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Alito A, de Sire A, Di Gesù M, Buccheri E, Borzelli D, Chiaramonte R, Longo UG, Ammendolia A, Vecchio M, Bruschetta D. Impact of Adequate Disinfection Techniques for Ultrasound-Guided Injections in Musculoskeletal Rehabilitation: A Scoping Review. Diagnostics (Basel) 2025; 15:933. [PMID: 40218283 PMCID: PMC11989170 DOI: 10.3390/diagnostics15070933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Revised: 03/28/2025] [Accepted: 04/01/2025] [Indexed: 04/14/2025] Open
Abstract
Background: Interventional physiatry is a branch of medicine that uses minimally invasive ultrasound-guided techniques for diagnosis and treatment in the musculoskeletal system. The aim of this scoping review is to investigate the sterilisation techniques used and the rate of infection with ultrasound-guided injections. Methods: PubMed was searched up to 30 September 2024 using the following search terms ("Ultrasound, Interventional"[mesh]) AND "Injections, Intra-Articular"[mesh]; "Ultrasound-guided intra-articular injection". The inclusion criteria were randomised clinical trials, written in English, involving US-guided mini-invaexercissive procedures. Results: The search identified a total of 256 potentially relevant publications. After screening for duplication, inclusion, and exclusion criteria, 105 articles were eligible for data extraction. In 51 studies, the method of skin disinfection was not specified, 18 RCT reported a 'sterile condition', 9 studies used povidone-iodine solution, 5 used alcohol, and 2 used chlorhexidine 0.5%. In 64 trials, the method of probe preparation was not specified, 11 trials described the use of sterile gel, 10 trials reported the use of a probe cover, sterile pad, or barrier, and 2 trials reported the use of chlorhexidine 0.5%; 41 studies reported mild adverse events and 4 serious adverse events. Conclusions: Taken together, the findings of this scoping review did not show a clear relationship between current sterilisation protocols and the prevention of the microbial contamination of the probes or the patient's skin. The variation in protocols highlights the need for standardised guidelines and more rigorous studies to accurately determine the most effective disinfection practices.
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98122 Messina, Italy; (A.A.); (D.B.); (D.B.)
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | | | - Enrico Buccheri
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (E.B.); (R.C.); (M.V.)
| | - Daniele Borzelli
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98122 Messina, Italy; (A.A.); (D.B.); (D.B.)
| | - Rita Chiaramonte
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (E.B.); (R.C.); (M.V.)
| | - Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy;
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (E.B.); (R.C.); (M.V.)
- Rehabilitation Unit, AOU Policlinico G. Rodolico-San Marco, 95123 Catania, Italy
| | - Daniele Bruschetta
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98122 Messina, Italy; (A.A.); (D.B.); (D.B.)
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Sconza C, Palloni V, Lorusso D, Guido F, Farì G, Tognolo L, Lanza E, Brindisino F. Ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a systematic review with meta-analysis of randomized controlled trials. Eur J Phys Rehabil Med 2024; 60:995-1008. [PMID: 39382530 PMCID: PMC11729717 DOI: 10.23736/s1973-9087.24.08544-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/21/2024] [Accepted: 08/06/2024] [Indexed: 10/10/2024]
Abstract
INTRODUCTION Ultrasound-guided lavage (UGL) is a minimally invasive percutaneous treatment for rotator cuff calcific tendinopathy (RCCT). It involves the use of a syringe containing saline and/or anesthetic solution injected directly into the calcification allowing aspiration of the fragmented calcific material. The aim of this systematic review is to investigate if UGL is effective in improving pain, function, quality of life, range of motion (ROM), and in promoting complete resorption of calcifications in patients with RCCT. EVIDENCE ACQUISITION Only randomized controlled trials considering people diagnosed with RCCT, at any stage and at any time of the onset of symptoms treated with UGL, were included. Embase, CENTRAL, CINHAL, PEDro and MEDLINE were explored up until May 2024. Two independent authors selected randomized controlled trials by title and abstract; afterwards, the full text was thoroughly evaluated. The risk of bias (ROB) was assessed using the Cochrane risk of bias 2 (ROB2) tool and the certainty of evidence was evaluated through the GRADE approach. EVIDENCE SYNTHESIS Seven studies (709 subjects) were included. Overall, three studies were judged as low risk of bias. Pooled results showed non-significant differences between UGL and extracorporeal shock-wave therapy (ESWT) at 12 weeks (SMD=-0.52, 95% CI -1.57, 0.54, P=0.34, I2=93%) and at 26 weeks (MD=-1.20, 95% CI -2.66, 0.27, P=0.11, I2=82%), while a significant difference favoring UGL (SMD=-0.52, 95% CI -0.85, -0.19, P=0.002, I2=38%) resulted at 52 weeks. In regard to function, pooled results showed non-significant difference between UGL and ESWT at 6 weeks (MD=3.34, 95% CI -11.45, 18.12, P=0.66, I2=79%) and at 52 weeks (SMD=0.10, 95% CI -0.40, 0.60, P=0.69, I2=30%). Considering the rate of resorption of calcifications between UGL combined with subacromial corticosteroid injection (SCI) versus injection alone, pooled results showed significant difference favoring UGL at <52 weeks (RR=1.63 95% CI 1.34, 1.98, P<0.00001, I2=0%). Certainty of evidence ranged from low to very low. CONCLUSIONS UGL seems to be a reasonable and safe treatment for RCCT, however compared to other non/mini-invasive approaches, UGL showed doubtful results in controlling pain and increasing function and rate of calcifications resorption. These results should be interpreted with caution because certainty of evidence ranged from low to very low.
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Affiliation(s)
| | - Valentina Palloni
- Department of Physical Medicine and Rehabilitation, University of Milan, Milan, Italy -
| | - Domenico Lorusso
- Operative Unit of Orthopedic and Traumatology, Mons. Dimiccoli Hospital, Barletta, Barletta-Andria-Trani, Italy
| | - Federico Guido
- Vincenzo Tiberio Department of Medicine and Health Science, Cardarelli Hospital, University of Molise, Campobasso, Italy
| | - Giacomo Farì
- Department of Experimental Medicine (Di.Me.S.), University of Salento, Lecce, Italy
| | - Lucrezia Tognolo
- Physical Medicine and Rehabilitation Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Ezio Lanza
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Fabrizio Brindisino
- Vincenzo Tiberio Department of Medicine and Health Science, Cardarelli Hospital, University of Molise, Campobasso, Italy
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Verstraelen F, Bemelmans Y, Lambers Heerspink O, van der Steen M, Jong B, Jansen E, Schotanus M. Comparing midterm clinical outcome of surgical versus ultrasound guided needle aspiration of the calcific deposits for therapy resistant calcifying tendinitis of the shoulder. A comparative cohort study. J Orthop Sci 2024; 29:802-808. [PMID: 37080824 DOI: 10.1016/j.jos.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Comparing the midterm clinical outcome of surgical treatment versus ultrasound guided needle aspiration of the calcific deposits (NACD) treatment for conservative therapy resistant calcifying tendinitis (CT) of the shoulder. The hypothesis is that both surgical treatment and NACD treatment led to a comparable good clinical outcome. METHODS A comparative cohort study was performed (n = 76). The allocation to surgical group (n = 35) or NACD group (n = 41) was the result of a shared decision-making strategy. Primary outcome was decrease in VAS for pain (pVAS). Secondary outcomes were EQ-5D index, DASH score, ASES, VAS for satisfaction, recommendation of treatment, adverse events, cross-over between groups, additional treatments, and symptomatology after care as usual. RESULTS At midterm follow-up (5.5 years, SD 0.5 years) decrease in pVAS did not differ (p = 0.20) between two groups (60.6 mm, SD 23.3 mm vs 53.4 mm, SD 24.2 mm). Secondary clinical outcomes were also comparable. In 68.3% surgical treatment was avoided. At final follow-up none of the outcome scores differed significantly between the crossed-over patients (n = 13, 31.7%) and the initial surgical group. DISCUSSION At midterm follow-up surgical and NACD treatment result in comparable clinical outcomes. In 68.3% a surgical treatment could be avoided. In 31.7% the patient eventually needed a surgical treatment after failed NACD treatment. After midterm follow-up these patients showed comparable good clinical outcomes. In our opinion, both NACD and surgical treatment could be considered as a next step treatment option for conservative therapy resistant CT of the shoulder. Though, one should be aware that after a midterm follow-up a high number of patients cross-over to surgical treatment after a NACD treatment.
