Ultrasound-guided shoulder puncture

If you feel pain when you raise your arm over your head or buckle your seatbelt or have difficulty raising your arm over your head or behind your back, if you wake up with shoulder pain at night and your pain starts to radiate down towards your elbow, this may be due to calcific tendonitis, a condition that causes a build-up of calcium and inflammation in the tendons.

The condition and thus the pain can be treated with a non-surgical ultrasound-guided shoulder puncture, a method that is well-established around the world.

Calcific tendonitis is a condition where a calcium deposit causes the surrounding tissue to become inflamed, often resulting in intense pain. It is a relatively common problem – studies have shown that it affects up to 20% of people between 40 and 65 years of age, though it sometimes occurs in younger people as well, with women being more likely to have it than men.

Calcium crystals are deposited in parts of the rotator cuff tendon that have degenerated due to impaired blood flow. When the calcium deposit reaches a critical volume, or following repeated injury to the affected area, the crystals begin to be released into the area surrounding the tendon, causing inflammation.

Who is it for?

The procedure is recommended for all those experiencing pain in the calcified area, preferably as quickly as possible after the pain starts. People who perform repetitive movements (lifting, carrying, computer work etc.) and those who have previously injured their tendon are particularly at risk.

When making an appointment, the patient needs to bring a recent ultrasound image to confirm that the pain is located in the calcified part of the tendon (usually accompanied by inflammation in the surrounding tendon) and rule out other causes, such as a tendon rupture or bursitis. A shoulder ultrasound can also be performed at the Diagnostic Centre Bled.

How is the procedure performed?

The procedure takes 20 to 40 minutes, depending on the size and hardness of the calcium deposit. The calcium deposit in the tendon needs to be larger than 8 mm for the procedure to be performed. The deposit is punctured under ultrasound guidance and irrigated to flush out part of the crystals. More than 80% of the deposit can be removed. A pain reliever (paracetamol or a non-steroidal anti-inflammatory drug) is recommended to be taken on the first day to relieve any pain caused by the swelling of the tissue surrounding the puncture site. A significant improvement in shoulder mobility is seen immediately after the procedure, and the pain will disappear completely after a few days.

The procedure does not have to be repeated for most patients. However, in some 20% of patients, the pain may return in a milder form in 3 to 6 months. In those cases, the shoulder is examined using ultrasound. If the tendon still contains calcium deposits larger than 8 mm, the procedure is repeated. If there are only individual smaller crystals (a few mm in size) remaining, shock wave therapy is recommended.

An ultrasound-guided shoulder puncture is not possible in patients allergic to xylocaine, a numbing agent that is also used in dentistry.

After the procedure

We recommend performing everyday activities as usual for four to eight weeks following the procedure, avoiding, however, any repetitive movements involving raising the arm above head level, or lifting heavy weights. It is recommended to perform shoulder girdle strengthening exercises with gradually increasing intensity under the supervision of a physical therapist. Other physical therapy procedures aimed at improving tendon regeneration (ultrasound, magnetic therapy) are also beneficial.

At Diagnostic Centre Bled, the mentioned examinations is performed as self-pay.  More >>