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Sakai S, Mitsui Y, Miyamoto A, Higuchi K, Yoshida T, Hara K, Gotoh M. Factors associated with resorption of calcific deposits in the shoulder with extracorporeal shock wave therapy. J Shoulder Elbow Surg 2025; 34:1208-1215. [PMID: 39369947 DOI: 10.1016/j.jse.2024.07.056] [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: 02/27/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Focused extracorporeal shock wave therapy (FSWT) is effective for treating calcific tendinitis of the shoulder. However, only a few reports exist on the factors related to calcium resorption after FSWT. Thus, this study aimed to investigate the factors associated with calcium resorption. METHODS In 117 shoulders with chronic calcific rotator cuff tendinitis, FSWT was administered 9 times once every 2 weeks (a total of 16 weeks). After 9 sessions of FSWT, the shoulders were radiographed and categorized into complete resorption (CR) and incomplete resorption (ICR) groups. Evaluated parameters included age; duration of disease; Gärtner classification; size of calcium deposits; presence of blood flow around calcium deposits using the Doppler function of the ultrasound imaging system; Japanese Orthopaedic Association score; University of California at Los Angeles (UCLA) score; Disability of the Arm, Shoulder, and Hand score; and tenderness. RESULTS The CR group included 93 shoulders (79.4%) and the ICR group included 24 shoulders (20.6%). In the two-arm comparison, CR showed significantly longer disease duration (P = .012) and high tenderness (P = .0013). Blood flow around calcium deposits was observed in 79.5% of shoulders in the CR group (P < .0001) and 29.1% in the ICR group. Type 1 Gärtner classification (P = .0009) was observed in 28 shoulders (30.1%) in the CR group and 17 shoulders (70.8%) in the ICR group. The 2 groups had no significant differences in age, size of calcium deposits, Japanese Orthopaedic Association score, or University of California at Los Angeles score. Multiple logistic regression analysis was performed using the following items that showed significant differences: absence of blood flow (odds ratio [OR], 8.51, 95% confidence interval [CI]: 2.24-22.8), Gärtner classification (OR, 5.60, 95%CI: 1.73-13.3), and duration of disease (OR, 1.06, 95%CI: 0.97-1.26). Longer disease duration, Gärtner type 1, and absence of blood flow around calcium deposits resulted in difficulty in calcium resorption. CONCLUSION Patients with Gärtner type 1 with prolonged disease duration and absence of blood flow around calcium deposits may have difficulty in achieving complete resorption.
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Affiliation(s)
| | | | | | | | | | - Koji Hara
- Hyakutake Orthopedic and Sports Clinic, Saga, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan
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Calvi M, Malnati S, Clivio V, Vincenzo Z, Callegari L, Genovese EA. Nonsurgical removal of a massive calcification of the shoulder. Radiol Case Rep 2024; 19:5226-5230. [PMID: 39263522 PMCID: PMC11387548 DOI: 10.1016/j.radcr.2024.07.194] [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: 07/16/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/13/2024] Open
Abstract
Calcific tendinopathy of the shoulder is a prevalent and painful condition marked by calcific deposits in the rotator cuff tendons or subacromial bursa, with an incidence of 2.7% to 20%, predominantly affecting individuals aged 30 to 50. Women are 1.5 times more likely to be affected than men. Deposits are frequently bilateral in 10%-20% of cases and most commonly found in the supraspinatus tendon. The pathogenesis remains unclear, with theories suggesting repetitive strain or ischemic degeneration leading to calcium deposition. The disease progresses through precalcific, calcific, and postcalcific phases, with symptoms ranging from mild pain to severe, disabling pain resistant to medication. Diagnosis primarily involves radiographs or CT scans, with ultrasound aiding in deposit staging. Conservative treatments include medication, physiotherapy, and subacromial corticosteroid injections. Novel nonsurgical treatments like ultrasound-guided needling (UGN) and extracorporeal shock wave therapy (ESWT) have shown promise. When conservative measures fail, surgical options achieve significant improvement. This case report details a 53-year-old woman with a 12 cm calcification treated successfully with UGN, demonstrating the efficacy of this minimally invasive technique for large deposits.
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Affiliation(s)
- Marco Calvi
- ASST-Settelaghi, Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Silvia Malnati
- Università degli Studi dell'Insubria, Varese 21100, Italy
| | | | | | - Leonardo Callegari
- ASST-Settelaghi, Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Eugenio Annibale Genovese
- Università degli Studi dell'Insubria, Varese 21100, Italy
- Medical Clinical Institute Intermedica - Columbus, Milan, Italy
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Deschler E, Galang E. Fluoroscopic-Guided Barbotage and Corticosteroid Injection for the Treatment of Symptomatic Calcification of the Lateral Collateral Ligament: A Case Report. Cureus 2024; 16:e64407. [PMID: 39130824 PMCID: PMC11317062 DOI: 10.7759/cureus.64407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Periarticular calcification of the knee joint is a rare pathology that may be challenging to diagnose and manage when symptomatic. Here, we describe the first use of fluoroscopic-guided percutaneous needle aspiration and lavage (barbotage) with corticosteroid injection in a case of symptomatic calcification of the lateral collateral ligament (LCL). A 75-year-old female presented with acute lateral knee pain and stiffness, which subsequent radiographic imaging and diagnostic injection confirmed to be attributed to calcification within the LCL. Initial treatment with analgesic medications and a genicular nerve block failed to alleviate symptoms. However, complete resolution of symptoms was achieved following fluoroscopic-guided barbotage and steroid injection. This case underscores the importance of considering LCL calcification in the differential diagnosis of lateral knee pain. This case also illustrates the potential effectiveness of barbotage and adjunctive steroid injection as a minimally invasive treatment option for symptomatic LCL calcification, emphasizing the need for more rigorous studies evaluating treatment strategies for managing periarticular calcifications involving the knee joint.
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Affiliation(s)
- Emily Deschler
- Department of Anesthesiology/Comprehensive Pain and Spine Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Enrique Galang
- Department of Anesthesiology/Comprehensive Pain and Spine Medicine, Wake Forest University School of Medicine, Winston-Salem, USA
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Rikhtehgar M, Sharifi Y, Mazaher FN, Azarpey N. Elbow calcific tendinosis initially detected by ultrasonography: a case report. J Med Case Rep 2024; 18:75. [PMID: 38403624 PMCID: PMC10895796 DOI: 10.1186/s13256-024-04381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/09/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Calcific tendinosis is a common condition caused by the deposition of hydroxyapatite crystals within the tendons that can impact any tendinous insertion. In this situation, ultrasound (US) may be a viable imaging modality in addition to radiography. CASE PRESENTATION A 56-year-old Iranian male presented with left elbow pain. US evaluation at the lump site revealed a subcutaneous lipoma. Ultrasonography showed a thickened and diffusely heterogeneously hypoechoic pronator teres tendon. These characteristics were consistent with the diagnosis of calcific tendinosis. DISCUSSION AND CONCLUSION Radiography is the most common and practical imaging modality for calcific tendinosis diagnosis. Despite this, the real-time nature of ultrasonography makes it both diagnostic and therapeutic in this condition. Other conditions, such as lipoma, may interfere with the proper diagnosis of calcific tendinosis.