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Affiliation(s)
- Freek Verstraelen
- Zuyderland MC, Dr. H. van der Hoffplein 1, 6162 BG Sittard, the Netherlands; ZorgSaam Terneuzen, Wielingenlaan 2, 4535 PA Terneuzen, the Netherlands.
| | - Yoeri Bemelmans
- Zuyderland MC, Dr. H. van der Hoffplein 1, 6162 BG Sittard, the Netherlands
| | | | - Marieke van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima MC, PO box 90052, 5600 PD Eindhoven, the Netherlands
| | - Bob Jong
- Zuyderland MC, Dr. H. van der Hoffplein 1, 6162 BG Sittard, the Netherlands
| | - Edwin Jansen
- Zuyderland MC, Dr. H. van der Hoffplein 1, 6162 BG Sittard, the Netherlands
| | - Martijn Schotanus
- Zuyderland MC, Dr. H. van der Hoffplein 1, 6162 BG Sittard, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Science, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
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Walter WR, Burke CJ, Adler RS. Tips and tricks in ultrasound-guided musculoskeletal interventional procedures. J Ultrason 2023; 23:e347-e357. [PMID: 38020507 PMCID: PMC10668939 DOI: 10.15557/jou.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/09/2023] [Indexed: 12/01/2023] Open
Abstract
Ultrasound visualization affords proceduralists versatile and accurate guidance for a variety of percutaneous, minimally invasive procedures in the musculoskeletal system including joint (intra-articular) injections or aspirations, intra-bursal injections, peritendinous, and perineural injections. A variety of percutaneous procedures are traditionally performed blindly, but may be more easily or more accurately performed with the real-time assistance of ultrasound guidance. Other procedures are only possible utilizing image-guidance, due to the required precision of the injection because of delicate local anatomy or depth of the injection; ultrasound is a safe, portable, and widespread modality that can be used to assist the proceduralist in localizing the needle tip in such cases, to ensure safe and accurate delivery of the medication, most frequently a solution of steroid and anesthetic. This review aims to provide a foundational approach to ultrasound-guided procedures in the musculoskeletal system, offering tips and tricks that can be employed in many different procedures including intra-articular, juxta-articular, and perineural injections for a multitude of clinical scenarios. Technical considerations regarding ultrasound transducer selection, sonographic technique, as well as common indications, contraindications, and complications of these procedures, are presented. Additionally, a variety of pharmacologic considerations for proceduralists contemplating ultrasound-guided injections are discussed.
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Chianca V, Pietto FD, Albano D, Corvino A, Del Grande F. Ultrasound-guided percutaneous irrigation of rotator cuff calcific tendinosis. What radiologist should know. Pol J Radiol 2022; 87:e87-e92. [PMID: 35280948 PMCID: PMC8906177 DOI: 10.5114/pjr.2022.113491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
Rotator cuff calcific tendinopathy is a common condition caused by the presence of calcification into the rotator cuff or in the subacromial-subdeltoid bursa. The pathogenetic mechanism of this pathology is still debated. Calcific tendinitis frequently affects the rotator cuff and may cause shoulder pain and reduction of range of motion. It can be diagnosed with conventional radiography, ultrasound, or magnetic resonance imaging. The first therapeutic option includes conservative management based on rest, physical therapy, and oral non-steroid anti-inflammatory administration. Extracorporeal shock wave therapy is a noninvasive technique that can be useful for the fragmentation of calcific deposits. Imaging-guided percutaneous irrigation is currently considered the gold standard technique for the treatment of calcific tendinitis due to its minimal invasiveness and its success rate of about 80%.
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Affiliation(s)
- Vito Chianca
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland
| | | | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Italy
| | - Antonio Corvino
- Motor Science and Wellness Department, University of Naples “Parthenope”, Naples, Italy
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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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D'Elia G, Meoni B, Paci M, Parretti F, Roselli G, Bartolini M, Miele V. Physiotherapy after ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy. J Back Musculoskelet Rehabil 2021; 34:983-988. [PMID: 33998531 DOI: 10.3233/bmr-191637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rotator cuff calcific tendinopathy (RCCT) is a very frequent and debilitating disease often treated with Ultrasound-guided percutaneous irrigation (UGPI) followed by physiotherapy. OBJECTIVE A multicenter observational clinical study was designed to assess the effects of physiotherapy after UGPI on the functional recovery of the shoulders of patients suffering from RCCT. METHOD One hundred sixty-six patients (mean age 50.7± 7.6 years), 121 women, with painful RCCT were treated with UGPI and assessed at the day of UGPI (T0), and at one (T1), 3 (T2) and 6 (T3) months after treatment by the Constant- Murley Score (CMS), Oxford Shoulder Scale (OSS) and Numerical Rating Scale (NRS). Patients were divided into 2 groups, Physiotherapy (PT+) and not Physiotherapy (PT-) according to the performance of the rehabilitation program based on personal decision. RESULTS A significant improvement at T1 in all outcomes in both groups and between T1 and T3 for NRS during movement and OSS was found, but not for NRS at rest and CMS. There was no difference between groups for all outcome measures. In 27,1% of patients symptoms recurred in an average of 13 ± 8 weeks. CONCLUSIONS Results suggest that post-UGPI not-standardized physiotherapy might not provide additional clinical benefits in short and medium term. Further studies could assess the effectiveness of physiotherapy performed after three months in patients with recurrence of pain.
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Affiliation(s)
| | - Barbara Meoni
- Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | | | | | | | | | - Vittorio Miele
- Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
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8
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Zagarella A, Signorelli G, Muscogiuri G, Colombo R, Folco G, Arrigoni P, Radici M, Randelli PS, Gallazzi MB. Overuse-related instability of the elbow: the role of CT-arthrography. Insights Imaging 2021; 12:140. [PMID: 34633569 PMCID: PMC8505589 DOI: 10.1186/s13244-021-01065-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/07/2021] [Indexed: 11/10/2022] Open
Abstract
The elbow is a complex joint whose biomechanical function is granted by the interplay and synergy of various anatomical structures. Articular stability is achieved by both static and dynamic constraints, which consist of osseous as well as soft-tissue components. Injuries determining instability frequently involve several of these structures. Therefore, accurate knowledge of regional anatomy and imaging findings is fundamental for a precise diagnosis and an appropriate clinical management of elbow instability. This review focuses particularly on the varied appearance of overuse-related elbow injuries at CT-arthrography.
