Tolerance and effect of sodium thiosulfate in calcific tendinitis of the rotator cuff
- 21 Downloads
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
• 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
KeywordsCalcific tendinitis Open label study Rotator cuff Sodium thiosulfate Ultrasound-guided percutaneous lavage
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
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.
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
The authors declare that they have no competing interest
- 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
- 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.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
- 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
- 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
- 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
- 36.Arakaki R, Kroshinsky D (2013) Treatment of cutaneous dystrophic calcification with intralesional sodium thiosulfate. J Am Acad Dermatol 68:AB73Google Scholar