Ultrasound-Guided Needling Combined With High- or Low-Energy Extracorporeal Shock Wave Therapy Versus Needling Alone for Calcified Rotator Cuff: A Retrospective Study

Background: Rotator cuff calcific tendinitis is a common shoulder joint disorder. Nonsurgical treatment methods, including multiple needling and extracorporeal shock wave therapy (ESWT), can effectively treat calcific tendinitis. Purpose: To evaluate the clinical results and radiological outcomes of treatment with ultrasound-guided needling (UGN) alone versus UGN with high-energy ESWT (UGN-H) or UGN with low-energy ESWT (UGN-L) in patients with calcific tendinitis of the rotator cuff. Study Design: Cohort study; Level of evidence, 3. Methods: Outpatient records for patients with calcific tendinitis of the rotator cuff were evaluated retrospectively. Patients were grouped into those treated with UGN-H, UGN-L, or controls with UGN alone. The visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) scores, Constant-Murley scores, and radiographic evaluation to assess calcification size were available before treatment and at 3, 6, and 12 months after the first treatment. Post event pairwise analysis to analyze score differences between treatment groups was used. Results: Overall, 130 patients were included for analysis (42 UGN-H, 44 UGN-L, and 44 with UGN alone). At 3 months, the VAS scores were UGN-H (4.13 ± 0.84; P < .001) and UGN-L (4.47 ± 1.01; P < .001) which were significantly better than UGN alone (5.35 ± 1.00) in terms of the VAS score; however, the difference was not significant between UGN-H and UGN-L. These differences persisted at months 6 and 12 (6 months: UGN-H, 2.66 ± 1.00; P < .001; UGN-L, 3.16 ± 1.05; P = .033; 12 months: UGN-H, 1.93 ± 0.43; P < .001; UGN-L, 2.04 ± 0.46; P < .001). The results of the ASES and Constant-Murley scores were similar to those of the VAS score. In terms of radiographic outcome, follow-up at months 3, 6, and 12 revealed that UGN-H and UGN-L were superior to UGN alone at removing calcification (median 95% CI; 3 months: UGN-H, 1.4 mm 2 [1.08, 7.25 mm 2 ); P = .002; UGN-L, 5.79 mm 2 (1.17, 7.85 mm 2 ]; P = .041; 6 months: UGN-H, 0.91 mm 2 [0, 1.15 mm 2 ); P < .001; UGN-L, 1.13 mm 2 [0.84, 5.10 mm 2 ]; P < .001; 12 months: UGN-H, 0 mm 2 [0, 0 mm 2 ]; P < .001; UGN-L, 0 mm 2 (0, 4.33 mm 2 ]; P = .023). There was no significant difference between UGN-H and UGN-L at the month 3 follow-up, but the month 6 and 12 follow-ups revealed that UGN-H was more effective at removing calcification compared with UGN-L. Conclusion: The study demonstrated that, for pain relief and recovery of shoulder joint function, UGN + ESWT was significantly superior to UGN alone. No significant difference was observed between different energy levels of ESWT. UGN + ESWT was significantly superior to UGN alone on radiographic evaluation. Furthermore, UGN-H performed better radiographically with reducing calcifications compared with UGN-L at 12 months.