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Affiliation(s)
- Andrea Zagarella
- U.O.C. Radiodiagnostica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
| | - Giulia Signorelli
- Scuola Di Specializzazione in Radiodiagnostica, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Giulia Muscogiuri
- Scuola Di Specializzazione in Radiodiagnostica, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Roberta Colombo
- Scuola Di Specializzazione in Radiodiagnostica, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Gianluca Folco
- Scuola Di Specializzazione in Radiodiagnostica, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Paolo Arrigoni
- I Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Mattia Radici
- Scuola Di Specializzazione in Ortopedia e Traumatologia Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Pietro Simone Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.,Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Mauro Battista Gallazzi
- U.O.C. Radiodiagnostica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
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Dumoulin N, Cormier G, Varin S, Coiffier G, Albert JD, Le Goff B, Darrieutort-Laffite C. Factors Associated With Clinical Improvement and the Disappearance of Calcifications After Ultrasound-Guided Percutaneous Lavage of Rotator Cuff Calcific Tendinopathy: A Post Hoc Analysis of a Randomized Controlled Trial. Am J Sports Med 2021; 49:883-891. [PMID: 33719606 DOI: 10.1177/0363546521992359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Calcific tendinitis of the rotator cuff is a frequent cause of shoulder pain. Ultrasound-guided percutaneous lavage (UGPL) is an effective treatment, but factors associated with good clinical and radiological outcomes still need to be identified. PURPOSE To study the clinical, procedural, and radiological characteristics associated with improved shoulder function and the disappearance of calcification on radiograph after UGPL. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This is a post hoc analysis of the CALCECHO trial, a double-blinded randomized controlled trial conducted on 132 patients. The trial assessed the effect of corticosteroid injections after UGPL, and patients were randomly assigned to receive either corticosteroid or saline solution in the subacromial bursa. We analyzed all patients included in the randomized controlled trial as 1 cohort. We collected the patients' clinical, procedural, and radiological characteristics at baseline and during follow-up (3, 6, and 12 months). Univariable analysis, followed by multivariable stepwise regression through forward elimination, was performed to identify the factors associated with clinical success (Disabilities of the Arm, Shoulder and Hand [DASH] score <15) or the disappearance of calcification. RESULTS Good clinical outcomes at 3 months were associated with steroid injections after the procedure (odd ratio [OR], 3.143; 95% CI, 1.105-8.94). At 6 months, good clinical evolution was associated with a lower DASH score at 3 months (OR, 0.92; 95% CI, 0.890-0.956) and calcium extraction (OR, 10.7; 95% CI, 1.791-63.927). A lower DASH at 6 months was also associated with a long-term favorable outcome at 12 months (OR, 0.939; 95% CI, 0.912-0.966). Disappearance of calcification at 3 and 12 months occurred more frequently in patients in whom communication was created between the calcification and the subacromial bursa during the procedure (OR, 2.728 [95% CI, 1.194-6.234] at 3 months; OR, 9.835 [95% CI, 1.977-48.931] at 12 months). Importantly, an association between calcification resorption and good clinical outcome was found at each time point. CONCLUSION Assessing patients at 3 months seems to be an essential part of their management strategy. Calcium extraction and creating a communication between the calcific deposits and subacromial bursa are procedural characteristics associated with good clinical and radiological evolution.
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In memoriam: Dr. Giovanni Serafini, MD. J Ultrasound 2020. [DOI: 10.1007/s40477-020-00459-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Lanza E, Piccoli F, Intrieri C, Muglia R, Politi LS, Borroni M, Castagna A, Sconfienza LM. US-guided percutaneous irrigation of calcific tendinopathy of the rotator cuff in patients with or without previous external shockwave therapy. Radiol Med 2020; 126:117-123. [PMID: 32451885 DOI: 10.1007/s11547-020-01229-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare the outcome of US-guided percutaneous irrigation of calcific tendinopathy (US-PICT) of the rotator cuff in patients with or without previous external shockwave therapy (ESWT). METHODS We analyzed all patients treated with US-PICT from March 1, 2016, to October 1, 2019, with shoulder pain refractory to conservative management for rotator cuff calcific tendinopathy, diagnosed with ultrasound. Each patient was examined using the Constant-Murley Score (CMS) questionnaire (score 0-100) before and after treatment. We tested CMS differences using the Mann-Whitney U (Wilcoxon rank-sum) test in the two groups. US-PICT was performed placing two or multiple 14G needles, according to the calcification size, inserted under US guidance to create a circuit of irrigation in the calcified tendon. NaCl solution at 38 °C was then injected from the entry needle in a variable amount to hydrate and fragment the calcification, finally allowing for its expulsion through the exit needle. All patients also received an intrabursal steroid injection. RESULTS From 2016 to 2019, 72 US-PICT treatments were performed on 70 patients (females = 46; males = 26) with a mean age of 49.7 years (SD = 8.7. Thirty-three (47%) underwent previous ESWT, while thirty-seven (53%) had no previous treatments. No treatment-related complications were observed. Follow-up was averagely 14.4 months (median = 11.6, SD = 11.9, range 1-45); 37 patients had a follow-up shorter than 12 months (1-11.6); 35 patients were visited after more than 1 year (12.2-45.6, Table W). Before treatment, the mean CMS was 35 (SD = 21); after treatment, it reached 75.4, with an average CMS improvement of 40.3 points (SD = 23.7, p < 0.001). The comparison of improvement between the ESWT and non-ESWT group yielded no significant difference (p = 0.3). CONCLUSIONS US-PICT of the rotator cuff is an effective procedure to reduce shoulder pain and increase mobility in patients with calcific tendinopathy, both in short- and long-term time intervals. Previous unsuccessful ESWT does not affect the outcome of US-PICT.
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Affiliation(s)
- Ezio Lanza
- Radiology Department, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.
| | - Francesca Piccoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Cristina Intrieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Riccardo Muglia
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Letterio Salvatore Politi
- Radiology Department, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Mario Borroni
- Shoulder and Elbow Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Alessandro Castagna
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Shoulder and Elbow Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Common Musculoskeletal Disorders in the Elderly: The Star Triad. J Clin Med 2020; 9:jcm9041216. [PMID: 32340331 PMCID: PMC7231138 DOI: 10.3390/jcm9041216] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/09/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022] Open
Abstract
Musculoskeletal disorders are debilitating conditions that significantly impair the state of health, especially in elderly subjects. A pathological triad of inter-related disorders that are highly prevalent in the elderly consists of the following main “components”: sarcopenia, tendinopathies, and arthritis. The aim of this review is to critically appraise the literature relative to the different disorders of this triad, in order to highlight the pathophysiological common denominator and propose strategies for personalized clinical management of patients presenting with this combination of musculoskeletal disorders. Their pathophysiological common denominator is represented by progressive loss of (focal or generalized) neuromuscular performance with a risk of adverse outcomes such as pain, mobility disorders, increased risk of falls and fractures, and impaired ability or disability to perform activities of daily living. The precise management of these disorders requires not only the use of available tools and recently proposed operational definitions, but also the development of new tools and approaches for prediction, diagnosis, monitoring, and prognosis of the three disorders and their combination.
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Abstract
Diagnosis is crucial in decision-making when treating a patient with shoulder pain. Ultrasound is also very important in the diagnostic and therapeutic pathway, especially when surgery is being considered. This article outlines the diagnostic pathway using the patient’s history, physical examination and ultrasound examination. It is important to correlate the clinical assessment with the imaging signs. It is also important to treat the patient and not the images as there may be abnormalities detected on imaging that are not symptomatic. The article covers the important diagnosis of subdeltoid subacromial bursitis, glenohumeral joint capsulitis, calcific tendinosis, acromioclavicular joint osteoarthritis and long head of biceps tendinosis. It will guide the reader in how to use the findings to treat, using ultrasound-guided injection and other techniques, including steroid injections, hydrodilatation, barbotage and extracorporeal shockwave treatment. These are discussed with the knowledge from over 30 years of experience with a literature review evidential support. I have included tips to make these procedures more effective in treatment and final outcome. There is discussion regarding the use of steroid injections in the presence of a rotator cuff tear and how to proceed if the patient has more than one disease process. The sensible use of steroids and local anesthetics are included, bearing in mind that lidocaine and high concentrations of long-acting local anesthetics are chondrotoxic and should not be injected into joints.
