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Before delving deep into USG or ultrasound-guided needling for calcification of rotator cuff, let’s first understand what a rotator cuff and calcification are.

If you have ever had rotator cuff troubles, you might have heard about terms like rotator cuff tears, calcification, and discomfort and complications arising thereof.  The shoulder joint is the most flexible joint in our body that allows the arm to have an incredible range of motion.  This same advantage of the shoulder joint makes it more vulnerable to injuries and when injury happens the lack of mobility of this important joint can be particularly frustrating and uncomfortable.

The rotator cuff is made up of tendons from the supraspinatus, infraspinatus, teres minor and subscapularis muscles, and plays an important role in the dynamic stability of the shoulder joint.  The rotator cuff muscles contract and pull on the tendons, the tendons then pull on the bone.  This pull helps the arm (humerus) move.  Their duty is to provide the power to lift and rotate the arm.  With age, these muscles become thinner and weak, thus prone to tear, even with minimal trauma.  Rotator cuff muscles are usually seen at the junction of the muscle with the tendon, which is the part of the muscle that goes into the bone.

Having understood what a rotator cuff is, let’s understand calcification.  Calcification is a condition that leads to the formation of small (generally one to two centimeter size) calcium deposits within the rotator cuff tendons, predominantly carbonate apatite.  People between the age of 30 and 40 are the most vulnerable group for calcification.  Though the exact cause of the calcification is not clear, it is believed that diabetic patients are more prone to this condition.  These calcium deposits cause moderate-to-chronic pain and functional disability.  In some cases, the pain will settle itself after a period of one to four weeks.  Calcification in the rotator cuff is a common complaint and generally occurs when a person returns to work or sports too quickly, before the completion of a thorough rehabilitation program.  It is estimated that about 20% of all the shoulder ailments are related to rotator cuff calcification.  Females are affected most than males.  The condition is generally characterized by acute or chronic inflammation around crystal hydroxyapatite on the rotator cuff tendons.

More often than not, it is the supraspinatus tendon that is susceptible to this condition, accounting for about 80%.  Calcification in the rotator cuff seriously affects the patient’s activities of daily living, overall quality of life and mobility.  That being the case, understanding the efficacy of treatment options is very important.  That is where ultrasound-guided needling assumes importance.

What is USG needling?

Ultrasound is established as a prominent modality for rotator cuff calcification, being accurate, affordable and above all radiation free.  As per ultrasound imaging, calcium deposits can be divided as hyper-reflexive nodule (hard), homogeneous hyperechoic foci (soft) and hyperechoic peripheral rim (fluid).  For patients who condition do not improve with traditional and conservative treatment modalities, removal of calcification in the rotator cuff may be facilitated ultrasound-guided needle lavage (a general term referring to the therapeutic washing, cleaning or rinsing).  This is a minimally-invasive treatment and it requires the use of one or two needles to perform the washout, though no clear-cut evidence exists in terms of using a specific number or size of needles.  Aspiration of calcium deposits is done with an ultrasound probe to see the procedure in real time.  Calcifications are subsequently broken up and the removal is aided with saline lavage.

Advantages of USG needling compared to blind injection:

Blind injections are not 100% accurate.  The principal advantage of using ultrasound in needling is doctors can locate the exact position of calcifications and no need of using hazardous radiation from fluoroscopy.  Compared to radiation, ultrasound is highly sensitive.  Furthermore, ultrasound coveys the exact size and softness of the calcification and which can be documented in medical records, allowing objective comparisons in the future.  Being an image-guided process, USG needling is less invasive, faster and reduced post-procedural complications.

Apart from aiding the calcifications to be removed, ultrasound-guided technique also throws light on the status of the surrounding tendons.  USG technique also helps to identify if there are any procedure-related tears.  Due to the overall simplicity of the treatment, USG needling is becoming increasingly popular among patients suffering from rotator cuff calcifications.  A vast majority of patients who underwent USG needling experienced rapid pain improvement with bare minimum complications rates.

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