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Affiliation(s)
- Masih Rikhtehgar
- Rasool_Akram Hospital, Radiology Department, Iran University of Medical Sciences, SattarKhan St., Tehran, Iran
| | - Yasaman Sharifi
- Rasool_Akram Hospital, Radiology Department, Iran University of Medical Sciences, SattarKhan St., Tehran, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farid Najd Mazaher
- Shafa Yahyaeian Hospital, Orthopedic Surgery Department, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Azarpey
- Rasool_Akram Hospital, Radiology Department, Iran University of Medical Sciences, SattarKhan St., Tehran, Iran
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Sperr A, Erber B, Horng A, Glaser C. [Calcific tendinitis]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:125-133. [PMID: 37819397 DOI: 10.1007/s00117-023-01218-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
CLINICAL ISSUE Calcific tendinitis (TC) is a common-usually self-limiting-musculoskeletal disease, histopathologically characterized by both deposition and subsequent inflammatory breakdown of calcium crystals in tendons. The disease can cause acute, sometimes excruciating pain and restricted movement in the shoulder joint. Furthermore, 10-30% of patients have a complicated course of the disease. STANDARD RADIOLOGICAL METHODS Imaging-based assessment by X‑ray and ultrasound is required to establish the initial diagnosis and differential diagnosis as well as for follow-up. METHODOLOGICAL INNOVATIONS Magnetic resonance imaging (MRI) and, to a lesser degree, computed tomography (CT) complete the imaging work-up for establishing differential diagnoses and detecting complications. PRACTICAL RECOMMENDATIONS The combined evaluation of clinical symptoms and imaging findings is crucial to assess prognosis, plan therapy and detect potential complications. This article provides an overview of imaging-based morphology as related to the different stages of TC, relevant complications and potential pitfalls with respect to comorbidities and differential diagnoses.
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Affiliation(s)
- Andreas Sperr
- Klinik und Poliklinik für Radiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Bernd Erber
- Klinik und Poliklinik für Radiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
| | - Annie Horng
- RZM - Radiologisches Zentrum München, München, Deutschland
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Lee JP, Kim DS, Han JY, Baik SH, Kwak JW, Kim SH. Clinical and radiological outcomes of ultrasound-guided barbotage using a spinal needle and subacromial steroid injection for calcific tendinitis of the shoulder. Clin Shoulder Elb 2022; 25:140-144. [PMID: 35698783 PMCID: PMC9185114 DOI: 10.5397/cise.2021.00724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Ultrasound (US)-guided techniques reported for the treatment of calcific tendinitis have mostly demonstrated good results. This study investigates the effect of US-guided barbotage using a spinal needle in patients with calcific tendinitis of the shoulder. Methods Thirty-six patients with calcific tendinitis of the shoulder treated by US-guided barbotage with a spinal needle and subacromial steroid injection were included in the study. We evaluated clinical outcomes based on American Shoulder and Elbow Surgeons (ASES) score, Constant score, and visual analog scale (VAS) for pain score. Radiological outcomes were assessed by X-ray imaging at each visit. Results Our results showed that US-guided barbotage and subacromial steroid injection produced good clinical and radiological outcomes in patients with calcific tendinitis of the shoulder. Of the 36 patients, only one required surgical treatment, while the others showed improvement without any complications. Compared to values before the procedure, calcific deposit size and VAS, ASES, and Constant scores showed significant improvement 6 weeks after the procedure. No significant correlation was found between the initial calcific deposit size and clinical outcomes at each time point. Conclusions In patients with calcific tendinitis of the shoulder, US-guided barbotage using a spinal needle and subacromial steroid injection can yield satisfactory clinical and radiological results.
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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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Cesarec G, Martinec S, Čičak N. CALCIFIC TENDINOPATHY: CALCIUM DEPOSIT MORPHOLOGY DIRECTLY AFFECTS PAIN AND FUNCTION OF THE SHOULDER. Acta Clin Croat 2021; 59:270-276. [PMID: 33456114 PMCID: PMC7808232 DOI: 10.20471/acc.2020.59.02.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to determine conventional ultrasonography characteristics of calcium deposits in patients diagnosed with calcific tendinopathy, to determine vascularization around deposits by power Doppler, and to compare morphological and power Doppler findings with clinical findings by use of two questionnaires. Pain and function were evaluated using the visual analog scale and two questionnaires, Constant Shoulder Score and Oxford Shoulder Score. All subjects underwent ultrasonography examination and evaluation of vascularization (flow) along calcium deposit using power Doppler. Fifty-one subjects were included in the study. The χ2-test, a non-parametric statistics method was used because of the categorical type of variables. The level of statistical significance was set at p<0.05. In the inactive phase, calcium deposit was shown as a hyperechoic focal point with dorsal acoustic shadow and negative power Doppler finding, whereas in the resorptive phase it appeared as fragmented irregular hyperechoic focal points with positive power Doppler findings. This study showed the patients with fragmented, cloudy calcification to have statistically significantly worse results on functional questionnaires and more positive power Doppler findings (grades II and III) and to experience stronger pain (visual analog scale 8-10). Upon defining the stage of calcific tendinopathy, the method of treatment can be determined and further course of the disease predicted. Defining the stage of calcification precisely helps avoid unnecessary and long-lasting physical therapy while introducing an effective treatment option, depending on the stage of the disease.