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Affiliation(s)
- Gina M Allen
- Oxford University and St Lukes Radiology Oxford Ltd, Oxford, UK
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Chianca V, Albano D, Messina C, Midiri F, Mauri G, Aliprandi A, Catapano M, Pescatori LC, Monaco CG, Gitto S, Pisani Mainini A, Corazza A, Rapisarda S, Pozzi G, Barile A, Masciocchi C, Sconfienza LM. Rotator cuff calcific tendinopathy: from diagnosis to treatment. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:186-196. [PMID: 29350647 PMCID: PMC6179075 DOI: 10.23750/abm.v89i1-s.7022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/15/2022]
Abstract
Rotator cuff calcific tendinopathy (RCCT) is a very common condition caused by the presence of calcific deposits in the rotator cuff (RC) or in the subacromial-subdeltoid (SASD) bursa when calcification spreads around the tendons. The pathogenetic mechanism of RCCT is still unclear. It seems to be related to cell-mediated disease in which metaplastic transformation of tenocytes into chondrocytes induces calcification inside the tendon of the RC. RCCT is a frequent finding in the RC that may cause significant shoulder pain and disability. It can be easily diagnosed with imaging studies as conventional radiography (CR) or ultrasound (US). Conservative management of RCCT usually involves rest, physical therapy, and oral NSAIDs administration. Imaging-guided treatments are currently considered minimally-invasive, yet effective methods to treat RCCT with about 80% success rate. Surgery remains the most invasive treatment option in chronic cases that fail to improve with other less invasive approaches. (www.actabiomedica.it)
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Silvestri E, Barile A, Albano D, Messina C, Orlandi D, Corazza A, Zugaro L, Masciocchi C, Sconfienza LM. Interventional therapeutic procedures in the musculoskeletal system: an Italian Survey by the Italian College of Musculoskeletal Radiology. Radiol Med 2017; 123:314-321. [PMID: 29249079 DOI: 10.1007/s11547-017-0842-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/04/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE To perform an online survey among all members of the Italian College of Musculoskeletal Radiology to understand how therapeutic musculoskeletal procedures are performed in daily practice in Italy. METHODS We administered an online survey to all 2405 members about the use of therapeutic musculoskeletal procedures in their institutions asking 16 different questions. Subgroup analysis was performed between general and orthopaedic hospitals with Mann-Whitney U and χ 2 statistics. RESULTS A total of 129/2405 answers (5.4% of members) were included in our analysis. A median of 142.5 (25th-75th percentiles: 50-535.5; range 10-5000) therapeutic musculoskeletal procedures per single institution was performed in 2016. Arthropathic pain was the main indication. The most common procedures were joint injection, bursal/tendon injection, and irrigation of calcific tendinopathy. Ultrasound-guided procedures were mainly performed in ultrasonography rooms (77.4%) rather than in dedicated interventional rooms (22.6%). Conversely, fluoroscopic procedures were performed almost with the same frequency in interventional radiology suites (52.4%) and in general radiology rooms (47.6%). In most institutions (72%), autologous blood or components were not used. The median number of therapeutic musculoskeletal procedures performed in orthopaedic hospitals was significantly higher than in general hospitals (P = 0.002), as well as for the use of autologous preparations (P = 0.004). CONCLUSION Joint injection, bursal/tendon injection, and irrigation of calcific tendinopathy were the most common therapeutic musculoskeletal procedures, being arthropathic pain the main indication. The percentage of procedures and the use of autologous preparations were significantly higher in orthopaedic hospitals than in general hospitals.
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Affiliation(s)
- Enzo Silvestri
- Unit of Radiology, Ospedale Evangelico Internazionale, Piazzale Gianasso 5, 16100, Genoa, Italy.,S.C. Diagnostica per Immagini e Ecografia Interventistica, Ospedale Evangelico Internazionale di Genova, Salita Superiore San Rocchio 31/A, 16122, Genoa, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Domenico Albano
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Davide Orlandi
- Unit of Radiology, Ospedale Evangelico Internazionale, Piazzale Gianasso 5, 16100, Genoa, Italy.,S.C. Diagnostica per Immagini e Ecografia Interventistica, Ospedale Evangelico Internazionale di Genova, Salita Superiore San Rocchio 31/A, 16122, Genoa, Italy
| | - Angelo Corazza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Luigi Zugaro
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
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Battaglia M, Guaraldi F, Gori D, Castiello E, Arvat E, Sudanese A. Efficacy of triamcinolone acetate and methylprednisolone acetonide for intrabursal injection after ultrasound-guided percutaneous treatment in painful shoulder calcific tendonitis: a randomized controlled trial. Acta Radiol 2017; 58:964-970. [PMID: 27856801 DOI: 10.1177/0284185116678275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) with intrabursal steroid injection is an elective treatment for painful rotator cuff calcific tendinopathy. Purpose To compare the efficacy of post-US-PICT intrabursal 40 mg injection of triamcinolone acetonide (TA) versus methylprednisolone acetate (MA). Material and Methods Forty patients (22 women; mean age 48.7 ± 7.2 years) with painful shoulder calcific tendinopathy, treated with TA or MA injected intrabursally after US-PICT, were included in this randomized controlled trial. At baseline and after 1, 7, 15, 30, 45, and 180 days, patients underwent US and clinical examination, using Constant (CS) and VAS (VS) scores. Complications and analgesic use were also recorded. Results Compared to baseline, at the 45-day follow-up, TA and MA group showed a similar improvement (Δ) in CS (42 ± 10 versus 36 ± 9 points) and VS (-4.4 ± 1.3 versus -3.6 ± 1.3 points). At the 180-day follow-up, the improvement was higher in TA versus MA (ΔCS: 53 ± 7 versus 44 ± 7 points; ΔVS: -4.9 ± 1.1 versus -3.9 ± 1 points). Multivariate analysis showed a mean CS higher ( P = 0.02) in TA versus MA group, while VS was similar. TA had a 5 × higher ( P = 0.007) chance of reaching complete remission (CS = 100 points) than MA group. A progressive decrease in analgesic use, concomitant to a significant and similar reduction of bursitis and calcifications, was observed in both groups. No major complications occurred. Conclusion Two-needle US-PICT with intrabursal steroid injection is safe and effective. The chance of reaching better scores and, even more important for a clinical perspective, of functional recovery, is higher in patients treated with TA than MA.
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Affiliation(s)
- Milva Battaglia
- Diagnostic and Interventional Radiology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | | | - Davide Gori
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Emanuela Castiello
- Department of Prosthetic Surgery and Revision of Hip and Knee Implants, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Emanuela Arvat
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alessandra Sudanese
- Department of Prosthetic Surgery and Revision of Hip and Knee Implants, Rizzoli Orthopaedic Institute, Bologna, Italy
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Orlandi D, Mauri G, Lacelli F, Corazza A, Messina C, Silvestri E, Serafini G, Sconfienza LM. Rotator Cuff Calcific Tendinopathy: Randomized Comparison of US-guided Percutaneous Treatments by Using One or Two Needles. Radiology 2017; 285:518-527. [PMID: 28613120 DOI: 10.1148/radiol.2017162888] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine whether the use of one or two needles influences procedure performance and patient outcomes for ultrasonography (US)-guided percutaneous irrigation of calcific tendinopathy. Materials and Methods Institutional review board approval and written informed patient consent were obtained. From February 2012 to December 2014, 211 patients (77 men and 134 women; mean age, 41.6 years ± 11.6; range, 24-69 years) with painful calcific tendinopathy diagnosed at US were prospectively enrolled and randomized. Operators subjectively graded calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous irrigation of calcific tendinopathy (local anesthesia, needle lavage, intrabursal steroid injection) was performed in 100 patients by using the single-needle procedure and in 111 patients by using the double-needle procedure. Calcium dissolution was subjectively scored (easy = 1; intermediate = 2; difficult = 3). Procedure duration was recorded. Clinical evaluation was performed by using the Constant score up to 1 year after the procedure. The occurrence of postprocedural bursitis was recorded. Mann-Whitney U, χ2, and analysis of variance statistics were used. Results No difference in procedure duration was seen overall (P = .060). Procedure duration was shorter with the double-needle procedure in hard calcifications (P < .001) and with the single-needle procedure in fluid calcifications (P = .024). Ease of calcium dissolution was not different between single- and double-needle procedures, both overall and when considering calcification appearance (P > .089). No clinical differences were found (Constant scores for single-needle group: baseline, 55 ± 7; 1 month, 69 ± 7; 3 month, 90 ± 5; 1 year, 92 ± 4; double-needle group: 57 ± 6; 71 ± 9; 89 ± 7; 92 ± 4, respectively; P = .241). In the single-needle group, nine of 100 cases (9%) of postprocedural bursitis were seen, whereas four of 111 cases (3.6%) were seen in the double-needle group (P = .180). Conclusion The only difference between using the single- or double-needle procedure when performing US-guided percutaneous irrigation of calcific tendinopathy is procedure duration in hard and fluid calcifications. Clinical outcomes are similar up to 1 year. © RSNA, 2017.
