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Calcific tendinopathy — MRCP Part 1 MCQ

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HardShoulder InjuriesCalcific tendinopathyMRCP Part 1

A 48-year-old has chronic painful calcific supraspinatus tendinopathy confirmed by ultrasound. Exercise-based care and analgesia have provided limited relief. She asks whether ultrasound-guided lavage with subacromial corticosteroid has proven durable benefit over a sham procedure. Which statement best reflects the strongest recent evidence?

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Correct answer: D — A sham-controlled trial found no durable advantage over sham treatment

The best answer is “A sham-controlled trial found no durable advantage over sham treatment”. The rigorous multicentre sham-controlled trial found no benefit of ultrasound-guided lavage with corticosteroid over sham treatment at the primary follow-up, and no durable advantage at longer follow-up. Earlier uncontrolled studies and lower-quality syntheses had suggested benefit, illustrating why radiographic deposit reduction should not be assumed to equal patient-important improvement. Management remains individualised and conservative rehabilitation is appropriate; the evidence does not support categorical size-based efficacy or guaranteed recurrence prevention.

Reference: BMJ randomised trial of lavage for calcific shoulder tendinopathy: https://pmc.ncbi.nlm.nih.gov/articles/PMC10565688/