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



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.


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.


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


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


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


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



sodium thiosulfate


visual analogue scale


ultrasound guided percutaneous lavage


extracorporeal shock wave therapy



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


  1. 1.
    Farin PU, Jaroma H (1995) Sonographic findings of rotator cuff calcifications. J Ultrasound Med 14:7–14CrossRefGoogle Scholar
  2. 2.
    Friedman MS (1957) Calcified tendinitis of the shoulder. Am J Surg 94:56–61CrossRefGoogle Scholar
  3. 3.
    Harmon PH (1958) Methods and results in the treatment of 2580 painful shoulders, with special reference to calcific tendinitis and the frozen shoulder. Am J Surg 95:527–544CrossRefGoogle Scholar
  4. 4.
    Louwerens JK, Sierevelt IN, van Hove RP, van den Bekerom M, van Noort A (2015) Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. J Shoulder Elb Surg 24:1588–1593CrossRefGoogle Scholar
  5. 5.
    Darrieutort-Laffite C, Blanchard F, Le Goff B (2018) Calcific tendonitis of the rotator cuff: from formation to resorption. Joint Bone Spine 85(6):687–692CrossRefGoogle Scholar
  6. 6.
    Le Goff B, Berthelot JM, Guillot P et al (2010) Assessment of calcific tendonitis of rotator cuff by ultrasonography: comparison between symptomatic and asymptomatic shoulders. Joint Bone Spine 77:258–263CrossRefGoogle Scholar
  7. 7.
    de Witte PB, Selten JW, Navas A, Nagels J, Visser CP, Nelissen RG, Reijnierse M (2013) Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med 41:1665–1673CrossRefGoogle Scholar
  8. 8.
    Wang CJ, Yang KD, Wang FS, Chen HH, Wang JW (2003) Shock wave therapy for calcific tendinitis of the shoulder: a prospective clinical study with two-year follow-up. Am J Sports Med 31:425–430CrossRefGoogle Scholar
  9. 9.
    Balke M, Bielefeld R, Schmidt C, Dedy N, Liem D (2012) Calcifying tendinitis of the shoulder: midterm results after arthroscopic treatment. Am J Sports Med 40:657–661CrossRefGoogle Scholar
  10. 10.
    Louwerens JK, Veltman ES, van Noort A, van den Bekerom MP (2016) The effectiveness of high-energy extracorporeal shockwave therapy versus ultrasound-guided needling versus arthroscopic surgery in the management of chronic calcific rotator cuff tendinopathy: a systematic review. Arthroscopy 32:165–175CrossRefGoogle Scholar
  11. 11.
    Arirachakaran A, Boonard M, Yamaphai S, Prommahachai A, Kesprayura S, Kongtharvonskul J (2017) Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs. Eur J Orthop Surg Traumatol 27:381–390CrossRefGoogle Scholar
  12. 12.
    Yoo JC, Koh KH, Park WH, Park JC, Kim SM, Yoon YC (2010) The outcome of ultrasound-guided needle decompression and steroid injection in calcific tendinitis. J Shoulder Elb Surg 19:596–600CrossRefGoogle Scholar
  13. 13.
    Krasny C, Enenkel M, Aigner N et al (2005) Ultrasound-guided needling combined with shock-wave therapy for the treatment of calcifying tendonitis of the shoulder. J Bone Joint Surg (Br) 87:501–507CrossRefGoogle Scholar
  14. 14.
    Del Castillo-González F, Ramos-Alvarez JJ, Rodríguez-Fabián G, González-Pérez J, Jiménez-Herranz E, Varela E (2016) Extracorporeal shockwaves versus ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a randomized controlled trial. Eur J Phys Rehabil Med 52(2):145–151PubMedGoogle Scholar
  15. 15.
    Aina R, Cardinal E, Bureau NJ, Aubin B, Brassard P (2001) Calcific shoulder tendinitis: treatment with modified US-guided fine-needle technique. Radiology 221:455–461CrossRefGoogle Scholar
  16. 16.
    Sconfienza LM, Bandirali M, Serafini G, Lacelli F, Aliprandi A, di Leo G, Sardanelli F (2012) Rotator cuff calcific tendinitis: does warm saline solution improve the short-term outcome of double-needle US-guided treatment? Radiology 262:560–566CrossRefGoogle Scholar
  17. 17.
    Orlandi D, Mauri G, Lacelli F et al (2017) Rotator cuff calcific tendinopathy: randomized comparison of US-guided percutaneous treatments by using one or two needles. Radiology 285:518–527CrossRefGoogle Scholar
  18. 18.
    Reade MC, Davies SR, Morley PT, Dennett J, Jacobs IC (2012) Australian Resuscitation Council. Review article: management of cyanide poisoning. Emerg Med Australas 24:225–238CrossRefGoogle Scholar