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Affiliation(s)
| | - Sunčica Martinec
- 1Krapinske Toplice Special Hospital for Medical rehabilitation, Krapinske Toplice, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Akromion Special Hospital for Orthopedic Surgery, Krapinske Toplice, Croatia; 4School of Medicine, University of Split, Split, Croatia
| | - Nikola Čičak
- 1Krapinske Toplice Special Hospital for Medical rehabilitation, Krapinske Toplice, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Akromion Special Hospital for Orthopedic Surgery, Krapinske Toplice, Croatia; 4School of Medicine, University of Split, Split, Croatia
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CONFORTI M. Combination of laser needling and hyaluronic acid infiltration treatments for rotator cuff calcific tendinopathies. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.20.04535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Suh DH, Ji JH, Kim CY. Isolated calcific tendinitis at the posterosuperior labrum: a rare case study. Clin Shoulder Elb 2020; 23:201-204. [PMID: 33330259 PMCID: PMC7726363 DOI: 10.5397/cise.2020.00297] [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: 10/27/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022] Open
Abstract
Calcific tendinitis of the shoulder joint, also known as chemical furuncle of the shoulder, causes intense shoulder pain and usually occurs within 1-2 cm from the insertion of the rotator cuff. We experienced a rare case of calcific tendinitis in the posterosuperior labrum of the shoulder joint in a 39-year-old male patient who presented with severe pain and weakness in the right shoulder. Radiographs and magnetic resonance imaging (MRI) findings showed calcific tendinitis in the posterosuperior labrum of the shoulder joint. A 1-week attempt at conservative treatment failed, so the calcified deposit in the posterosuperior labrum was arthroscopically removed. The patient's symptoms were completely relieved, and satisfactory clinical outcomes were achieved. Postoperative follow-up X-ray and MRI showed no recurrence of calcific tendinitis.
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Affiliation(s)
- Dong-Hwan Suh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Yeon Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Albano D, Vicentin I, Messina C, Sconfienza LM. Post-surgical Achilles calcific tendinopathy treated with ultrasound-guided percutaneous irrigation. Skeletal Radiol 2020; 49:1475-1480. [PMID: 32385596 DOI: 10.1007/s00256-020-03453-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 02/02/2023]
Abstract
Calcific tendinopathy typically affects the shoulder rotator cuff tendons. Its management includes shock wave therapy and US-guided percutaneous irrigation, with surgery being less and less used. Extra-shoulder calcific tendinopathy is relatively infrequent and typically affects the hip. While the diagnostic techniques and the treatment options for shoulder calcific tendinopathy have been extensively described, there are only anecdotic reports on the other sites. In this paper, we have reported an unusual case of non-insertional Achilles calcific tendinopathy which occurred many years after Achilles surgical repair. This condition, which presented similar appearance to that of the rotator cuff calcific tendinopathy, is totally different from the well-known and more common insertional calcific Achilles tendinopathy in terms of pathophysiological, imaging, and clinical findings. Further, we have shown that US-guided percutaneous irrigation might be a safe, technically feasible, mini-invasive, and effective treatment also for Achilles calcific tendinopathy.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy. .,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy.
| | - Ilaria Vicentin
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, 20122, Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122, Milan, Italy
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Malahias MA, Chronopoulos E, Raoulis V, Vergados N, Kaseta MK, Nikolaou VS. Questioning the therapeutic value of corticosteroid bursal injection after ultrasound-guided irrigation and lavage for the treatment of shoulder calcific tendinosis. J Orthop 2020; 18:16-22. [PMID: 32189877 PMCID: PMC7067993 DOI: 10.1016/j.jor.2019.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/27/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The therapeutic value of corticosteroid bursal injection after ultrasound-guided irrigation and lavage for the treatment of shoulder calcific tendinosis has not been established yet in the long term. METHODS 41 patients suffering from chronic symptomatic rotator cuff calcific tendinopathy were recruited for this study. Group A (20 patients) received a double needle ultrasound-guided irrigation and lavage of the calcification with xylocaine injection, while group B (21 patients) underwent a double needle ultrasound-guided irrigation and lavage of the calcification with a xylocaine and betamethazone bursal injection. RESULTS After twelve months, we documented full -or almost full- decline (VAS: 0-20/100) of the symptoms in 70% of the group A patients and in 61.9% of the group B patients. There was no statistical difference (chi square, p < 0.05) in group success ratio. We also did not find any statistical difference as for the mean Q-DASH difference between the two groups (t-test). CONCLUSIONS It was proven that the additional use of corticosteroid bursal injection did not provide with any additional short- to mid-term therapeutic benefit those patients with shoulder calcific tendinopathy who were treated with ultrasound-guided aspiration.
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Affiliation(s)
- Michael-Alexander Malahias
- 2nd Orthopaedic Department. National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Chronopoulos
- 2nd Orthopaedic Department. National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vasileios Raoulis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | | - Maria-Kyriaki Kaseta
- 2nd Orthopaedic Department. National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vasileios S. Nikolaou
- 2nd Orthopaedic Department. National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Sconfienza LM, Chianca V, Messina C, Albano D, Pozzi G, Bazzocchi A. Upper Limb Interventions. Radiol Clin North Am 2019; 57:1073-1082. [PMID: 31351537 DOI: 10.1016/j.rcl.2019.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Ultrasound has been reported to be a quick, cheap, and effective imaging modality to guide the interventional procedures in the musculoskeletal system. The use of ultrasound results in increased accuracy of needle placement associated with a reduction of complications. In the upper limb, ultrasound-guided procedures are applied to joints and soft tissues around the shoulder, elbow, wrist, and hand. This article reviews the clinical and technical aspects of the most common procedures performed in this anatomic area.
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, Milano 20122, Italy.