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Affiliation(s)
- Davide Orlandi
- From the Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy (D.O., E.S.); Division of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Diagnostic Radiology, ASL 2 Savonese, Presidio di Santa Corona, Pietra Ligure, Italy (F.L., G.S.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (A.C., L.M.S.); Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Italy (C.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (L.M.S.)
| | - Giovanni Mauri
- From the Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy (D.O., E.S.); Division of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Diagnostic Radiology, ASL 2 Savonese, Presidio di Santa Corona, Pietra Ligure, Italy (F.L., G.S.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (A.C., L.M.S.); Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Italy (C.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (L.M.S.)
| | - Francesca Lacelli
- From the Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy (D.O., E.S.); Division of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Diagnostic Radiology, ASL 2 Savonese, Presidio di Santa Corona, Pietra Ligure, Italy (F.L., G.S.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (A.C., L.M.S.); Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Italy (C.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (L.M.S.)
| | - Angelo Corazza
- From the Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy (D.O., E.S.); Division of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Diagnostic Radiology, ASL 2 Savonese, Presidio di Santa Corona, Pietra Ligure, Italy (F.L., G.S.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (A.C., L.M.S.); Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Italy (C.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (L.M.S.)
| | - Carmelo Messina
- From the Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy (D.O., E.S.); Division of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Diagnostic Radiology, ASL 2 Savonese, Presidio di Santa Corona, Pietra Ligure, Italy (F.L., G.S.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (A.C., L.M.S.); Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Italy (C.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (L.M.S.)
| | - Enzo Silvestri
- From the Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy (D.O., E.S.); Division of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Diagnostic Radiology, ASL 2 Savonese, Presidio di Santa Corona, Pietra Ligure, Italy (F.L., G.S.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (A.C., L.M.S.); Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Italy (C.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (L.M.S.)
| | - Giovanni Serafini
- From the Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy (D.O., E.S.); Division of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Diagnostic Radiology, ASL 2 Savonese, Presidio di Santa Corona, Pietra Ligure, Italy (F.L., G.S.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (A.C., L.M.S.); Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Italy (C.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (L.M.S.)
| | - Luca Maria Sconfienza
- From the Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy (D.O., E.S.); Division of Interventional Radiology, Istituto Europeo di Oncologia, Milan, Italy (G.M.); Department of Diagnostic Radiology, ASL 2 Savonese, Presidio di Santa Corona, Pietra Ligure, Italy (F.L., G.S.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy (A.C., L.M.S.); Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Italy (C.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (L.M.S.)
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Moosmayer S, Ekeberg OM, Hallgren HB, Heier I, Kvalheim S, Blomquist J, Pripp AH, Juel NG, Kjellevold SH, Brox JI. KALK study: ultrasound guided needling and lavage (barbotage) with steroid injection versus sham barbotage with and without steroid injection - protocol for a randomized, double-blinded, controlled, multicenter study. BMC Musculoskelet Disord 2017; 18:138. [PMID: 28376756 PMCID: PMC5379547 DOI: 10.1186/s12891-017-1501-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/24/2017] [Indexed: 11/29/2022] Open
Abstract
Background For the treatment of calcific tendinitis of the shoulder a variety of treatment regimes exist. Commonly used treatment measures include medication with oral analgesics, corticosteroid injections, extracorporeal shockwave therapy, ultrasound guided needling and lavage, and surgical treatment. Earlier cohort studies suggest that patients may benefit from these treatments, but there are few randomized studies and conflicting evidence about the effectiveness of the various treatments. In the present study we aim to compare the effectiveness of ultrasound guided needling and lavage (barbotage) together with a steroid injection to sham barbotage with and without an additional steroid injection. Methods The study will be performed in six secondary-care institutions in Norway and Sweden. It is designed as a pragmatic, randomized, three-arm, parallel group, double-blinded, sham-controlled clinical trial with a 2-year follow-up. It will be performed on 210 patients, aged 30 years or older, presenting with painful arc, positive impingement sign and a calcium deposit > 5 mm. Randomization to one of the three treatment options will be performed by using an online central randomization system. The three treatment groups are barbotage together with a subacromial steroid injection (the barbotage group), sham barbotage together with a subacromial steroid injection (the steroid group) or sham barbotage without a subacromial steroid injection (the placebo group). In the placebo group the steroid injection will be replaced by a short-acting local anaesthetic. Standardized home-based post-treatment physiotherapy will be performed by all patients for 8 weeks. Follow-ups are at 2 and 6 weeks, 4, 8, 12 and 24 months after treatment was given and will be performed with the patients and the outcome assessors blinded for group assignment. Primary outcome will be the Oxford shoulder score at 4 month follow-up. Secondary outcome measures are the QuickDASH upper extremity score, the EQ-5D-5L general health score and visual analogue scales for pain at rest, during activity, and at night. Discussion The scientific evidence from this placebo-controlled trial will be of importance for future treatment recommendations in patients with calcific tendinitis. Trial registration ClinicalTrials.gov: NCT02419040, registered 10 April 2015 EudraCT: 2015-002343-34, registered 23 September 2015 (retrospectively registered) Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1501-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefan Moosmayer
- Orthopedic Department, Martina Hansens Hospital, Dønskiveien 8, 1346, Gjettum, Norway.
| | - Ole Marius Ekeberg
- Department for Physical Medicine and Rehabilitation, Helse Fonna Hospital, Stord, Tysevegen 64, Stord Sjukehus HF, 5416, Stord, Norway
| | - Hanna Bjørnsson Hallgren
- Orthopedic Department, Linköping University Hospital, Garnisonsvägen 10, 581 85, Linköping, Sweden
| | - Ingar Heier
- Department for Physical Medicine and Rehabilitation, Vestfold Hospital, Stavern, Kysthospitalveien 61, 3294, Stavern, Norway
| | - Synnøve Kvalheim
- Department for Physical Medicine and Rehabilitation, Oslo University Hospital, P.O.B. 4956, Nydalen, 0424, Oslo, Norway
| | - Jesper Blomquist
- Orthopedic Department, Haraldsplass Deaconess Hospital, P.O.B. 6165, 5892, Bergen, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0424, Oslo, Norway
| | - Nils Gunnar Juel
- Department for Physical Medicine and Rehabilitation, Oslo University Hospital, P.O.B. 4956, Nydalen, 0424, Oslo, Norway
| | | | - Jens Ivar Brox
- Department for Physical Medicine and Rehabilitation, Oslo University Hospital, P.O.B. 4956, Nydalen, 0424, Oslo, Norway
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Pollard J. Ultrasound-Guided Percutaneous Treatment for Calcific Tendinitis of the Rotator Cuff. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2017. [DOI: 10.1177/8756479316669498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Calcific tendinitis is a common pathology of the rotator cuff. More prevalent in women of middle age, calcific tendinitis is often extremely painful and can cause a significant decrease in patient quality of life. The following case study demonstrates the important role of sonography in diagnosis and treatment of calcific tendinitis.
