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Three Part Question

In [adults with calcified supraspinatus tendon] which [solution or injection technique] is best for [pain and function]

Clinical Scenario

A 40 year male presents with acute pain in the shoulder and limited ROM especially in abduction. A plain radiograph reveals calcification of the supraspinatus tendon. You propose to inject the calcified area with steroid, but a colleague questions if any other solution or injection technique will just as beneficial.

Search Strategy

MEDLINE 1950-09/08, CINAHL 1982 –09/08, AMED 1985-09/08, via the OVID interface and EMBASE 1980-09/08 and SPORTDiscus. Also the Cochrane database and PEDro.
Medline, CINAHL, EMBASE, AMED, SPORTDiscus, PEDro and the Cochrane database: [{(supraspinatus.mp OR rotator cuff/ OR shoulder joint/ OR shoulder/) AND (calcific.mp OR calcification.mp OR calcinosis/ OR calcified.mp) AND (lavage.mp OR aspiration.mp OR barbotage.mp OR irrigation/ OR injections/ OR injections.mp) AND (steroids/ OR corticosteroids.mp OR saline.mp OR saline solution, hypertonic/ OR local anaesthesia.mp OR anesthetics, local/)}] LIMIT to human AND English language.

Search Outcome

A Cochrane review of corticosteroid injection in shoulder pain did not include any studies on calcified tendonosis. There was one prospective RCT which compared a needling technique and shock-wave therapy to shock-wave therapy alone in calcific supraspinatus. All other injection studies on this subject were case series designs or proceedings abstracts

Comment(s)

Although injections and other needling techniques (e.g. barbotage, irrigation, aspiration and lavage) are frequently used in clinical practice, there have not been any robust RCT studies to compare one technique against another, or against placebo solution. The therapeutic contribution of needling itself remains unclear and should be evaluated in a prospective RCT.

Clinical Bottom Line

No injection technique has been proven to be superior to another in the treatment of calcific supraspinatus tendonitis.