| | - Vito Chianca
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, Milano 20122, Italy
| | - Domenico Albano
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Via del Vespro, 129, 90127 Palermo, Italy
| | - Grazia Pozzi
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
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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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de Witte PB, Kolk A, Overes F, Nelissen RGHH, Reijnierse M. Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Needling and Lavage Versus Subacromial Corticosteroids: Five-Year Outcomes of a Randomized Controlled Trial. Am J Sports Med 2017; 45:3305-3314. [PMID: 28898104 DOI: 10.1177/0363546517721686] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Barbotage (needling and lavage) is often applied in the treatment of calcific tendinitis of the rotator cuff (RCCT). In a previously published randomized controlled trial, we reported superior clinical and radiological 1-year outcomes for barbotage combined with a corticosteroid injection in the subacromial bursa (SAIC) compared with an isolated SAIC. There are no trials with a midterm or long-term follow-up of barbotage available. PURPOSE To compare the 5-year results of 2 regularly applied treatments of RCCT: ultrasound (US)-guided barbotage combined with a SAIC (group 1) versus an isolated US-guided SAIC (group 2). STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients were randomly assigned to group 1 or 2 and evaluated before and after treatment at regular time points until 12 months and also at 5 years using the Constant score (CS), the Western Ontario Rotator Cuff Index (WORC), and the Disabilities of the Arm, Shoulder and Hand (DASH). The calcification location and size and Gärtner classification were assessed on radiographs. The rotator cuff condition was evaluated with US. Results were analyzed using t tests, linear regression, and a mixed model for repeated measures. RESULTS Forty-eight patients were included (mean age, 52.0 ± 7.3 years; 25 [52%] female) with a mean baseline CS of 68.7 ± 11.9. After a mean follow-up of 5.1 ± 0.5 years, the mean CS was 90 (95% CI, 83.0-95.9) in group 1 versus 87 (95% CI, 80.5-93.5) in group 2 ( P = .58). The mean improvement in the CS in group 1 was 18 (95% CI, 12.3-23.0) versus 21 (95% CI, 16.2-26.2) in group 2 ( P = .32). There was total resorption in 62% of group 1 and 73% of group 2 ( P = .45). The US evaluation of the rotator cuff condition showed no significant differences between the groups. With the mixed model for repeated measures, taking into account the baseline CS and Gärtner classification, the mean treatment effect for barbotage was 6 (95% CI, -8.9 to 21.5), but without statistical significance. Follow-up scores were significantly associated with baseline scores and the duration of follow-up. Results for the DASH and WORC were similar. There were no significant complications, but 4 patients in group 1 and 16 in group 2 underwent additional treatment during the follow-up period ( P < .001). CONCLUSION No more significant differences were found in the clinical and radiological outcomes between barbotage combined with a SAIC versus an isolated SAIC after 5 years of follow-up. Registration: NTR2282 (Dutch Trial Registry).
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Affiliation(s)
- Pieter Bas de Witte
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjen Kolk
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Ferdinand Overes
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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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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Radiological and clinical predictors of long-term outcome in rotator cuff calcific tendinitis. Eur Radiol 2016; 26:3401-11. [PMID: 26945760 PMCID: PMC5021725 DOI: 10.1007/s00330-016-4224-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/04/2016] [Accepted: 01/15/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Knowledge on the epidemiology and long-term course of rotator cuff calcific tendinitis (RCCT) is scarce. We assessed demographics, radiological characteristics, and their association with long-term outcomes in a large patient group. METHODS Baseline demographics, radiological characteristics and treatment were recorded in 342 patients. Interobserver agreement of radiological measures was analyzed. Long-term outcome was evaluated with questionnaires (WORC, DASH). The association of baseline characteristics with outcome was assessed. RESULTS Mean age was 49.0 (SD = 10.0), and 59.5 % were female. The dominant arm was affected in 66.0 %, and 21.3 % had bilateral disease. Calcifications were on average 18.7 mm (SD = 10.1, ICC = 0.84 (p < 0.001)) and located 10.1 mm (SD = 11.8) medially to the acromion (ICC = 0.77 (p < 0.001)). Gärtner type I calcifications were found in 32.1 % (Kappa = 0.47 (p < 0.001)). After 14 years (SD = 7.1) of follow-up, median WORC was 72.5 (range, 3.0-100.0; WORC < 60 in 42 %) and median DASH 17.0 (range, 0.0-82.0). Female gender, dominant arm involvement, bilateral disease, longer duration of symptoms, and multiple calcifications were associated with inferior WORC. DASH results were similar. CONCLUSIONS Many subjects have persisting shoulder complaints years after diagnosis, regardless of treatment. Female gender, dominant arm involvement, bilateral disease, longer duration of symptoms, and multiple calcifications were associated with inferior outcome. Radiological measures had moderate-to-good reliability and no prognostic value. KEY POINTS • Most RCCT studies report on short-term outcome and/or small patients groups. • In this large, long-term observational study, RCCT appeared to not be self-limiting in many subjects. • Negative prognostic factors included female gender, more calcifications, dominant arm affected, and longer duration of symptoms. • Interobserver agreement of general radiological RCCT measures is moderate to good. • More rigorous diagnostics and treatment might be needed in specific RCCT cases.
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Merolla G, Singh S, Paladini P, Porcellini G. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment. J Orthop Traumatol 2016; 17:7-14. [PMID: 26163832 PMCID: PMC4805635 DOI: 10.1007/s10195-015-0367-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/25/2015] [Indexed: 12/21/2022] Open
Abstract
Calcific tendinitis is a painful shoulder disorder characterised by either single or multiple deposits in the rotator cuff tendon. Although the disease subsides spontaneously in most cases, a subpopulation of patients continue to complain of pain and shoulder dysfunction and the deposits do not show any signs of resolution. Although several treatment options have been proposed, clinical results are controversial and often the indication for a given therapy remains a matter of clinician choice. Herein, we report on the current state of the art in the pathogenesis, diagnosis and treatment of calcific tendinitis of the rotator cuff.
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Affiliation(s)
- Giovanni Merolla
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy.
- Biomechanics Laboratory "Marco Simoncelli", D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy.
| | - Sanjay Singh
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy
| | - Paolo Paladini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy
| | - Giuseppe Porcellini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy
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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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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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Bazzocchi A, Pelotti P, Serraino S, Battaglia M, Bettelli G, Fusaro I, Guglielmi G, Rotini R, Albisinni U. Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome. Br J Radiol 2015; 89:20150407. [PMID: 26607641 DOI: 10.1259/bjr.20150407] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Rotator cuff calcific tendinitis (RCCT) is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. Between non-surgical and surgical treatment options, today a few minimal invasive techniques are available to remove the calcific deposit, and they represent a cornerstone in the management of this painful clinical condition. The aim of the work was a retrospective evaluation of double-needle ultrasound-guided percutaneous fragmentation and lavage (DNL), focused on understanding the factors which are of major importance in determining a quick and good response at 1 month. METHODS A series of 147 patients affected by RCCT and suitable for DNL were evaluated. A systematic review of anamnestic, clinical and imaging data was performed in 144 shoulders treated in a single-centre setting. Clinical reports and imaging examinations were revisited. The inclusion criteria were submission to DNL, therefore fitness for the percutaneous procedure, and following 1-month follow-up. There was no exclusion owing to risk of bias. The treatment was defined as successful for constant shoulder modified score (CSS) improvement of >50% at 1 month. RESULTS In 70% of shoulders, the treatment resulted in a quick and significant reduction of symptoms (successful). On the whole, CSS increase at 1 month was estimated at 91.5 ± 69.1%. CSS variations were significantly related to age of patients (better results between 30 and 40 years old), calcification size (more relevant improvement for middle-sized calcifications, 12-17 mm), sonographic and radiographic features of calcific deposits (softer calcifications) and thickening of subacromial/subdeltoid bursa walls. In the final model of stepwise regression for CSS variation, ultrasound score pre-treatment and post-treatment, the distance between bursa and calcification before treatment and the size of post-treatment calcification area were shown to be independently correlated to success. Numeric rating scale score for pain showed similar results. Pain at admission was also related to age, calcification size, ultrasound and Gärtner score, power Doppler positivity, bursal wall thickening and biceps tenosynovitis. CONCLUSION The success of the procedure with quick improvement in function and symptoms is warranted in soft and middle-sized calcifications, in young adults. ADVANCES IN KNOWLEDGE Ultrasound-guided percutaneous procedures for RCCT must be safe, effective and with prompt pain relief and function restoration. This study shows which clinical picture is more favourable to this purpose and actual prognostic factors for DNL (soft and middle-sized calcifications, in young adults, are more favourable).
