Long-term outcome of ultrasound therapy for calcific tendinitis of the shoulder: Results of a RCT

Objective: To follow the structure and function related outcome of shoulders affected with symptomatic calcific tendinitis that had been treated with ultrasound therapy. Design: Ten years follow-up of a RCT. Setting: Outpatient PM&R department. Participants: Patients with symptomatic calcific tendinitis of the shoulder, who had successfully completed treatment as allocated and for whom 9-month follow-up examinations were available. Interventions: Series of 24 verum or sham ultrasound therapies. Main Outcome Measures: Resolution of calcium deposits on X-ray imaging, changes in symptoms (Binder score) and shoulder related function (Constant score) as at both the 9 months' and 10 years' follow-up examinations. Results: Of 61 shoulders that had completed treatment as allocated, a total of 45 were followed (ultrasound-group: n=27, sham-group: n=18). Ten years after ultrasound therapy, calcium deposits were resolved in 22 (82%) shoulders of the verum group compared with 16 (89%) of the sham group. Resorption rates were unanimous between groups. However, a significantly higher number of calcium deposits had been completely resolved (13/27) 9 months after therapy in the ultrasound treated group than in the sham treated one (2/18; Fisher exact: P=.045). Shoulder symptoms and function were found significantly improved at both the 10 years and 9 months follow-up examinations for both groups with no significant differences between groups. At the long-term follow-up there was no correlation between the presence of a calcium deposit and shoulder symptoms or function. Conclusions: Patients with symptomatic calcifying tendinitis of the shoulder have a good likelihood that their calcium deposits will resolve and their symptoms and shoulder function will improve to normal values in the long-term. Ultrasound therapy likely enhances these processes. However, the lack of correlation between calcification and symptoms/ function challenges the prevailing opinion that therapies administered to treat a calcium deposit would also improve recovery from symptoms and function in these patients.