Rotator cuff calcific tendinitis: does warm saline solution improve the short-term outcome of double-needle US-guided treatment?

Abstract

Purpose: To determine whether saline temperature influences procedure performance and outcome in patients undergoing ultrasonography (US)-guided lavage for the treatment of rotator cuff calcific tendinitis (RCCT).

Materials and methods: This study was approved by the institutional review board, and informed consent was obtained from all patients. From December 2009 to May 2011, 462 patients (191 men and 271 women; mean age, 39.7 years) with painful RCCT diagnosed at US were prospectively enrolled and randomized into two groups. Operators subjectively classified calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous treatment of RCCT (local anesthesia, double-needle lavage, intrabursal steroid injection) was performed with warm saline (42°C, 107°F) in 229 patients and with room-temperature saline in 233. Operators and patients were not blinded to saline temperature. The ease of calcium dissolution was subjectively scored (easy=1, intermediate=2, difficult=3). Procedure duration was recorded. Patient discomfort was assessed by using a visual analog scale (VAS). The occurrence of postprocedure bursitis was recorded. Statistical analyses were performed with Mann-Whitney U, χ2, and analysis of variance tests.

Results: Procedure duration was significantly shorter (P<.001) in patients treated with warm saline (mean, 576 seconds±121) than in those treated with room-temperature saline (mean, 777 seconds±151). Calcium dissolution was significantly easier in patients treated with warm saline (median score, 1) than in those treated with room-temperature saline (median score, 2). Subgroup analysis according to calcification appearance at US showed a significant difference between groups for both soft (P=.003) and hard (P<.001) calcifications. No overall significant differences were found for VAS score (warm saline group: baseline=8.9±0.6, 1 month=4.7±0.6, 2 months=4.0±0.7, 3 months=3.4±0.4, 1 year=3.0±0.7; room-temperature saline group: baseline=9.2±0.4, 1 month=4.5±0.7, 2 months=4.1±0.9, 3 months=3.1±0.7, 1 year=3.2±0.8; P=.491). Postprocedural bursitis was observed in eight patients in the warm saline group and 20 in the room-temperature saline group (P<.022).

Conclusion: In the treatment of RCCT, warm saline appears to reduce procedure duration and improve calcification dissolution while reducing the frequency of postprocedural bursitis.