From the Guidelines
No, an ultrasound of the shoulder is not necessarily recommended for a patient with calcific tendinopathy on X-ray, as the routine use of imaging for musculoskeletal pain is often discouraged and associated with harms. According to a systematic review published in the British Journal of Sports Medicine in 2020 1, overuse of imaging is a common problem in musculoskeletal pain care, with 25% to 42% of patients with low back pain undergoing imaging despite its routine use being discouraged. Similarly, a study published in the same journal in 2018 1 found that 69% of general practitioners would refer patients for radiography and 82% would refer for ultrasound on first presentation with rotator cuff tendinopathy, despite the lack of evidence supporting this practice.
Some key points to consider when evaluating the need for an ultrasound in this context include:
- The potential for overuse of imaging and associated harms
- The lack of evidence supporting the routine use of ultrasound for rotator cuff tendinopathy
- The importance of considering the clinical presentation and symptoms of the patient, rather than relying solely on imaging findings
- The potential benefits of alternative approaches, such as exercise-based rehabilitation or education and advice, which may be more effective and less harmful than imaging and surgical interventions.
It's worth noting that while ultrasound can provide valuable information about the condition of the shoulder and surrounding soft tissues, its use should be guided by a thorough clinical evaluation and a consideration of the potential benefits and harms. In some cases, ultrasound may be useful for guiding treatment decisions or monitoring the progression of the condition, but its routine use for patients with calcific tendinopathy on X-ray is not supported by the current evidence.
From the Research
Diagnosis and Treatment of Calcific Tendinopathy
- Calcific tendinopathy of the shoulder is a common cause of shoulder pain and debility, and diagnosis is usually based on ultrasound (US) and/or x-ray 2.
- Ultrasound-guided treatments, such as ultrasonic tenotomy and debridement, have been shown to be safe and effective for patients with calcific tendinopathy of the supraspinatus 3.
- A network meta-analysis of RCTs found that combined US-guided needling and subacromial corticosteroid injection significantly decreased shoulder pain and improved CMS score and decreased the size of calcium deposits 4.
Role of Ultrasound in Diagnosis and Treatment
- Ultrasound is considered an inherently operator-dependent imaging modality, but a study found very good interobserver reliability of type and size measurement of shoulder calcifying tendinopathy in experienced musculoskeletal radiologists 2.
- Ultrasound-guided needle aspiration and lavage techniques can provide long-term improvement in pain and function in patients with rotator cuff calcific tendinopathy 5.
- Ultrasound can be used to guide minimally invasive treatment options, such as ultrasonic tenotomy and debridement, for management of calcific tendinopathy of the shoulder 3.
Recommendation for Ultrasound
- Based on the evidence, an ultrasound (US) of the shoulder is recommended for a patient with calcific tendinopathy on X-ray (XR), as it can provide valuable information for diagnosis and treatment 3, 4, 2, 5.
- Ultrasound can be used to confirm the diagnosis, guide treatment, and monitor the effectiveness of treatment 3, 4, 2, 5.