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Affiliation(s)
- Alberto Bazzocchi
- 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - Patrizia Pelotti
- 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - Salvatore Serraino
- 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - Milva Battaglia
- 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - Graziano Bettelli
- 2 Shoulder and Elbow Surgery Unit, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - Isabella Fusaro
- 3 Physical Therapy and Rehabilitation Unit, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - Giuseppe Guglielmi
- 4 Department of Radiology, University of Foggia, Foggia, Italy.,5 Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy
| | - Roberto Rotini
- 2 Shoulder and Elbow Surgery Unit, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - Ugo Albisinni
- 1 Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Bologna, Italy
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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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25
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Abate M, Schiavone C, Salini V. Usefulness of rehabilitation in patients with rotator cuff calcific tendinopathy after ultrasound-guided percutaneous treatment. Med Princ Pract 2015; 24:23-9. [PMID: 25227950 PMCID: PMC5588184 DOI: 10.1159/000366422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/05/2014] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of a specific rehabilitation program for patients in whom ultrasound-guided percutaneous treatment (UGPT) was performed for rotator cuff calcific tendinopathy (RCCT). SUBJECTS AND METHODS In this prospective observational study, 86 patients (22 males and 64 females) with shoulder calcific tendinopathy treated with UGPT were enrolled. At the end of the procedure, a corticosteroid injection into the subacromial-subdeltoid bursa was performed. The patients were then asked to follow a specific rehabilitation protocol (2 times/week for 5 weeks) that focused on mobility, strength and function. At baseline and after 6 weeks, clinical parameters, visual analog scale (VAS) and Constant-Murley scale (CMS) scores and ultrasound (US) features were collected. RESULTS The mean age of the patients was 48.9 ± 8.4 years and their mean BMI was 22.7 ± 2.1. Considering the whole cohort, the treatment was effective, with a significant decrease in the VAS score and an improvement in the CMS score. Thereafter, on the basis of the compliance to the rehabilitation program (by self-report), 53 and 33 patients were included in the rehabilitation group (Rehab group; performed exercises ≥2 times/week) and the No Rehab group (performed exercises <2 times/week), respectively. The comparison between the groups showed that the subjects who performed the exercises regularly had better results in terms of pain and functional recovery, and less associated diseases (e.g. adhesive bursitis and tenosynovitis of the long head of the biceps) than those who were less compliant with the program. CONCLUSIONS UGPT, followed by a specific postprocedure rehabilitation program, was an effective treatment for RCCT.
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Affiliation(s)
- Michele Abate
- *Dr. Michele Abate, Department of Medicine and Science of Aging, University G. d'Annunzio, Chieti-Pescara, Via dei Vestini 31, IT–66013 Chieti Scalo (Italy), E-Mail
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Gil-Agudo Á, Solís-Mozos M, Crespo-Ruiz B, Del-Ama Eng AJ, Pérez-Rizo E, Segura-Fragoso A, Jiménez-Díaz F. Echographic and kinetic changes in the shoulder joint after manual wheelchair propulsion under two different workload settings. Front Bioeng Biotechnol 2014; 2:77. [PMID: 25566539 PMCID: PMC4275037 DOI: 10.3389/fbioe.2014.00077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/07/2014] [Indexed: 11/13/2022] Open
Abstract
Manual wheelchair users with spinal cord injury (SCI) have a high prevalence of shoulder pain due to the use of the upper extremity for independent mobility, transfers, and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with SCI while they performed high- and low-intensity wheelchair propulsion tests (constant and incremental). Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high-intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics.
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Affiliation(s)
- Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Marta Solís-Mozos
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Beatriz Crespo-Ruiz
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Antonio J Del-Ama Eng
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Enrique Pérez-Rizo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | | | - Fernando Jiménez-Díaz
- Laboratory of Performance and Sports Rehabilitation, Faculty of Sport Science, University of Castilla-La Mancha , Toledo , Spain
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Tagliafico A, Russo G, Boccalini S, Michaud J, Klauser A, Serafini G, Martinoli C. Ultrasound-guided interventional procedures around the shoulder. LA RADIOLOGIA MEDICA 2014; 119:318-326. [PMID: 24297588 DOI: 10.1007/s11547-013-0351-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 02/10/2013] [Indexed: 01/08/2023]
Abstract
The aim of this review is to illustrate the spectrum of ultrasound-guided procedures around the shoulder. The shoulder is affected by a wide range of both, traumatic and degenerative diseases. Ultrasound guidance is a low-cost and safe tool to perform minimally invasive interventional procedures around the shoulder. The clinical outcome is shown by the use of clinical scores: visual analogue scale (VAS), Constant's score and Shoulder Pain Disability Index (SPADI). Rotator cuff calcification is a common painful condition that occurs in up to 7.5 % of otherwise healthy adults. Ultrasound-guided procedures include single-needle and double-needle approach with different needles. These techniques are described and the results are critically compared. Ultrasound-guided viscosupplementation is a new therapeutic approach for treatment of several shoulder pain disorders: osteoarthritis, rotator cuff tear and tendinosis. In adhesive capsulitis, different therapeutic ultrasound-guided techniques such as corticosteroid injection, capsular distension (sodium chlorate solution; sodium chlorate and corticosteroids; air) and viscosupplementation are evaluated. Acromion-clavear injection of steroid and lidocaine solution under ultrasound guidance is easy to perform and is indicated in conservative treatment of painful osteoarthrosis. The treatment of rotator cuff tendinosis and partial tears with ultrasound-guided injection of concentrated autologous platelets is also described.
