Ultrasound-Guided Needling Without Lavage Followed by Platelet-Rich Plasma or Corticosteroid in Rotator Cuff Calcific Tendinitis: A Comparative Cohort Study.

Background/Objectives: This study aimed to compare the effects of platelet-rich plasma (PRP) versus corticosteroid injection administered after ultrasound-guided needling without lavage on pain, shoulder function, and radiographic resorption in rotator cuff calcific tendinitis. Methods: This retrospective single-centre cohort included 93 patients. All underwent ultrasound-guided needling of the calcific deposit without lavage. Treatment allocation reflected routine clinical practice and was non-randomised. Patients with Gartner type 1-2 calcifications received either PRP or corticosteroid injections, whereas type 3 patients were treated with needling + PRP or conservative management. Outcomes were VAS pain, Constant-Murley Score (CMS), QuickDASH, and radiographic resorption, assessed at baseline, 2 weeks, 6 months, and 12 months. Results: In Gartner type 1-2 disease, needling followed by PRP resulted in greater 12-month pain reduction than needling followed by corticosteroid (both p < 0.05), while improvements in CMS, QuickDASH, and 1-year complete resorption rates were similar between groups. Gartner type 3 calcifications showed substantial clinical improvement irrespective of treatment modality, but the combined needling + PRP intervention was associated with a higher rate of complete radiographic resorption at 2 weeks than conservative care (72.2% vs. 13.3%; p = 0.001). Four patients (4/93, 4.3%) required arthroscopic surgery (three corticosteroid, one PRP). Conclusions: In Gartner type 1-2 calcific tendinitis, ultrasound-guided needling followed by PRP was associated with greater 12-month pain reduction than needling followed by corticosteroid, whereas functional and 1-year radiographic outcomes were comparable. In symptomatic Gartner type 3 disease, the combined needling + PRP intervention was associated with faster early radiographic resorption but did not demonstrate superior long-term clinical outcomes; conservative treatment remains appropriate for patients with tolerable symptoms.