It’s known as a fairly common treatment – using saline solution to wash limescale off people’s shoulders. Approximately twice a week, Stefan Moosmayer and his colleagues at Martina Hansens Hospital in Bærum have carried out this treatment. For many years. And the impression has been that people have improved. – Too many of the patients are satisfied, says Moosmayer, who is an orthopedist and researcher. But now he is no longer so sure. Because the results from a new study show that the treatment has little or no effect whatsoever. Peels off the calcium Initially, people with calcification get help with the pain in the form of an exercise program. If that doesn’t work then the next step is to try and remove the scale. – It can be done with surgery, that you go in and peel the calcareous out. It can also be done with shock wave treatment, where you try to break up the limescale. And the most popular method is lime rinsing, says Moosmayer. It involves inserting a needle into the shoulder while the doctors check with an ultrasound that they are in the right place. Then they squeeze in salt water and dissolve the lime that is there like dry toothpaste. Here, the calcium is “washed” out of the shoulder using a saline solution.Stefan Moosmayer But the doctors have not had proof that this works. Therefore, they recruited 218 women and men in Norway and Sweden whom they could examine. Got the same result – We let people draw lots for one of three groups, says Moosmayer. One group received a calcium rinse and a cortisone injection. The other group received a cortisone shot and a similar rinse. The third group received a similar treatment, where they carried out the entire procedure without rinsing away the lime. – The patients were stabbed in the shoulder, and we played a bit of theater for them, so they thought we were washing out the limescale, says the superintendent. Afterwards, the researchers followed the patients to see which group came out the best. – Surprisingly, after four months we found no difference. The placebo treatment had the same result as the lime rinse and the cortisone injection. Stefan Moosmayer is a senior physician in orthopedics at Martina Hansens Hospital in Bærum. He is one of the researchers behind the new study. Photo: Privat The only difference was that those who received cortisone had less pain in the first six weeks after the treatment. But after four months the differences were gone. – So it was a bit disappointing for us, says Moosmayer. – Why? – Yes, because we have been using this method, and we felt that we were doing something good for the patients. Now that method is falling away a bit. – Not really surprising Lennart Bentsen is a university lecturer in the physiotherapist education at NTNU. He is also the leader of the Norwegian Physiotherapist Association’s professional group for manual therapy. Bentsen thinks the study is both important and exciting. But had he expected these results? – I’m not really surprised. Several studies in recent years have investigated commonly used surgical treatments and injection treatments for common musculoskeletal ailments. These are also checked against fake treatments where the patients do not know whether they received real or fake treatment. What these studies have in common is that the results are mostly the same, and that they rarely favor surgery or injections. He believes the new study is important in terms of overtreatment in the healthcare system. – It provides a better knowledge base for practice and changing practice, says the university lecturer. Ailments that include calcification belong under the collective term “subacromial pain.” But professionals cannot be sure which tissue triggers the pain, says Bentsen. Such subacromial pain is the most common among shoulder complaints, and shoulder complaints in general are considered the third most common musculoskeletal complaint. Back and neck smarts come first. The causes of calcification are not well enough known, and what’s more, it also occurs in people without shoulder problems, explains Lennart Bentsen. Photo: Morten Waagø / news Perhaps the intervention should be reconsidered Researcher and senior doctor Stefan Moosmayer says they would like to have a fourth control group to assess the natural course of the condition. Nevertheless, they believe the results clearly show that the treatment should be reconsidered. In addition, the findings in the study make the doctors suspect that it is not the calcium that causes pain in the shoulders after all. – In some patients the calculus is gone after four months, in others it is not gone. But we find no difference between them. So it challenges our way of thinking about the whole disease. – This is important, because we do not want to overtreat the patients. In addition, there is something else that is positive. – The patients are getting better. It is also the best message for us to take forward. You have to be patient. You can tell the patients that you know they will get better over time. It may be enough that they receive pain treatment, but that we refrain from surgery or limescale.
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Conventional treatment for shoulder pain does not work, according to a Norwegian study. Worked just as well with a placebo – news Trøndelag – Local news, TV and radio
