Adults with calcific tendinopathy of the shoulder, persistent for at least three months, in Norway and Sweden
Lavage + steroid
Ultrasound guided deposit lavage plus subacromial injection of 20 mg triamcinolone acetonide and 9 mL 1% lidocaine hydrochloride
Sham lavage + steroid
Sham lavage plus subacromial injection of 20 mg triamcinolone acetonide and 9 mL 1% lidocaine hydrochloride
Sham lavage plus subacromial injection of 10 mL 1% lidocaine hydrochloride
All patients received a physiotherapeutic treatment regimen consisting of four home exercises
Impact of the size of the deposit at baseline and of the persistence or disappearance of the deposit was investigated
Result on the 48 point scale of the Oxford Shoulder Score (OSS) at four month follow-up (0=worst | 48=best)
Measurements on the short form of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH)
Pain intensity up to 24 months
There were no significant differences between the groups for OSS score at four months
Lavage + steroid vs sham
Difference 0.2 (95% CI, −2.3 to 2.8) | P=1.0
Sham lavage + steroid vs sham
Difference 2.0 (95% CI, −0.5 to 4.6) | P=0.35)
Lavage + steroid vs sham lavage + steroid
Difference −1.8 (95% CI, −4.3 to 0.7) | P=0.47
Patients who received supplementary treatment at 4 months: 65.6% (143 patients)
At 24 months, none of the study procedures was superior to sham
There were no serious adverse events
For patients with calcific tendinopathy of the shoulder, lavage with steroid did not improve pain compared to sham treatment
The companion editorial states
In summary, this important study challenges the clinical utility of a common intervention, ultrasound guided lavage, currently considered to be evidence driven and therefore best practice in the care of patients struggling with chronic symptomatic calcific rotator cuff tendinopathy
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