Comparable Midterm Outcomes for Ultrasound‐Guided Needling Versus High‐Energy Shockwave Therapy for Rotator Cuff Calcific Tendinitis: A Randomized Controlled Trial

PURPOSE: To compare the midterm clinical and radiographic outcomes of extracorporeal shockwave therapy (ESWT) and ultrasound-guided needling (UGN) in symptomatic calcific tendinitis of the rotator cuff (RCCT). METHODS: This study is a follow-up of a randomized controlled trial. Eighty-two patients with shoulder complaints due to RCCT (>5 mm in size, Gärtner type I-II) persisting >4 months despite nonoperative treatment, including a subacromial corticosteroid injection, were allocated to ESWT (4 sessions of high-energy ESWT) or UGN (single ultrasound-guided puncture and lavage using two 17-gauge needles). Outcomes at 5 years were the Constant-Murley Score (CMS), Disabilities of the Arm, Shoulder, and Hand questionnaire, and visual analog scale for pain. Radiographs were used to evaluate the size, location, morphology, and recurrence of the deposits. RESULTS: The minimum follow-up in this study was 5 years (mean 6.8 ± 1.1 years; range 60-106 months). Sixty-seven (82%) of the original 82 patients were included (43 females; 64%, mean age 51.8 ± 9.0 years). Baseline CMS was 67.4 ± 12.5. At 5 years, the mean CMS was 94.4 ± 6.4 and 93.3 ± 13.6 for ESWT and UGN, respectively (P = .67). Ninety-four percent of both groups achieved the minimal clinically important difference threshold value for CMS. Additional treatment was received by 42% and 26% of ESWT and UGN, respectively (P = .17). No recurrence of calcific deposits was found in treated tendons. New deposits in a different rotator cuff tendon were observed in 15% of UGN patients. CONCLUSIONS: Patients with RCCT treated with ESWT and UGN show excellent midterm clinical and radiographic outcomes, with most achieving clinically important difference threshold values without significant intergroup differences. Both treatment groups showed high rates of additional treatments with the potential of underpowered analysis. LEVEL OF EVIDENCE: Level II, randomized controlled trial.