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Affiliation(s)
- Jenny Pollard
- Johnston Community College, Raleigh Radiology, Garner, NC, USA
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20
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Messina C, Guglielmi G, Orlandi D, Corazza A, Mauri G, Sconfienza LM. The Role of Joint Viscosupplementation in Geriatric Population. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0196-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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21
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Zappia M, Aliprandi A, Pozza S, Doniselli FM, Gitto S, Sconfienza LM. How is shoulder ultrasound done in Italy? A survey of clinical practice. Skeletal Radiol 2016; 45:1629-1634. [PMID: 27638153 DOI: 10.1007/s00256-016-2477-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To define when an ultrasound examination of the shoulder can be considered complete and how many examinations currently performed in Italy are actually complete according to that definition. MATERIALS AND METHODS Reports and images of previously performed ultrasound examinations of the shoulder of patients seen in 2014 for interventional procedures were reviewed for the following items, according to guidelines published by the European Society of Musculoskeletal Radiology: long biceps, subscapularis, supraspinatus, external rotators, acromioclavicular joint, subacromial bursa, subacromial space, coraco-acromial ligament, and the posterior recess. The first six items were considered mandatory in a complete shoulder ultrasound examination. The specialization of the performing physician was noted. The number of complete examinations performed by different physicians was compared with the number of incomplete examinations. RESULTS We analyzed 324 examinations (212 women, 112 men; mean age = 47 ± 12 years). The most frequently reported item was the supraspinatus tendon (83 %), the least frequently reported was the posterior recess (3 %). The image that was most frequently found was the long head of the biceps tendon (77 %), the least frequently found was the coraco-acromial ligament (3 %). The median number of images/examination was 6 (25th-75th percentiles, range 4-9). The mean number of unrecognizable images was 3 (2-4). A radiologist performed the examination in 269 patients (83 %). The rate of complete examinations was 47 %. The number of complete examinations performed by physicians from different specialties was not significantly different from that of incomplete examinations (P = 0.228). CONCLUSIONS Complete shoulder ultrasound examinations account for less than 50 % of those performed in clinical practice in some Italian regions. Standardized scanning protocols and structured reporting may help to improve this figure and consistency among providers performing these examinations.
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Affiliation(s)
- Marcello Zappia
- Dipartimento di Medicina e di Scienze della Salute, Università degli Studi del Molise, Via De Sanctis 1, 86100, Campobasso, Italy
| | - Alberto Aliprandi
- Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | - Simona Pozza
- Dipartimento di Radiologia, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico, Via Zuretti 29, 10126, Turin, Italy
| | - Fabio Martino Doniselli
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Salvatore Gitto
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20100, Milan, Italy. .,Unità Operativa di Radiologia/Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20166, Milan, Italy.
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23
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Honda H, Gotoh M, Kanazawa T, Nakamura H, Ohta K, Nakamura KI, Shiba N. Effects of lidocaine on torn rotator cuff tendons. J Orthop Res 2016; 34:1620-7. [PMID: 26742649 DOI: 10.1002/jor.23153] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/04/2016] [Indexed: 02/04/2023]
Abstract
We determined lidocaine's action on torn rotator cuff tendons in vitro and in vivo. For in vitro experiments, cell proliferation and viability assays were performed using tenocytes derived from human torn rotator cuff tendons. For in vivo experiments, acute rotator cuff tears were made on the supraspinatus tendons in the rats' bilateral shoulders; before closure, lidocaine was injected into the shoulder and saline into the contralateral shoulder (control). After sacrifice, the specimens underwent biomechanical testing or histological analysis at 24 h and at 2, 4, and 8 weeks after surgery. The extent of collagen organization and apoptosis were semi-quantitatively evaluated using collagen picrosirius red staining. Apoptosis was examined using TUNEL staining and electron microscopy. Cell proliferation decreased dose-dependently. After exposure to 0.1% lidocaine for 24 h, cell viability decreased. Two and 4 weeks after surgery, the ultimate load to failure decreased more in the lidocaine group than in the control group, with significantly reduced stiffness in the lidocaine group 2 weeks after surgery. Collagen organization significantly decreased in the lidocaine group by 4 weeks after surgery but returned to baseline at 8 weeks. TUNEL staining detected numerous apoptotic tenocytes at the torn tendon edge exposed to lidocaine 24 h after surgery; electron microscopy confirmed the condensed cell nuclei. These changes were not observed in controls. Lidocaine caused cytotoxicity to tenocytes under both conditions, decreased biomechanical properties, and induced apoptosis and delay of collagen organization in this model. Subacromial lidocaine injections in patients with rotator cuff tears should be performed carefully. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1620-1627, 2016.
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Affiliation(s)
- Hirokazu Honda
- Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan
| | - Tomonoshin Kanazawa
- Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan.,Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Fukuoka, Japan
| | | | - Keisuke Ohta
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Fukuoka, Japan
| | - Kei-Ichiro Nakamura
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Fukuoka, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan
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Kang BS, Lee SH, Cho Y, Chung SG. Acute Calcific Bursitis After Ultrasound-Guided Percutaneous Barbotage of Rotator Cuff Calcific Tendinopathy: A Case Report. PM R 2016; 8:808-12. [PMID: 26902864 DOI: 10.1016/j.pmrj.2016.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 01/31/2016] [Accepted: 02/13/2016] [Indexed: 11/29/2022]
Abstract
Ultrasound-guided percutaneous barbotage is an effective treatment for rotator cuff calcific tendinopathy, providing rapid and substantial pain relief. We present the case of a 49-year-old woman with aggravated pain early after ultrasound-guided barbotage of a large calcific deposit in the supraspinatus tendon. Subsequent examination revealed a thick calcification spreading along the subacromial-subdeltoid bursa space, suggesting acute calcific bursitis complicated by barbotage. Additional barbotage alleviated her pain completely. Therefore, a high index of suspicion for acute calcific bursitis is required in patients with unresolved or aggravated pain after barbotage. Repeated barbotage could be effective for this condition.
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Affiliation(s)
- Bo-Sung Kang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea(∗)(†)(‡); Department of Rehabilitation Medicine, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates(∗)
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea(∗)(†)(‡)
| | - Yung Cho
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea(∗)(†)(‡)
| | - Sun Gun Chung
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea(∗)(†)(‡); Department of Rehabilitation Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea(¶).
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25
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ElShewy MT. Calcific tendinitis of the rotator cuff. World J Orthop 2016; 7:55-60. [PMID: 26807357 PMCID: PMC4716572 DOI: 10.5312/wjo.v7.i1.55] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/05/2015] [Accepted: 11/17/2015] [Indexed: 02/06/2023] Open
Abstract
Calcific tendinitis within the rotator cuff tendon is a common shoulder disorder that should be differentiated from dystrophic calcification as the pathogenesis and natural history of both is totally different. Calcific tendinitis usually occurs in the fifth and sixth decades of life among sedentary workers. It is classified into formative and resorptive phases. The chronic formative phase results from transient hypoxia that is commonly associated with repeated microtrauma causing calcium deposition into the matrix vesicles within the chondrocytes forming bone foci that later coalesce. This phase may extend from 1 to 6 years, and is usually asymptomatic. The resorptive phase extends from 3 wk up to 6 mo with vascularization at the periphery of the calcium deposits causing macrophage and mononuclear giant cell infiltration, together with fibroblast formation leading to an aggressive inflammatory reaction with inflammatory cell accumulation, excessive edema and rise of the intra-tendineous pressure. This results in a severely painful shoulder. Radiological investigations confirm the diagnosis and suggest the phase of the condition and are used to follow its progression. Although routine conventional X-ray allows detection of the deposits, magnetic resonance imaging studies allow better evaluation of any coexisting pathology. Various methods of treatment have been suggested. The appropriate method should be individualized for each patient. Conservative treatment includes pain killers and physiotherapy, or "minimally invasive" techniques as needling or puncture and aspiration. It is almost always successful since the natural history of the condition ends with resorption of the deposits and complete relief of pain. Due to the intolerable pain of the acute and severely painful resorptive stage, the patient often demands any sort of operative intervention. In such case arthroscopic removal is the best option as complete removal of the deposits is unnecessary.
