evaluated using the Molé classification. Clinical outcomes were compared between the complete resorption and residual groups.

Results: Complete resorption occurred in 82.9 % of the 204 shoulders. Partial resorption was observed in 38 shoulders, and no change was noted in 4 shoulders. The mean number of FSW and US-PICT treatments was 4.0 and 2.4, respectively. The UCLA and Constant scores considerably improved from 18.7 to 33.0 and from 68.9 to 95.0, respectively. The number of treatments was markedly higher in Molé classification type B. The complete resorption group exhibited better UCLA and Constant scores and required fewer treatments. Additionally, Molé classification type B had a higher proportion of patients in the residual group.

Conclusions: The combined FSW and US-PICT therapy showed good clinical outcomes with a high resorption rate for refractory calcific tendinitis of the shoulder. Patients in the complete resorption group had better clinical outcomes and required fewer treatment sessions. Furthermore, attention should be paid to the refractory radiological characteristics of patients with Molé classification type B.