Disclosures: Shiv H. Patel, MD: Nothing to disclose

Case Description: The resolution of calcific rotator tendinosis with ultrasound guided lavage and aspiration.

Setting: Outpatient clinic.

Patient: A 57-year-old woman presented with a 6-month history of progressively worsening right shoulder pain radiating to her proximal right arm without inciting event. She reported pain as dull, constant, and aching, averaging 7/10 in intensity. Pain was exacerbated by overhead motions, reaching back, and sleeping on her right side. She denied limitations in range of motion (ROM) or weakness. Physical examination revealed tenderness of the AC joint. She had mild limitations in ROM with forward flexion and abduction as well as pain at end range of motion. Hawkin’s, empty can, O’Brien’s, Speed’s, and painful arc were positive on examination. No cervical pain noted on examination with full ROM and negative Spurling’s.

Assessment/Results: A right shoulder x-ray revealed a 1.2 cm globular focus of calcific tendinopathy. Despite physical therapy, the pain persisted. MRI revealed partial tear involving the anterior fibers of the supraspinatus tendon and a signal intensity within the posterior fibers of the supraspinatus tendon consistent with calcific rotator cuff tendinosis. One month after initial presentation, she underwent ultrasound guided lavage and aspiration. At 4-week follow-up, she reported significant improvement in right shoulder pain. Physical examination revealed no pain on ROM of right shoulder. A repeat shoulder x-ray 10 months later revealed complete resolution of the calcification.

Discussion: Calcific rotator cuff tendinosis is a disorder of the shoulder defined by pain with activity. Though symptoms usually resolve without treatment, some individuals may have persistent symptoms. Diagnosis can be made with imaging including x-ray, ultrasound, or MRI. Treatment options include conservative treatment, shockwave therapy, surgical removal, and ultrasound guided lavage and aspiration.

Conclusion: Bedside ultrasound guided lavage and aspiration is an effective and safe alternative to surgery for persistent symptomatic calcific rotator cuff tendinosis.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-guided-lavage-and-aspiration-on-calcific-rotator-cuff-tendinosis/