A recent clinical trial has cast doubt on the effectiveness of a commonly used treatment for calcific tendinopathy of the shoulder. The study, published in The BMJ, found that saline injections combined with ultrasound-guided lavage offer no significant advantage compared to a placebo.
Calcific tendinopathy is a painful condition caused by the accumulation of calcium in the shoulder’s rotator cuff tendons. For years, ultrasound-guided lavage has been a go-to treatment for this condition. However, the recent trial, which is the first of its kind to test the true effect of the treatment, has raised questions about its efficacy.
The trial involved 218 adults with persistent symptoms of calcific tendinopathy. The participants were randomly assigned to receive ultrasound-guided lavage with a steroid injection, a sham lavage with a steroid injection, or a sham treatment only. The main measure of interest was pain intensity and functional disability reported by the patients over a 24 month period.
The study found that at four months, there was no significant difference in pain and functional limitation among the three groups. Furthermore, even in patients whose calcium deposits had disappeared, the symptoms persisted. This calls into question the belief that dissolving the calcium around the joint resolves the symptoms.
The researchers conclude that the findings challenge existing recommendations for the treatment of calcific tendinopathy and may require a critical reconsideration of established treatment concepts for these patients. They recommend further studies to investigate alternative treatments and include a no-treatment group to assess the natural course of the condition.
While the study raises doubts about the effectiveness of ultrasound-guided lavage, some researchers caution against completely dismissing the treatment. They suggest that future studies should include a sham control group, assess treatment response earlier in the symptomatic course, and explore better ways to predict treatment response.
The study was funded by the Bergersen Foundation, the Aase Bye and Trygve J.B. Hoffs Foundation, Smith and Nephew, and the Medical Research Council of Southeast Sweden. This research provides valuable insights that may lead to a reevaluation of current treatment methods and open doors for alternative approaches.