Ultrasonography-Guided Percutaneous Irrigation for Calcific Tendinopathy: 1 vs 2 Needles

shoulder joints
shoulder joints
No difference in outcomes was found between a single- and a double-needle ultrasonography-guided percutaneous irrigation in patients with calcific tendinopathy.

Findings published in Radiology show no difference in outcomes between single- and double-needle ultrasonography (US)-guided percutaneous irrigation in patients with calcific tendinopathy.1 

Up to 20% of shoulder pain is associated with rotator cuff calcific tendinopathy, a condition that most commonly affects women in their 40s and 50s.2 One proposed underlying mechanism is impaired oxygen supply within the tendon. “Symptoms may vary from low-grade, subacute pain that worsens during the night, to intense, highly disabling pain resistant to high doses of oral anti-inflammatory drugs and painkillers,” wrote the investigators in the new study.

The first-line treatment for calcific tendinopathy is US-guided percutaneous irrigation, which uses a fluid to dissolve and aspirate calcium deposits. The use of 2 needles vs 1 needle raises concerns in some clinicians regarding the potential for greater damage.

Noting the lack of studies comparing the two methods, researchers sought to examine procedure performance and clinical outcomes for both in 211 patients (63.5% women; mean age, 41.6±11.6). Participants were randomly assigned to receive the single-needle (n=100) or double-needle procedure (n=111).

Calcifications were graded as soft, hard, or fluid, before the procedure, and calcium dissolution during the procedure was scored as easy, intermediate, or difficult. Follow-up occurred at 1, 3, and 12 months.

While no overall difference in the duration of the procedure was observed (P =.06), the duration for hard calcifications was found to be shorter with the double needle (P <.001) and for fluid calcifications with the single needle (P =.024). No difference in ease of dissolution was found between methods (P >.089), and no differences in short- or long-term clinical outcomes were observed between groups (P =.241). Post-procedural bursitis was noted in 9% of the single-needle group and in 3.6% of the double-needle group (P =.180), but the difference was not significant. 

Summary and Clinical Applicability

Outcomes are similar between single-needle and double-needle ultrasonography (US)-guided percutaneous irrigation in the treatment of patients with calcific tendinopathy.


One limitation may be the use of different-size needles between the 2 methods: 16-gauge for the double-needle procedure and 18-gauge for the single-needle procedure.

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  1. Orlandi D, Mauri G, Lacelli F, et al. Rotator cuff calcific tendinopathy: randomized comparison of US-guided percutaneous treatments by using one or two needles [published online June 14, 2017]. Radiology. doi:10.1148/radiol.2017162888f
  2. Sconfienza LM, Bandirali M, Serafini G, et al. Rotator cuff calcific tendinitis: does warm saline solution improve the shortterm outcome of double-needle US-guided treatment? Radiology. 2012;262(2):560-566. doi:10.1148/radiol.11111157