Disclosures: David J. Park, MD: No financial relationships or conflicts of interest

Case Description: The patient presented with a one-year history of insidious onset left-sided posterolateral shoulder pain. The pain woke her up at night and worsened with any shoulder movement, especially reaching behind her back. Eight months of physical therapy made minimal improvements. Two prior subacromial steroid injections temporarily provided 50 percent pain reduction. Physical examination revealed a painful arc, pain during Hawkin’s maneuver, and painful restricted active internal rotation. Her MRI revealed infraspinatus tendinopathy with a large (1.6 x 0.6 cm) calcification within the tendon. A diagnostic block around the calcific deposit with 1% lidocaine (2 mL) provided complete resolution of pain with re-examination. The patient opted for percutaneous ultrasonic tenotomy to debride and remove the calcification. The procedure was done under sterile conditions using local anesthesia. An 11-blade scalpel was used to make an incision through the skin and into the tendon. The surgical cutting needle was then inserted into the infraspinatus to cut, debride, and irrigate the pathologic tissue under direct ultrasound guidance. The procedure was followed by a subacromial bursal steroid injection and the skin was closed with a wound closure strip.

Setting: Outpatient sports clinic

Patient: A 60-year-old woman with left shoulder pain Assessment/

Results: The patient was discharged home and instructed to perform pendulum exercises and range of motion as tolerated. At 2 weeks post-procedure she noted 60 percent improvement in pain, denied pain at night, and could easily reach behind her back. She started physical therapy and at 6 weeks noted 70 percent improvement. Her satisfaction with the procedure was excellent and she did not experience any complications.

Discussion: This is the first reported case, to our knowledge, of rotator cuff calcific tendinopathy of the infraspinatus successfully treated with percutaneous ultrasonic tenotomy.

Conclusion: Percutaneous ultrasonic tenotomy may be a reasonable alternative to surgery for patients with rotator cuff calcific tendinopathy.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/percutaneous-ultrasonic-tenotomy-for-rotator-cuff-calcific-tendinopathy-a-case-report/