Lavage treatments for calcific rotator cuff tendinopathy

Calcific tendinopathy is a painful condition characterized by calcium hydroxyapatite deposition within a tendon, most commonly the shoulder. Many factors are classically thought to be important when considering a treatment regimen, such as duration and severity of symptoms, characteristics of the calcification, and the patient’s goals.

Subacromial bursal corticosteroid injection with and without ultrasound guided lavage and shockwave therapy are widely studied interventions, and meta-analyses suggest that ultrasound guided lavage with steroid injection is associated with the greatest clinical benefits.12 However, interventional studies to date have usually lacked a sham treatment control group. In the linked BMJ paper (doi:10.1136/bmj-2023-076447), Moosmayer and colleagues report their multi-arm, double blinded, sham controlled, randomized controlled trial, conducted in an effort to fill this important evidence gap and challenge the claims of previous interventional trials.3

Moosmayer and colleagues should be commended on a well conducted randomized controlled trial, representing one of the largest sample sizes to date (220 patients). Patients were randomized to receive ultrasound guided lavage plus subacromial injection with 20 mg triamcinolone and 9 mL of 1% lidocaine (lavage+steroid), sham lavage plus the same subacromial injection (sham lavage+steroid), or sham lavage plus subacromial injection of 10 mL of 1% lidocaine only (sham). Lavage was done using a single needle technique. Participants in …