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Affiliation(s)
- Alberto Tagliafico
- Department of Experimental Medicine, Institute of Anatomy, DIMES, University of Genova, Vie de Toni 14, 16132, Genoa, Italy,
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28
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de Witte PB, Selten JW, Navas A, Nagels J, Visser CPJ, Nelissen RGHH, Reijnierse M. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med 2013; 41:1665-73. [PMID: 23696211 DOI: 10.1177/0363546513487066] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [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 (RCCT) is frequently diagnosed in patients with shoulder pain, but there is no consensus on its treatment. PURPOSE To compare 2 regularly applied RCCT treatments: ultrasound (US)-guided needling and lavage (barbotage) combined with a US-guided corticosteroid injection in the subacromial bursa (subacromial bursa injection [SAI]) (group 1) versus an isolated SAI (group 2). STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients were randomly assigned to the 2 groups. Shoulder function was assessed before treatment and at regular follow-up intervals (6 weeks and 3, 6, and 12 months) using the Constant shoulder score (CS, primary outcome), the Western Ontario Rotator Cuff Index (WORC), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Additionally, calcification location, size, and Gärtner classification were assessed on radiographs. Results were analyzed using the t test, linear regression, and a mixed model for repeated measures. RESULTS This study included 48 patients (25 female, 52.1%; mean age, 52.0 ± 7.3 years; 23 patients in group 1) with a mean baseline CS of 68.7 ± 11.9. No patients were lost to follow-up. Four patients in group 1 and 11 in group 2 (P = .06) had an additional barbotage procedure or surgery during the follow-up period because of persisting symptoms and no resorption. At 1-year follow-up, the mean CS in group 1 was 86.0 (95% CI, 80.3-91.6) versus 73.9 (95% CI, 67.7-80.1) in group 2 (P = .005). The mean calcification size decreased by 11.6 ± 6.4 mm in group 1 and 5.1 ± 5.7 mm in group 2 (P = .001). There was total resorption in 13 patients in group 1 and 6 patients in group 2 (P = .07). With regression analyses, correcting for baseline CS and Gärtner type, the mean treatment effect was 20.5 points (P = .05) in favor of barbotage. Follow-up scores were significantly influenced by baseline scores. Results for the DASH and WORC were similar. CONCLUSION On average, there was improvement at 1-year follow-up in both treatment groups, but clinical and radiographic results were significantly better in the barbotage group.
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Affiliation(s)
- Pieter Bas de Witte
- Department of Orthopaedics, Leiden University Medical Center, Postzone J11R, Postbus 9600, 2300 RC Leiden, the Netherlands.
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29
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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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30
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Fabbro E, Ferrero G, Orlandi D, Martini C, Nosenzo F, Serafini G, Silvestri E, Sconfienza LM. Rotator cuff ultrasound-guided procedures: technical and outcome improvements. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/iim.12.57] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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31
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Saboeiro GR. Sonography in the treatment of calcific tendinitis of the rotator cuff. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1513-1518. [PMID: 23011613 DOI: 10.7863/jum.2012.31.10.1513] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Gregory R Saboeiro
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
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Sconfienza LM, Bandirali M, Serafini G, Lacelli F, Aliprandi A, Di Leo G, Sardanelli F. Rotator Cuff Calcific Tendinitis: Does Warm Saline Solution Improve the Short-term Outcome of Double-Needle US-guided Treatment? Radiology 2012; 262:560-566. [DOI: 10.1148/radiol.11111157] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Lin CH, Chao HL, Chiou HJ. Calcified plaque resorptive status as determined by high-resolution ultrasound is predictive of successful conservative management of calcific tendinosis. Eur J Radiol 2011; 81:1776-81. [PMID: 21664086 DOI: 10.1016/j.ejrad.2011.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 05/12/2011] [Accepted: 05/13/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In patients with calcific tendinosis, the morphology of calcified plaques is associated with response to conservative management. We aimed to determine changes in pain and morphology of plaques in patients with calcific tendinosis and non-arc-shaped plaques identified by high-resolution ultrasonography who received only conservative treatment. METHODS A total of 33 patients with a mean age of 63.3±10.3 years were included. Pain scores at the time of first and follow-up ultrasound were recorded, and the degree of plaque resolution was calculated. RESULTS At follow-up, 90.9% (30 of 33) of patients reported improvement in pain, and 84.8% (28 of 33) patient had more than 50% elimination of plaques. Most of increased vascularity observed in color Doppler ultrasonography during 1st visit disappeared at follow-up. CONCLUSIONS In patients with calcific tendinosis, non-arc-shaped plaques determined by high-resolution ultrasonography are likely to resolve and conservative management is warranted.
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Affiliation(s)
- Chien-Hung Lin
- Department of Diagnostic Radiology, Chi-Mei Medical Center, Yung Kang City, Tainan, Taiwan
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Abstract
Ultrasound is used increasingly in the investigation of the rotator cuff. It is as accurate as magnetic resonance imaging in the detection of rotator cuff tears and the assessment of tear size and can demonstrate atrophy and fatty infiltration in the rotator cuff muscles. This article reviews the anatomy and technique of shoulder ultrasound, the ultrasound findings in rotator cuff disease, the accuracy of ultrasound and magnetic resonance imaging in the assessment of rotator cuff tears and the role of interventional ultrasound of the shoulder.
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Affiliation(s)
- Ian Beggs
- Department of Radiology, Royal Infirmary, Edinburgh, UK.
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Davidson J, Jayaraman S. Guided interventions in musculoskeletal ultrasound: what’s the evidence? Clin Radiol 2011; 66:140-52. [PMID: 21216330 DOI: 10.1016/j.crad.2010.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 08/13/2010] [Accepted: 09/21/2010] [Indexed: 11/26/2022]
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De Conti G, Marchioro U, Dorigo A, Boscolo N, Vio S, Trevisan M, Meneghini A, Baldo V, Angelini F. Percutaneous ultrasound-guided treatment of shoulder tendon calcifications: Clinical and radiological follow-up at 6 months(). J Ultrasound 2010; 13:188-98. [PMID: 23396318 DOI: 10.1016/j.jus.2010.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Calcific tendinitis of the shoulder is a common condition characterized by chronic pain and/or very painful acute episodes. Different treatments are used during painful flare-up, but they are often ineffective. US-guided percutaneous needle aspiration/lavage is proving to be an effective means for eliminating these calcifications. MATERIALS AND METHODS We treated 123 consecutive patients (mean age 48 years) with calcific tendinitis of the shoulder. Fifty-five patients had persistent symptoms requiring 2 or more treatments with lavage and intrabursal steroid infiltration. Before and after treatment, US studies were done independently by 2 radiologists with experience in musculoskeletal ultrasound. Results were concordant in over 90% of the cases. Constant Shoulder Scores were calculated before and 6 months after treatment. At 6 months, MRI was performed to identify impingement and/or bursitis. RESULTS Post-treatment Constant scores were significantly improved in all 68 patients treated once (Group 1: mean scores 28.6 vs. 81.4) and in 52 of the 55 treated twice or more (Group 2: mean scores 34.1 vs. 71.1) (p < 0.0001 in both cases). Pretreatment Constant scores were similar in patients with and without shoulder impingement on MRI (31.2 vs. 30.9, respectively), but after treatment the impingement group's scores were significantly higher (82.2 vs. 73.3, respectively; p < 0.001). CONCLUSIONS US-guided percutaneous needle aspiration/lavage is an effective and economic treatment for calcific tendinitis of the shoulder. Pretreatment MRI should be done to check for impingement since it is often associated with an incomplete response to the first treatment.