  19. 19.
    Cicone JS, Petronis JB, Embert CD, Spector DA (2004) Successful treatment of calciphylaxis with intravenous sodium thiosulfate. Am J Kidney Dis 43:1104–1108CrossRefGoogle Scholar
  20. 20.
    Nigwekar SU, Brunelli SM, Meade D, Wang W, Hymes J, Lacson E Jr (2013) Sodium thiosulfate therapy for calcific uremic arteriolopathy. Clin J Am Soc Nephrol 8:1162–1170CrossRefGoogle Scholar
  21. 21.
    Ossorio-García L, Jiménez-Gallo D, Arjona-Aguilera C, Linares-Barrios M (2016) Intralesional sodium thiosulfate to treat calciphylaxis. Actas Dermosifiliogr 107:359–362CrossRefGoogle Scholar
  22. 22.
    Jost J, Bahans C, Courbebaisse M, Tran TA, Linglart A, Benistan K, Lienhardt A, Mutar H, Pfender E, Ratsimbazafy V, Guigonis V (2016) Topical sodium thiosulfate: a treatment for calcifications in hyperphosphatemic familial tumoral calcinosis? J Clin Endocrinol Metab 101:2810–2815CrossRefGoogle Scholar
  23. 23.
    Guigonis V, Bahans C, Ea K, Bourrat E, Lienhardt A, Chabre O, Jost J, Mutar H, Ratsimbazafy V, Linglart A (2015) Treatment of heterotopic ossifications secondary to pseudohypoparathyroid. Ann Endocrinol (Paris) 76:183–184CrossRefGoogle Scholar
  24. 24.
    Del Barrio-Díaz P, Moll-Manzur C, Álvarez-Veliz S, Vera-Kellet C (2016) Topical sodium metabisulfite for the treatment of calcinosis cutis: a promising new therapy. Br J Dermatol 175:608–611CrossRefGoogle Scholar
  25. 25.
    Ratsimbazafy V, Bahans C, Guigonis V (2012) Dramatic diminution of a large calcification treated with topical sodium thiosulfate. Arthritis Rheum 64:3826CrossRefGoogle Scholar
  26. 26.
    Smith GP (2013) Intradermal sodium thiosulfate for exophytic calcinosis cutis of connective tissue disease. J Am Acad Dermatol 69:e146–e147CrossRefGoogle Scholar
  27. 27.
    Strazzula L, Nigwekar SU, Steele D, Tsiaras W, Sise M, Bis S, Smith GP, Kroshinsky D (2013) Intralesional sodium thiosulfate for the treatment of calciphylaxis. JAMA Dermatol 149:946–949CrossRefGoogle Scholar
  28. 28.
    O'Neill WC (2013) Sodium thiosulfate: mythical treatment for a mysterious disease? Clin J Am Soc Nephrol 8:1068–1069CrossRefGoogle Scholar
  29. 29.
    Mole D, Kempf JF, Gleyze P et al (1993) la Societe Francaise d’Arthroscopie. Resultats du traitement arthroscopique des tendinopathies non rompues de la coiffe des rotateurs. 2e partie: les calcifications de la coiffe des rotateurs. Rev Chir Orthop 79:532e41Google Scholar
  30. 30.
    Fayad F, Lefevre-Colau MM, Macé Y, Fermanian J, Mayoux-Benhamou A, Roren A, Rannou F, Roby-Brami A, Gautheron V, Revel M, Poiraudeau S (2008) Validation of the French version of the Disability of the Arm, Shoulder and Hand questionnaire (F-DASH). Joint Bone Spine 75:195–200CrossRefGoogle Scholar
  31. 31.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608CrossRefGoogle Scholar
  32. 32.
    Chiou HJ, Chou YH, Wu JJ, Huang TF, Ma HL, Hsu CC, Chang CY (2001) The role of high-resolution ultrasonography in management of calcific tendonitis of the rotator cuff. Ultrasound Med Biol 27:735–743CrossRefGoogle Scholar
  33. 33.
    van Holsbeeck M, Strouse PJ (1993) Sonography of the shoulder: evaluation of the subacromial-subdeltoid bursa. Am J Roentgenol 160:561–564CrossRefGoogle Scholar
  34. 34.
    Jelsing EJ, Maida E, Smith J (2013) A simple technique to restore needle patency during percutaneous lavage and aspiration of calcific rotator cuff tendinopathy. PM R 5:242–244CrossRefGoogle Scholar
  35. 35.
    Maugars Y, Varin S, Gouin F, Huguet D, Rodet D, Nizard J, N'Guyen JM, Guillot P, Glémarec J, Passutti N, Berthelot JM (2009) Treatment of shoulder calcifications of the cuff: a controlled study. Joint Bone Spine 76:369–377CrossRefGoogle Scholar
  36. 36.
    Arakaki R, Kroshinsky D (2013) Treatment of cutaneous dystrophic calcification with intralesional sodium thiosulfate. J Am Acad Dermatol 68:AB73Google Scholar
  37. 37.
    Sconfienza LM, Randelli F, Sdao S, Sardanelli F, Randelli P (2014) Septic bursitis after ultrasound-guided percutaneous treatment of rotator cuff calcific tendinopathy. PM R 6:746–748CrossRefGoogle Scholar
  38. 38.
    del Cura JL, Torre I, Zabala R, Legórburu A (2007) Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results. AJR Am J Roentgenol 189:W128–W134CrossRefGoogle Scholar

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

Personalised recommendations