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26
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Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, Smith J. American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. PM R 2015; 7:151-68.e12. [PMID: 25708351 DOI: 10.1016/j.pmrj.2015.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 12/23/2022]
Abstract
The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based upon the evidence, the official AMSSM position relevant to each subject is made.
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Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, University of California, Davis School of Medicine, Sacramento, CA; Tahoe Orthopedics and Sports Medicine, 1139 Third St, South Lake Tahoe, CA 96150.(∗); Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, IA(†).
| | - Mederic M Hall
- Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, IA(†)
| | - Erik Adams
- Midwest Sports Medicine Institute, Middleton, WI(‡)
| | - David Berkoff
- Department of Orthopaedics and Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC(§)
| | - Andrew L Concoff
- Outpatient Musculoskeletal Rehabilitation, St Jude Medical Center, Fullerton, CA(¶)
| | - William Dexter
- Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA(#)
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, MN; Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN(∗∗)
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27
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Messina C, Banfi G, Orlandi D, Lacelli F, Serafini G, Mauri G, Secchi F, Silvestri E, Sconfienza LM. Ultrasound-guided interventional procedures around the shoulder. Br J Radiol 2015; 89:20150372. [PMID: 26313499 DOI: 10.1259/bjr.20150372] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Ultrasound is an established modality for shoulder evaluation, being accurate, low cost and radiation free. Different pathological conditions can be diagnosed using ultrasound and can be treated using ultrasound guidance, such as degenerative, traumatic or inflammatory diseases. Subacromial-subdeltoid bursitis is the most common finding on ultrasound evaluation for painful shoulder. Therapeutic injections of corticosteroids are helpful to reduce inflammation and pain. Calcific tendinopathy of rotator cuff affects up to 20% of painful shoulders. Ultrasound-guided treatment may be performed with both single- and double-needle approach. Calcific enthesopathy, a peculiar form of degenerative tendinopathy, is a common and mostly asymptomatic ultrasound finding; dry needling has been proposed in symptomatic patients. An alternative is represented by autologous platelet-rich plasma injections. Intra-articular injections of the shoulder can be performed in the treatment of a variety of inflammatory and degenerative diseases with corticosteroids or hyaluronic acid respectively. Steroid injections around the long head of the biceps brachii tendon are indicated in patients with biceps tendinopathy, reducing pain and humeral tenderness. The most common indication for acromion-clavicular joint injection is degenerative osteoarthritis, with ultrasound representing a useful tool in localizing the joint space and properly injecting various types of drugs (steroids, lidocaine or hyaluronic acid). Suprascapular nerve block is an approved treatment for chronic shoulder pain non-responsive to conventional treatments as well as candidate patients for shoulder arthroscopy. This review provides an overview of these different ultrasonography-guided procedures that can be performed around the shoulder.
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Affiliation(s)
- Carmelo Messina
- 1 Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy
| | - Giuseppe Banfi
- 2 IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,3 Università Vita-Salute San Raffaele, Milano, Italy
| | - Davide Orlandi
- 4 Scuola di dottorato in Medicina Interna, Università degli Studi di Genova, Genova, Italy
| | - Francesca Lacelli
- 5 Dipartimento di Radiologia, Ospedale Santa Corona, Pietra Ligure, Italy
| | - Giovanni Serafini
- 5 Dipartimento di Radiologia, Ospedale Santa Corona, Pietra Ligure, Italy
| | - Giovanni Mauri
- 6 Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Francesco Secchi
- 6 Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.,7 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Enzo Silvestri
- 8 Servizio di Radiologia, Ospedale Evangelico Internazionale, Genova, Italy
| | - Luca Maria Sconfienza
- 6 Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.,7 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
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Ultrasound guidance to perform intra-articular injection of gadolinium-based contrast material for magnetic resonance arthrography as an alternative to fluoroscopy: the time is now. Eur Radiol 2015; 26:1221-5. [PMID: 26253260 DOI: 10.1007/s00330-015-3945-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/09/2015] [Accepted: 07/23/2015] [Indexed: 01/27/2023]
Abstract
UNLABELLED Magnetic resonance (MR) imaging has been definitively established as the reference standard in the evaluation of joints in the body. Similarly, magnetic resonance arthrography has emerged as a technique that has been proven to increase significantly the diagnostic performance if compared with conventional MR imaging, especially when dealing with fibrocartilage and articular cartilage abnormalities. Diluted gadolinium can be injected in the joint space using different approaches: under palpation using anatomic landmarks or using an imaging guidance, such as fluoroscopy, computed tomography, or ultrasound. Fluoroscopy has been traditionally used, but the involvement of ionizing radiation should represent a remarkable limitation of this modality. Conversely, ultrasound has emerged as a feasible, cheap, quick, and radiation-free modality that can be used to inject joints, with comparable accuracy of fluoroscopy. In the present paper, we discuss the advantages and disadvantages of using fluoroscopy or ultrasound in injecting gadolinium-based contrast agents in joints to perform magnetic resonance arthrography, also in view of the new EuroSAFE Imaging initiative promoted by the European Society of Radiology and the recent updates to the European Atomic Energy Community 2013/59 directive on the medical use of ionizing radiation. KEY POINTS • Intra-articular contrast agent injection can be performed using different imaging modalities • Fluoroscopy is widely used, but uses ionizing radiation • Ultrasound is an accurate, quick, and radiation-free modality for joint injection • X-rays should be avoided when other radiation-free modalities can be used.
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Vinanti GB, Pavan D, Rossato A, Biz C. Atypical localizations of calcific deposits in the shoulder. Int J Surg Case Rep 2015; 10:206-10. [PMID: 25884610 PMCID: PMC4430114 DOI: 10.1016/j.ijscr.2015.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/20/2015] [Accepted: 04/03/2015] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Calcific tendinopathies of the shoulder are due to inflammation around deposits of calcium within periarticular tendineal structures. PRESENTATION OF CASES We present three cases of atypical localization of calcium deposits in the shoulder. All of the cases have been treated with arthroscopic excision, followed by post-operative rehabilitation, regaining excellent results. Patients were evaluated 6 months after surgery using the Visual Analogue Scale (VAS), the Simple Shoulder Test (SST) and the UCLA modified shoulder rating. DISCUSSION Calcific tendinopathy is a self-limiting condition or is successfully treated with conservative therapy especially during the early phases of the pathology. If conservative measures fail, removal of calcium deposits is recommended. Arthroscopic management showed good results in our three cases. CONCLUSION We suggest that arthroscopic treatment of calcific tendonitis guarantees good results even when calcium deposits are in atypical locations.
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Affiliation(s)
- G B Vinanti
- Saint Rocco Clinic, via dei Sabbioni 24, 25050 Ome, Brescia, Italy.
| | - D Pavan
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128 Padova, Italy.
| | - A Rossato
- Saint Rocco Clinic, via dei Sabbioni 24, 25050 Ome, Brescia, Italy.
| | - Carlo Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128 Padova, Italy.
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Lanza E, Banfi G, Serafini G, Lacelli F, Orlandi D, Bandirali M, Sardanelli F, Sconfienza LM. Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting. Eur Radiol 2015; 25:2176-83. [PMID: 25583182 DOI: 10.1007/s00330-014-3567-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 11/08/2014] [Accepted: 12/12/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We performed a systematic review of current evidence regarding ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in the shoulder aimed to: assess different published techniques; evaluate clinical outcome in a large combined cohort; and propose suggestions for homogeneous future reporting. METHODS Cochrane Collaboration for Systematic Reviews of Interventions Guidelines were followed. We searched MEDLINE/MEDLINE In-Process/EMBASE/Cochrane databases from 1992-2013 using the keywords 'ultrasound, shoulder, needling, calcification, lavage, rotator cuff' combined in appropriate algorithms. References of resulting papers were also screened. Risk of bias was assessed with a modified Newcastle-Ottawa Scale. RESULTS Of 284 papers found, 15 were included, treating 1,450 shoulders in 1,403 patients (females, n = 838; mean age interval 40-63 years). There was no exclusion due to risk of bias. CONCLUSIONS US-PICT of rotator cuff is a safe and effective procedure, with an estimated average 55% pain improvement at an average of 11 months, with a 10% minor complication rate. No evidence exists in favour of using a specific size/number of needles. Imaging follow-up should not be used routinely. Future studies should aim at structural uniformity, including the use of the Constant Score to assess outcomes and 1-year minimum follow-up. Alternatives to steroid injections should also be explored. KEY POINTS • US-PICT of rotator cuff is a safe and effective procedure. • On average 55% pain improvement with 10% minor complication rate. • No evidence exists in favour of using a specific size/number of needles. • Future need to assess outcome using Constant Score with 1-year minimum follow-up.