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Affiliation(s)
- G De Conti
- Radiology Unit I, Hospital Authority of Padua, Italy
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Calcific tendinitis: a pictorial review. Can Assoc Radiol J 2010; 60:263-72. [PMID: 19931132 DOI: 10.1016/j.carj.2009.06.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Accepted: 06/17/2009] [Indexed: 11/23/2022] Open
Abstract
Calcific tendinitis is caused by the pathologic deposition of calcium hydroxyapatite crystals in tendons and is a common cause of joint pain. The disease typically affects the shoulder and hip, with characteristic imaging findings; however, any joint can be involved. Occasionally, calcific tendinitis can mimic aggressive disorders, such as infection and neoplasm, especially on magnetic resonance imaging. Radiologists should be familiar with the imaging findings to distinguish calcific tendinitis from more aggressive processes. Image-guided percutaneous needle aspiration and steroid injection of calcific tendinitis are useful techniques performed by the radiologist for the treatment of symptomatic cases. Familiarity with these procedures and their imaging appearance is an important aspect in the management of this common disease.
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Using ultrasonography to facilitate best practice in diagnosis and management of RA. Nat Rev Rheumatol 2009; 5:698-706. [PMID: 19901917 DOI: 10.1038/nrrheum.2009.227] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The key to successful management of rheumatoid arthritis (RA) is early objective quantification of inflammation and ongoing precise, tailored therapy to ensure long term suppression of inflammatory disease activity. Musculoskeletal ultrasonography (MSKUS) has emerged as a tool with the potential to enhance disease assessment and management in this area. This includes applications in patients with undifferentiated arthropathy attending an early inflammatory arthritis clinic, in which the diagnosis of inflammatory disease may be confirmed or refuted at an early stage, and those with treated RA where accurate measurement of outcomes, such as response to therapy, structural damage and disease remission, are extremely important. This imaging modality is safe and portable, making it ideal for outpatient and inpatient settings, and can be used to assess many joints in multiple planes and to demonstrate changes in disease activity and structural damage over time. MSKUS is gaining popularity among rheumatologists, as increasing evidence supports the added value of a physician-performed ultrasonography assessment above traditional clinical, laboratory and radiographic measures, enabling greater confidence in diagnostic and management decisions. Although additional longitudinal data are required and further applications are likely to arise, MSKUS may well possess the necessary attributes to facilitate best practice in inflammatory arthritis management.
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Ucuncu F, Capkin E, Karkucak M, Ozden G, Cakirbay H, Tosun M, Guler M. A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain. Clin J Pain 2009; 25:786-9. [PMID: 19851159 DOI: 10.1097/ajp.0b013e3181acb0e4] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To compare the effectiveness of landmark-guided local injections and ultrasonography (USG) guided injections for shoulder pain. METHODS A total 60 consecutive patients with shoulder pain due to soft tissue disorders was enrolled, and randomly assigned to receive triamcinolone (40 mg) either by landmark-guided (LMG, n=30) or USG guided (n=30) injection. The patients were evaluated on admission and 6 weeks after the injection. Clinical assessment included demographic and clinical data, a visual analoge scale (VAS) for pain (0 to 10 cm), the Constant scale (0 to 100) for function, passive and active shoulder range of motion (ROM) with goniometric evaluation, and postinjection adverse effects. RESULTS Initial demographic, clinical and USG findings in the groups exhibited no significant differences. Six weeks after injection, the VAS and the Constant score showed a significantly better improvement in USG group compared with LMG group (mean VAS score decrease: 4.0+/-1.7 for USG vs. 2.2+/-0.9 for LMG, P<0.05; mean Constant score change: 32.2 for USG vs. 12.2 for LMG, P<0.05). Significant improvements were observed in active and passive ROM values in both groups, USG group values being better. Initially 18 patients in LMG and 24 patients in USG had limited shoulder ROM, of which 6 was returned to normal values in LMG group and 12 in USG group at 6 week after injection (P<0.05). CONCLUSIONS Our results indicate that the injection of corticosteroids to patients with shoulder pain due to soft tissue disorders under the USG-guidance may improve therapeutic effectiveness and reduce adverse effects.
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Affiliation(s)
- Faik Ucuncu
- Department of Physical Medicine and Rehabilitation, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
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Serafini G, Sconfienza LM, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F. Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial. Radiology 2009; 252:157-64. [PMID: 19561254 DOI: 10.1148/radiol.2521081816] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To compare short- and long-term outcomes of patients with rotator cuff calcific tendonitis who did and did not undergo ultrasonographically (US)-guided percutaneous treatment. MATERIALS AND METHODS Institutional review board approval and informed patient consent were obtained. Of patients referred for US-guided treatment of rotator cuff calcific tendonitis, 219 (86 men, 133 women; mean age, 40.3 years +/- 10.9 [standard deviation]) were treated; 68 (31 men, 37 women; mean age, 40.2 years +/- 11.3) patients refused treatment and served as control subjects. After local anesthesia was induced, two 16-gauge needles were inserted into the calcific deposit. Saline solution was injected through one needle, and the dissolved calcium was extracted through the other needle. Shoulder joint function was assessed by using Constant scores, and pain was assessed by using visual analogue scale (VAS) scores. Mann-Whitney U and chi(2) tests were performed. RESULTS At baseline, no significant difference in age or sex distribution, Constant score, or VAS score was detected between treated and nontreated (control) patients. Compared with control subjects, treated patients reported a significant decrease in symptoms at 1 month (mean Constant score, 73.2 +/- 6.2 vs 57.5 +/- 3.9; mean VAS score, 4.8 +/- 0.6 vs 9.1 +/- 0.5), 3 months (mean Constant score, 90.2 +/- 2.6 vs 62.6 +/- 7.2; mean VAS score, 3.3 +/- 0.4 vs 7.3 +/- 1.8), and 1 year (mean Constant score, 91.7 +/- 3.1 vs 78.4 +/- 9.5; mean VAS score, 2.7 +/- 0.5 vs 4.5 +/- 0.9) (P < .001). Symptom scores were not significantly different between the groups at 5 years (mean Constant score, 90.9 +/- 3.6 vs 90.5 +/- 4.8; mean VAS score, 2.6 +/- 0.5 vs 2.8 +/- 0.7) (P >or= .795) and 10 years (mean Constant score, 91.8 +/- 5.0 vs 91.3 +/- 9.6; mean VAS score, 2.5 +/- 0.6 vs 2.7 +/- 0.6) (P >or= .413). CONCLUSION US-guided percutaneous treatment facilitated prompt shoulder function recovery and pain relief. Treated patients had better outcomes than did nontreated patients at 1 year. However, 5 and 10 years after the procedure, the nontreated group reported outcomes similar to those of the treated group.
