Ultrasound-guided Placement of a Localization Wire For Arthroscopic Treatment of Calcific Tendonitis

Surgical decompression of calcific tendonitis of the shoulder can be difficult because identification of the lesion is problematic, as the lesion is usually within the supraspinatus and cannot be directly visualized. We demonstrate a technique to identify and mark the calcific lesion using portable 2-D ultrasound to guide the placement of a breast-biopsy localization wire into the calcific lesion, followed by arthroscopic decompression of the calcific lesion. After regional anesthesia, portable ultrasound is used to identify the calcific lesion. The introducer needle of the breast-lesion localization wire is then advanced into the calcific lesion. The localization wire, with 2 barbs at its tip, is advanced through the introducer needle into the lesion. The barbs secure the wire into the lesion. After diagnostic arthroscopy, the arthroscope is placed into the subacromial space. The localization wire is identified and followed to the calcific lesion. The lesion is debrided with a motorized shaver, removing as much calcific material as possible. The supraspinatus tendon is then examined. If a significant defect is present, it is repaired. Early clinical results show good subjective and objective improvement.