Ultrasound guided lavage with corticosteroid injection versus sham lavage with and without corticosteroid injection for calcific tendinopathy of shoulder: randomised double blinded multi-arm study

Fluoroscopic-Guided Barbotage and Corticosteroid Injection for the Treatment of Symptomatic Calcification of the Lateral Collateral Ligament: A Case Report

Periarticular calcification of the knee joint is a rare pathology that may be challenging to diagnose and manage when symptomatic. Here, we describe the first use of fluoroscopic-guided percutaneous needle aspiration and lavage (barbotage) with corticosteroid injection in a case of symptomatic calcification of the lateral collateral ligament (LCL). A 75-year-old female presented with acute lateral knee pain and stiffness, which subsequent radiographic imaging and diagnostic injection confirmed to be attributed to calcification within the LCL. Initial treatment with analgesic medications and a genicular nerve block failed to alleviate symptoms. However, complete resolution of symptoms was achieved following fluoroscopic-guided barbotage and steroid injection. This case underscores the importance of considering LCL calcification in the differential diagnosis of lateral knee pain. This case also illustrates the potential effectiveness of barbotage and adjunctive steroid injection as a minimally invasive treatment option for symptomatic LCL calcification, emphasizing the need for more rigorous studies evaluating treatment strategies for managing periarticular calcifications involving the knee joint.

Effectiveness of non-surgical management in rotator cuff calcific tendinopathy (the effect trial): protocol for a randomised clinical trial

INTRODUCTION

Rotator cuff calcific tendinopathy (RCCT) involves calcific deposits in the rotator cuff. Non-surgical interventions such as extracorporeal shockwave therapy (ESWT) and ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) are recommended for its early management. Exercise therapy (ET) has shown to be an effective intervention for people with rotator cuff tendinopathy, but it has not been formally tested in RCCT. The main objective of this study is to compare the effectiveness of an ET programme with ESWT and US-PICT in people with RCCT. As a secondary aim, this study aims to describe the natural history of RCCT.

METHODS AND ANALYSIS

A randomised, single-blinded four-group clinical trial will be conducted. Adults from 30 to 75 years diagnosed with RCCT who accomplish eligibility criteria will be recruited. Participants (n=116) will be randomised into four groups: ET group will receive a 12-week rehabilitation programme; ESWT group will receive four sessions with 1 week rest between sessions during 1 month; US-PICT group will receive two sessions with 3 months of rest between sessions; and (actual) wait-and-see group will not receive any intervention during the 12-month follow-up. The primary outcome will be shoulder pain assessed with the Shoulder Pain and Disability Index at baseline, 2 weeks, 4 months, 6 months and 12 months from baseline. The primary analysis will be performed at 12 months from baseline. Secondary outcomes will include pain, range of motion, patient satisfaction and imaging-related variables. Moreover, the following psychosocial questionnaires with their corresponding outcome measure will be assessed: Central Sensitization Inventory (symptoms related to central sensitization); Pain Catastrophizing Scale (pain catastrophizing); Tampa Scale for Kinesiophobia 11 items (fear of movement); Fear Avoidance Belief Questionnaire (fear avoidance behaviour); Hospital Anxiety and Depression Scale (anxiety and depression); Pittsburgh Sleep Quality Index (sleep quality); and the EuroQol-5D (quality of life). An intention-to-treat analysis will be performed to reduce the risk of bias using a worst-case and best-case scenario analysis.

ETHICS AND DISSEMINATION

Ethics committee approval for this study has been obtained (reference number: 1718862). The results of the main trial will be submitted for publication in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT05478902.