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Affiliation(s)
- Ezio Lanza
- Radiologia Oncologica ed Interventistica, Istituto Clinico Humanitas, Rozzano, Milano, Italy
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American Medical Society for Sports Medicine position statement: interventional musculoskeletal ultrasound in sports medicine. Clin J Sport Med 2015; 25:6-22. [PMID: 25536481 DOI: 10.1097/jsm.0000000000000175] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based on the evidence, the official AMSSM position relevant to each subject is made.
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Orlandi D, Corazza A, Fabbro E, Ferrero G, Sabino G, Serafini G, Silvestri E, Sconfienza LM. Ultrasound-guided percutaneous injection to treat de Quervain's disease using three different techniques: a randomized controlled trial. Eur Radiol 2014; 25:1512-9. [PMID: 25465711 DOI: 10.1007/s00330-014-3515-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/13/2014] [Accepted: 11/17/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare the six-month outcome of three different ultrasound-guided treatments for de Quervain's disease (DQD). METHODS We prospectively treated 75 consecutive patients (51 females, 24 males, mean age ± standard deviation = 45.3 ± 9.8 years) with DQD. Patients' features (hand dominance, intraretinaculum septum, accessory tendons) were recorded. Visual analogue scale (VAS), reduced disability (quickDASH) score, and retinaculum thickness were evaluated at baseline and after one (excluding retinaculum thickness), three, and six months. Patients were randomized into three groups of 25 patients each treated under ultrasound guidance: Group A (1 ml methylprednisolone acetate; mean baseline thickness = 1.6 mm; mean baseline VAS = 6; mean baseline quickDASH = 55); Group B (1 ml methylprednisolone acetate +15-day delayed 2 ml saline 0.9 %; 1.4; 6; 56); Group C (1 ml methylprednisolone acetate +15-day delayed 2 ml low molecular weight hyaluronic acid; 1.7; 6; 55). RESULTS After one month results were: Group A mean VAS = 2; mean quickDASH = 23; Group B 2; 22; Group C 2; 21. After three months results were: Group A retinaculum thickness = 0.7 mm; 3; 27); Group B 0.8 mm; 1; 25; Group C 0.5 mm; 1; 23. After six months results were: Group A 1.5 mm; 3; 51; Group B 1 mm; 2; 51; Group C 0.7 mm; 1; 26 (P < 0.001 for all vs. baseline). Patients' age, sex, hand dominance, presence of subcompartment dividing septum, and supernumerary tendons had no influence on outcome (P ≥ 0.177). CONCLUSION Addition of hyaluronic acid to ultrasound-guided injections of steroids to treat DQD seems to improve the outcome and to reduce the recurrence rate. KEY POINTS • Ultrasound guidance allows for safe injection procedures to treat de Quervains' disease • Steroid injections allow prompt recovery in de Quervain's disease with short-term recurrence • Addition of hyaluronic acid allows recurrence rate reduction compared to simple steroid injections.
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Affiliation(s)
- Davide Orlandi
- Department of Radiology, Genoa University, Via L.B. Alberti 4, 16100, Genova, Italy,
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Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, Smith J. American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. Br J Sports Med 2014; 49:145-50. [PMID: 25330777 DOI: 10.1136/bjsports-2014-094219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilisation is by non-radiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases and hydrodissections. OBJECTIVE Critically review the literature related to the accuracy, efficacy and cost-effectiveness of ultrasound-guided injections (USGIs) in major, intermediate and small joints; and soft tissues. DESIGN Systematic review of the literature. RESULTS USGIs are more accurate than landmark-guided injections (LMGIs; strength of recommendation taxonomy (SORT) Evidence Rating=A). USGIs are more efficacious than LMGIs (SORT Evidence Rating=B). USGIs are more cost-effective than LMGIs (SORT Evidence Rating=B). Ultrasound guidance is required to perform many new procedures (SORT Evidence Rating=C). CONCLUSIONS The findings of this position statement indicate there is strong evidence that USGIs are more accurate than LMGI, moderate evidence that they are more efficacious and preliminary evidence that they are more cost-effective. Furthermore, ultrasound-guided (USG) is required to perform many new, advanced procedures and will likely enable the development of innovative USG surgical techniques in the future.
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Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, Sacramento, California, USA Department of Physical Medicine and Rehabilitation, Mayo Clinic college of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA
| | - Mederic M Hall
- Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, Iowa, USA
| | - Erik Adams
- Midwest Sports Medicine Institute, Middleton, Wisconsin, USA
| | - David Berkoff
- Department of Orthopaedics and Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew L Concoff
- Outpatient Musculoskeletal Rehabilitation, St. Jude Medical Center, Fullerton, California, USA Department of Family Medicine, Division of Sports Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - William Dexter
- Maine Medical Center, Portland, Maine, USA Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Sconfienza LM, Randelli F, Sdao S, Sardanelli F, Randelli P. Septic Bursitis After Ultrasound-guided Percutaneous Treatment of Rotator Cuff Calcific Tendinopathy. PM R 2014; 6:746-8. [DOI: 10.1016/j.pmrj.2014.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/30/2013] [Accepted: 01/05/2014] [Indexed: 11/25/2022]
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Rosenthal AK, Ryan LM. Nonpharmacologic and pharmacologic management of CPP crystal arthritis and BCP arthropathy and periarticular syndromes. Rheum Dis Clin North Am 2014; 40:343-56. [PMID: 24703351 DOI: 10.1016/j.rdc.2014.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Calcium crystal arthritis is often unrecognized, poorly managed, and few effective therapies are available. The most common types of calcium crystals causing musculoskeletal syndromes are calcium pyrophosphate (CPP) and basic calcium phosphate (BCP). Associated syndromes have different clinical presentations and divergent management strategies. Acute CPP arthritis is treated similarly to acute gouty arthritis, whereas chronic CPP and BCP arthropathy may respond to strategies used for osteoarthritis. Calcific tendonitis is treated with a variety of interventions designed to dissolve BCP crystals. A better understanding of the causes and larger well-planned trials of current therapies will lead to improved care.
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Affiliation(s)
- Ann K Rosenthal
- Division of Rheumatology, Department of Medicine, Zablocki VA Medical Center and The Medical College of Wisconsin, FEOB 4th Floor, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| | - Lawrence M Ryan
- Division of Rheumatology, Department of Medicine, Zablocki VA Medical Center and The Medical College of Wisconsin, FEOB 4th Floor, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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RE: A Simple technique to restore needle patency during percutaneous lavage and aspiration of calcific rotator cuff tendinopathy. PM R 2014; 5:633. [PMID: 23880051 DOI: 10.1016/j.pmrj.2013.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/23/2013] [Indexed: 11/21/2022]
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Jelsing E, Smith J. Reply. PM R 2013; 5:633-4. [DOI: 10.1016/j.pmrj.2013.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
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A Simple Technique to Restore Needle Patency During Percutaneous Lavage and Aspiration of Calcific Rotator Cuff Tendinopathy. PM R 2013; 5:242-4. [DOI: 10.1016/j.pmrj.2013.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/06/2013] [Indexed: 11/20/2022]
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