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Published on: May 26, 2023
Comparison of Physical Therapy, Corticosteroid Injections, and Ultrasound-Guided Barbotage for Nonoperative and
Ryan Gilbert1, Sahil Dadoo2, Ryan Lin1
1University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA.
Background:
Calcific tendinitis of the shoulder is a common, painful rotator cuff disorder with both nonoperative and operative treatment options. The optimal nonoperative modality remains unclear, and it is not well understood how previous nonoperative treatments influence eventual surgical outcomes.
Purpose/Hypothesis:
The purpose of this study was to compare success rates, defined as avoidance of surgery, among 3 nonoperative treatments for calcific tendinitis: physical therapy (PT), corticosteroid injection (CSI), and ultrasound-guided barbotage (USB). For patients who underwent surgery, outcomes were compared according to previous nonoperative management. It was hypothesized that success rates and postoperative outcomes would not differ significantly between modalities.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A retrospective review of patients diagnosed with calcific tendinitis from 2009 to 2023 was performed. Exclusion criteria were lack of radiographic confirmation, <6 months follow-up, or incomplete electronic medical record data. Patients were categorized by attempted nonoperative treatment (none, PT, CSI, USB, multiple) and by final management (nonoperative vs operative). Patient-reported outcomes included the visual analog scale (VAS), Subjective Shoulder Value (SSV), and range of motion (ROM), collected at initial and final presentation. Radiographic findings were extracted from radiology reports. Statistical testing used parametric or nonparametric methods as well as a multivariable Cox proportional hazards model to predict nonoperative failure. Significance was set at P < .05.
Results:
A total of 257 patients (mean age 55 ± 11 years) were analyzed with a mean follow-up of 18 ± 16 months with an overall nonoperative success rate of 63%. Success rates did not differ significantly among PT (59%), CSI (75%), and USB (72%), but patients with multiple tendon involvement or calcifications >3 cm were more likely to fail nonoperative management. Patients completing successful nonoperative management improved in VAS, SSV, and ROM, with no between-group differences. All patients who attempted multiple modalities (18/18; 100%) required surgery (P < .01). Among 121 patients undergoing surgery, final VAS, SSV, and ROM outcomes did not differ based on previous nonoperative management.
Conclusion:
PT, CSI, and USB demonstrate similar rates of avoiding surgery for calcific tendinitis. For patients ultimately requiring surgery, outcomes are not influenced by previous nonoperative management. Surgical intervention may be indicated after failure of a single nonoperative modality.
