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Published on: December 23, 2022
Power Doppler Ultrasound after Ultrasound-Guided Lavage of Rotator Cuff Calcific Tendinopathy: Association with
Stefan Diermayr1, Franziska Despont1,2, Daniela Brune3
1Department of Rheumatology, Schulthess Klinik, Switzerland.
Objectives:
Ultrasound-guided puncture and lavage (UGPL) is an established first-line therapy for chronic rotator cuff calcific tendinopathy (RCCT). However, insufficient treatment response remains common, and residual calcification may contribute to persistent tendinitis. This study examines tendon neovascularization assessed by power Doppler ultrasound (PDUS) following UGPL and evaluates its correlation with clinical symptoms.
Methods:
Twenty-four patients with a single, large and dense calcific deposit underwent UGPL without steroid injection and were followed for 12 months. Vascularization was quantified by PDUS using the Chiou Score and a novel Vascular Score. Patient-reported outcomes included pain intensity (Pain NRS) and the subjective shoulder value (SSV). Associations between PDUS scores and outcomes were assessed using linear mixed-effects models.
Results:
Relevant PDUS signals (Chiou Score ≥2) were observed in 54% of patients at least once during the 12-month follow-up, without clustering at specific time points. Despite radiographic resolution in 70% of cases, residual calcifications remained detectable on ultrasound in all patients except 1. In the mixed-effects models including all follow-up events, PDUS scores were significantly associated with clinical symptoms. Higher Chiou and Vascular Scores corresponded to lower SSV values (Chiou Score: β = -5.91, p < .001; Vascular Score: β = -3.12, p < .001) and higher Pain NRS values (Chiou Score: β = 0.67, p = .001; Vascular Score: β = 0.34, p < .001).
Conclusion:
Persistent tendon hypervascularization correlates with worse outcomes after UGPL, despite radiographic resolution. These findings support the concept of postinterventional "microcalcific associated tendinopathy" and highlight the potential of PDUS as a monitoring tool in the management of RCCT.
