Treatment of shoulder calcifications of the cuff: a controlled study.

Objectives: About 1 in 10 patients with shoulder calcifications complains of chronic pain. Removal techniques have been developed. We carried out the first randomized study to validate bursoscopy (BS) and (needling fragmentation irrigation) (NFI) versus a control group (CT).

Methods: 102 shoulders (96 patients) with calcifications >5 mm whose medical treatment had failed (>4 months) were first injected using a corticosteroid; 49 shoulders improved by more than 70%. The other 53 shoulders were randomized in 3 groups: NFI (n=16), BS (n=20), and CT (n=17). All patients were reviewed at T 1-4-12-24 months.

Results: After 4 months, we observed respectively in groups NFI-BS-CT: 62%, 65% and 29% patients showing global improvements >70% (NFI vs CT: p=0.03; BS vs CT: p=0.02); -37%, -29% and -11% pain VAS variation (ns), +16%, +12% and -15% Constant score variation (NFI vs CT: p=0.03; BS vs CT: p=0.02), and -58%, -77% and +4% area calcification variation (NFI vs CT: p=0.005; BS vs CT: p=0.0002; BS vs NFI: p=0.01). After 24 months, results were maintained in NFI and BS groups, and in the CT group only 6/17 patients were still improved. There were no significant differences between NFI and BS groups. Three partial tears of the cuff were found using MRI in failures, (1 in each group).

Conclusion: NFI and BS are now validated removal techniques of shoulder calcifications when there is chronic pain and other medical treatments have failed. Results were maintained after 24 months, and were similar between NFI and BS. However NFI could be preferred because of its simplicity and low cost.