First off, I'd like to thank my mentor, Dr. Albert Lin, for his help with this project and Dr. Mauricio Drummond for laying the groundwork for me to be able to do it. This is sort of a continuation of the previous study, so I won't belabor the pathophysiology. We all know about calcific tendonitis, what it is, risk factors. In terms of treatment options at our institution, the options we have are rest, observation, physical therapy, corticosteroid injections, and ultrasound-guided aspiration. As Dr. Drummond alluded to earlier, for patients who fail to respond to those treatment options, they generally go on to surgery, which involves arthroscopic decompression of the calcium with possible concomitant rotator cuff repair. This is just an example of the ultrasound-guided aspiration. So our question for this study was, of these three most common treatments or initial treatments for calcific tendonitis, physical therapy, corticosteroid injection, and ultrasound-guided aspiration, which works best in attempting to avoid surgery? And secondarily, if the patient goes on to surgery, does the type of presurgical treatment modality affect their postoperative outcomes? Our hypothesis was basically the null hypothesis, that we would see similar rates of avoidance of surgery, and that we would see no significant differences in outcomes after surgery. So this was a retrospective cohort study. All patients were diagnosed with calcific tendonitis between 2009 and 2019. We grouped them into five groups. One that went straight on to surgery due to the severity of symptoms without trying some sort of non-operative treatment. The three treatments that I mentioned a second ago, as well as those patients who attempted multiple non-operative modalities, some combination of the above. The outcomes that we looked at, our primary outcome was avoiding surgery. Secondary outcomes were VAS pain scores, subjective shoulder value, and active range of motion in those three planes. This is just a schematic of kind of how the project was set up. So we had, after the initial evaluation, we got those PROs. The patients attempted an initial treatment, and then we evaluated how many of those worked. Secondarily, for those patients who then went on to surgery, we compared those outcome measures based on the type of preoperative treatment they had. So let's get to the results. We in this cohort of patients had 120, average age of 55 years. Our follow-up was 190 days on average for the non-operative treatment group, and the surgical group was 151 days. This is our general results. Overall, we saw a success rate, meaning 44% of the patients overall were able to avoid surgery, slightly higher than Dr. Drummond reported in his study. We did note that there was significant heterogeneity among the groups in avoiding surgery, but that's likely due to the fact that those patients who tried multiple modalities failed. When we eliminated those and looked only at the patients in those three groups, physical therapy, steroid injection, and ultrasound-guided aspiration, there was no significant difference. So in our non-surgical patients, all patients improved from their initial evaluation to final evaluation with regards to all of our outcome measures, pain, as well as range of motion. Of note, there was no significant difference among the groups. For the patients who did go on to surgery, we saw statistically significant improvement in all groups from pre-op to post-op, and no significant differences among the groups with regards to pain or range of motion. So overall discussion here. Our patients are able to avoid surgery in this cohort about 44% of the time, so roughly half of the time. We noted no difference among the groups in terms of avoiding surgery. The non-operative group, everyone improved, and there was no significant differences in our outcome measures. And for those surgical patients, everyone improved from pre-op to post-op, and again, there was no significant differences. As well of note, all patients who did try multiple modalities eventually went on to surgery. So our conclusions here. How do we put this all together, make sense of it? Overall, conservative treatments for calcific tendinitis will help patients avoid surgery about 50% of the time, and it doesn't really matter which one you try of the above. And if it doesn't work, it doesn't seem like it's worthwhile to beat a horse or beat a dead horse, and it might be time to go to surgery. Surgical patients generally do very well regardless of the conservative treatment you tried pre-operatively. And that's it. Thank you so much.

calcific tendonitis

treatment options

avoiding surgery

preoperative treatment

postoperative outcomes