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Tolerance and effect of sodium thiosulfate in calcific tendinitis of the rotator cuff

  • C. Darrieurtort-Laffite
  • A. Bertrand-Vasseur
  • T. Garraud
  • L. Planche
  • B. Le GoffEmail author
Original Article
  • 21 Downloads

Abstract

Background

Calcific tendinitis of the rotator cuff is one of the most common causes of shoulder pain. Ultrasound-guided percutaneous lavage of calcific tendinopathy is performed when conservative treatments have failed. Sodium thiosulfate (STS) has recently been used with success in the treatment of tumoral calcinosis. The goal of this phase II study was to assess the tolerance and the feasibility of STS lavage of calcific tendinopathy.

Methods

We included patient with type hard calcifications. Patients were treated with puncture and lavage followed by injection of STS in the calcification. VAS pain at rest and during activities, ultrasound, and X-ray were evaluated at 1 week and 1 and 3 months.

Results

Seventeen patients were included. Baseline VAS at rest and during daily activities was a mean 40.2 ± 25.9 and 65.5 ± 21.6 respectively. All patients underwent the entire procedure with no adverse event. Calcium backflow could be obtained in 15 patients (88.2%). Five patients (30%) had more than 50% decrease of their calcific deposit size at 1 month and 8 (47%) patients at 3 months. VAS pain during activities and at rest decreased significantly at 3 months (p = 0.0004; p = 0.001). Efficacy would be demonstrated if 60% of the patients had more than 50% decrease size of their calcification

Conclusion

Overall, STS was well tolerated with no side effect occurring during the procedure and the follow-up. However, no significant effect on calcium disappearance could be demonstrated compared with what is expected without STS. New studies using larger volume and repeated injections of STS are now needed.

Clinical trial registration number

NCT02538939

Key Points

• Lavage of calcific tendinopathy of the rotator cuff with sodium thiosulfate is feasible

• No adverse events have been observed after or in the 3 months after the procedure

• We could not demonstrate that sodium thiosulfate increases the chance of calcium disappearance

• New studies using larger volume and repeated injections of STS are needed to further explore the interest of sodium thiosulfate in the treatment of calcific tendinopathy

Keywords

Calcific tendinitis Open label study Rotator cuff Sodium thiosulfate Ultrasound-guided percutaneous lavage 

Abbreviations

STS

sodium thiosulfate

VAS

visual analogue scale

UGPL

ultrasound guided percutaneous lavage

ESWT

extracorporeal shock wave therapy

Notes

Acknowledgements

We would like to acknowledge Karine Fajoles and Peggy Ageneau for their help in the follow-up of the patients

Authors’ contributions

CDL, LP, TG, and BLG designed the study and interpreted data. ABV interpreted the X-ray. CDL, TG, and BLG performed the procedure. LP made the statistical analyses. CDL, LP, and BLG wrote the manuscript. All authors critically revised different versions of the manuscript, and all authors read and approve the final version of the manuscript. BLG is the corresponding author.

Funding information

This work has been supported by a grant from the Nantes University Hospital (AOI2014)

Compliance with ethical standards

Ethics approval and consent to participate

The protocol was approved by our local medical comity, the French National Agency for Medicines and Health Products Safety (ANSM; ref 141584A-32) and ethics review boards (Comité de Protection des Personnes (CPP); ref 09/15), and all participating patients signed informed consent forms.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interest

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Rheumatology DepartmentHôtel-DieuNantesFrance
  2. 2.INSERM UMR1238, Bone Sarcoma and Remodeling of Calcified TissueNantesFrance
  3. 3.Radiology DepartmentHôtel-DieuNantesFrance
  4. 4.Biometrics and Statistic PlatformHôtel-DieuNantesFrance

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