ArticlePM & R : the journal of injury, function, and rehabilitation2025
Correlation between aspiration of calcific rotator cuff tendinopathy and morphology on imaging.
Article in PM & R : the journal of injury, function, and rehabilitation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCalcific rotator cuff (RTC) tendinopathy is a self-limited, atraumatic cause of shoulder pain. Ultrasound-guided percutaneous needling and aspiration (USPNA) can be used when other nonoperative treatments fail.
objectiveTo determine if there is an association between morphology of RTC calcifications on imaging and the ability to aspirate calcifications.
designCase series.
settingTertiary orthopedic institution. PATIENTS: A total of 272 patients who underwent USPNA for symptomatic calcific RTC tendinopathy and had available imaging and clinical data.
interventionsImaging was categorized using Gärtner-Heyer (x-ray), Farin-Jaroma (ultrasound), and Chiou (ultrasound) morphological classifications.
main outcome measuresPercentages of successful and unsuccessful aspirations were calculated.
resultsThere were 292 USPNA cases; 170 (58.2%) aspirations were successful. Inter-rater reliability was almost-perfect for Farin-Jaroma and Chiou classifications (kappa: 0.92-1.00; p < .001) and fair-to-moderate for Gärtner-Heyer classifications (kappa: 0.38-0.74; p < .001). When applying the Gärtner-Heyer classification, 92/134 (68.7%) type I, 65/117 (55.6%) type II, and 10/35 (28.6%) type III calcifications were successfully aspirated (p < .001). Six calcifications could not be classified. No statistical difference was appreciated when using Farin-Jaroma (p = .939) or Chiou (p = .524) classifications. The mean calcification size for successful aspirations was significantly larger than that for unsuccessful aspirations (16.7 ± 6.4 mm vs. 13.4 ± 7.5 mm; p < .001), although there was no difference in ability to aspirate single versus multiple calcifications. The regression analysis showed an association between increasing calcification size and greater odds of aspiration success (10% increase; p < .001). Compared with type I Gärtner-Heyer classifications, type II and type III were associated with decreased odds of aspiration success (64% and 91% decreases, respectively; p ≤ .003).
conclusionsGärtner-Heyer classification was associated with the ability to successfully aspirate calcifications; type I calcifications were most frequently aspirated. Larger calcifications were also more frequently aspirated successfully. These factors may improve patient selection for USPNA. Further studies are needed to explore whether imaging classifications of RTC calcifications are correlated with patient-reported outcomes following USPNA.
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