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Sonographically Guided Percutaneous Needle Lavage in Calcific Tendinitis of the Shoulder: Short- and Long-Term Results

¹ Department of Radiology, Hospital de Basurto, Ave. Montevideo 18, 48013 Bilbao, Spain.
² Department of Surgery and Radiology, Basque Country University, Bilbao, Spain.
³ Department of Rheumatology, Hospital de Basurto, Bilbao, Spain.

View larger version (17K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Examination of shoulder range of motion. Measurement of motion angles in abduction (0-180°) and adduction (0-50°) (A), anterior (0-180°) and posterior (0-50°) elevation (B), and external (0-90°) and internal (0-90°) rotation (C).

View larger version (17K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Examination of shoulder range of motion. Measurement of motion angles in abduction (0-180°) and adduction (0-50°) (A), anterior (0-180°) and posterior (0-50°) elevation (B), and external (0-90°) and internal (0-90°) rotation (C).

View larger version (16K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Examination of shoulder range of motion. Measurement of motion angles in abduction (0-180°) and adduction (0-50°) (A), anterior (0-180°) and posterior (0-50°) elevation (B), and external (0-90°) and internal (0-90°) rotation (C).

View larger version (175K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Aspiration and lavage of focus of calcific tendinitis in supraspinatus tendon. Twenty-gauge needle (arrows) is directed under sonographic guidance toward calcification (star).

View larger version (193K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Aspiration and lavage of focus of calcific tendinitis in supraspinatus tendon. Local anesthetic is injected into subacromial-subdeltoid bursa before penetrating tendon.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Aspiration and lavage of focus of calcific tendinitis in supraspinatus tendon. Once inside calcification, lidocaine is injected and aspirated. Liquefied area appears that progressively replaces calcium (arrows).

View larger version (181K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Aspiration and lavage of focus of calcific tendinitis in supraspinatus tendon. Once inside calcification, lidocaine is injected and aspirated. Liquefied area appears that progressively replaces calcium (arrows).

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —56-year-old woman who had calcific tendinitis for 2 years. Anteroposterior radiograph of shoulder shows large calcifications involving supraspinatus and infraspinatus tendons.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —56-year-old woman who had calcific tendinitis for 2 years. Ten weeks after treatment, significant reduction in calcification is seen.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —56-year-old woman who had calcific tendinitis for 2 years. No calcification can be seen 1 year after treatment.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —46-year-old man with calcific tendinitis for 4 years in whom aspiration and lavage failed. Anteroposterior radiograph of shoulder obtained before treatment shows dense calcification in supraspinatus tendon.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —46-year-old man with calcific tendinitis for 4 years in whom aspiration and lavage failed. After 10 weeks, no changes are seen, although patient received two percutaneous treatments.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —46-year-old man with calcific tendinitis for 4 years in whom aspiration and lavage failed. Radiograph shows no changes 1 year after treatment. Patient's symptoms remained unchanged.

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —39-year-old woman with calcific tendinitis for 6 months. Note changes in sonogram of calcification after percutaneous treatment. Before treatment, longitudinal sonogram of supraspinatus tendon shows focus of calcification and acoustic shadow.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —39-year-old woman with calcific tendinitis for 6 months. Note changes in sonogram of calcification after percutaneous treatment. Ten weeks after treatment, volume of calcification has been considerably reduced and no acoustic shadow is seen.

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