Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Ku, Seoul, Korea.
J Shoulder Elbow Surg. 2010 Jun;19(4):596-600. doi: 10.1016/j.jse.2009.09.002. Epub 2009 Dec 2.
Needle lavage is frequently performed before consideration of surgical removal in shoulders with calcific tendinitis because this may avoid surgery. However, its role in nonoperative treatment has not been fully investigated in terms of clinical and radiographic response. We hypothesized that needle decompression and subacromial steroid injection would show good clinical results in chronic calcific tendinitis patients.
Thirty-five shoulders in 30 consecutive patients with painful calcific tendinitis were treated by ultrasound-guided needle decompression and subacromial corticosteroid injection. Patients were prospectively evaluated using American Shoulder and Elbow Surgeons (ASES) and Constant scores at 1, 3, and 6 months after the intervention. Size and morphology of the calcific deposits were compared with those in baseline radiographs at each visit.
At 6 months after the index procedure, 25 shoulders (71.4%) showed ASES and Constant score improvements from 48.0 and 53.7 to 84.6 and 87.9, respectively (P < .01). Ten shoulders (28.6%) showed no symptom relief at the last follow-up. In shoulders with pain improvement, the mean size of calcific deposits reduced from 13.6 to 5.6 mm (P < .01), and in shoulders with no pain improvement or that underwent operation, mean size was 13.1 mm at initial visits and 12.7 mm at final visits (P = .75).
Shoulders showing little evidence of deposit size reduction at 6 months after needle decompression are less likely to achieve symptomatic improvement and may be considered as candidates for surgical removal.
Needle decompression with subacromial steroid injection is effective in 71.4% of calcific tendinitis within 6 months. The size of calcific deposits in patients that achieved symptom relief was reduced.
在患有钙化性肌腱炎的肩部，在考虑手术切除之前，经常进行针吸冲洗，因为这可能避免手术。然而，在非手术治疗方面，其在临床和影像学反应方面的作用尚未得到充分研究。我们假设，在慢性钙化性肌腱炎患者中，针减压和肩峰下皮质类固醇注射将显示出良好的临床效果。
对 30 例连续患有疼痛性钙化性肌腱炎的 35 例肩部进行超声引导下的针减压和肩峰下皮质类固醇注射治疗。患者前瞻性地使用美国肩肘外科医生协会（ASES）和Constant 评分在干预后 1、3 和 6 个月进行评估。在每次就诊时，将钙化沉积物的大小和形态与基线 X 光片进行比较。
在指数手术后 6 个月时，25 例肩部（71.4％）的 ASES 和 Constant 评分分别从 48.0 和 53.7提高到 84.6 和 87.9（P <.01）。在最后一次随访时，10 例肩部（28.6％）没有缓解症状。在疼痛改善的肩部中，钙化沉积物的平均大小从 13.6 减少到 5.6 毫米（P <.01），而在疼痛未改善或接受手术的肩部中，平均大小在初次就诊时为 13.1 毫米，在末次就诊时为 12.7 毫米（P =.75）。
在针减压后 6 个月，钙化沉积物的大小减少迹象很少的肩部不太可能获得症状改善，并且可能被认为是手术切除的候选者。
在 6 个月内，针减压联合肩峰下皮质类固醇注射对 71.4％的钙化性肌腱炎有效。症状缓解患者的钙化沉积物大小减少。