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Affiliation(s)
- Giovanni Serafini
- Unit of Radiology, Azienda Sanitaria Locale 2 Savonese, Ospedale Santa Corona, Via XXV Aprile 38, 17027 Pietra Ligure, Italy
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del Cura JL. Ultrasound-guided therapeutic procedures in the musculoskeletal system. Curr Probl Diagn Radiol 2008; 37:203-18. [PMID: 18662599 DOI: 10.1067/j.cpradiol.2007.08.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ultrasound allows the exploration of most of the musculoskeletal system, including lytic bone lesions. Its flexibility, availability, and low cost make it the best tool to guide interventional therapeutic procedures in any musculoskeletal system lesion visible on ultrasound. These techniques include drainages of abscesses, bursitis, hematomas or muscular strains, treatment of cystic lesions (ganglions, Baker's cysts), arthrocentesis, injection of substances in joints and soft tissues, and aspiration of calcific tendinitis. Although the puncture of joints for arthrocentesis and injection of substances are performed by clinicians using palpation, the use of ultrasound guidance improves the effectiveness of the technique especially for small or poorly accessible lesions and joints and for obese patients. Drainage can be performed using catheters or needles and can avoid a more aggressive approach most of the time. Intracavitary urokinase helps when the aim is to drain clotted hematomas or fibrinous collections. Injection of corticoids is useful in the treatment of ganglia, Baker's cysts, tendinitis, and noninfected arthritis. Calcific tendinitis of the shoulder can be effectively treated using percutaneous "lavage" with lidocaine. Calcifications usually disappear and symptoms improve in nearly 90% of the cases within a year. Most of these techniques are low cost and require only a moderate skill. Ultrasound-guided procedures are useful tools to effectively treat some diseases of the musculoskeletal system and should be routine in any imaging department.
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Louis LJ. Musculoskeletal Ultrasound Intervention: Principles and Advances. Radiol Clin North Am 2008; 46:515-33, vi. [DOI: 10.1016/j.rcl.2008.02.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
Ultrasound is a valuable imaging technique for musculoskeletal pathology. It is increasingly used for image-guided procedures such as aspiration of superficial or deep collections, injection of drugs, or biopsies. Ultrasound guidance is an interesting alternative to procedures performed either blindly or under fluoroscopic or CT guidance. Advantages of US-guided procedures include the absence of ionizing radiation, real-time monitoring during needle placement, decreased risk of injury to neighboring structures (namely vessels and nerves), real time confirmation of procedure success (injection, drainage, biopsy). Minor inconveniences relate to the proper conditions for performance of ultrasound. Complications are rare and can be avoided by using proper sterile technique and evaluate for potential contra-indications to the procedure. As with any other image guided procedure, informed consent is required.
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Affiliation(s)
- M Cohen
- Hôpital Saint-Joseph, Service d'Imagerie Médicale, 26 Boulevard de Louvain, 13008 Marseille, France.
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del Cura JL, Torre I, Zabala R, Legórburu A. Sonographically Guided Percutaneous Needle Lavage in Calcific Tendinitis of the Shoulder: Short- and Long-Term Results. AJR Am J Roentgenol 2007; 189:W128-34. [PMID: 17715078 DOI: 10.2214/ajr.07.2254] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the short- and long-term effectiveness of sonographically guided percutaneous needle aspiration and lavage in calcific tendinitis of the shoulder and to study the progress of calcifications and symptoms in the first year after treatment. MATERIALS AND METHODS Symptoms and radiologic findings after percutaneous aspiration of calcific tendinitis were prospectively evaluated in the short and the long term using a shoulder pain and disability index, evaluation of shoulder motion, and a survey of the self-perception by the patients regarding the progress of their disease. RESULTS Sixty-seven consecutive shoulders were treated. A significant improvement was seen in shoulder motion, pain, and disability in the short term and in the long term (p < 0.0001). One year after treatment, 91% of shoulders had substantially or completely improved, 64% had perfect motion, and calcifications on radiography had resolved completely or nearly completely in 89%. A transitory recurrence was observed approximately 15 weeks after treatment in 44.3% of shoulders that improved. CONCLUSION Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques, and it is only slightly invasive and painful. Progress after treatment may include a transitory period of recurrence of the pain.
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Affiliation(s)
- Jose Luis del Cura
- Department of Radiology, Hospital de Basurto, Ave. Montevideo 18, 48013 Bilbao, Spain
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Lin JT, Adler RS, Bracilovic A, Cooper G, Sofka C, Lutz GE. Clinical outcomes of ultrasound-guided aspiration and lavage in calcific tendinosis of the shoulder. HSS J 2007; 3:99-105. [PMID: 18751778 PMCID: PMC2504102 DOI: 10.1007/s11420-006-9037-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the effectiveness of ultrasound-guided aspiration and lavage in the treatment of patients with calcific tendinosis of the shoulder. MATERIALS AND METHODS Retrospective chart review resulted in 44 patients who were identified as having received ultrasound-guided aspiration of calcific tendinosis of the shoulder between 2000 and 2003. Of these, 36 patients were interviewed by telephone for pre- and posttreatment assessment of pain, shoulder function, prior shoulder surgery, injury, and prescribed treatment modalities with a follow-up time of 8 months to 3.1 years (mean = 22.5 months). L'Insalata score, numeric rating scale (NRS), and patient satisfaction score served as outcome measures. RESULTS Our criteria for a successful outcome included (1) 12-point or greater improvement in the L'Insalata shoulder rating questionnaire, (2) 2-point or greater improvement in the NRS, (3) patient satisfaction rating of "good", "very good", or "excellent", (4) patients' willingness to undergo the procedure again if they experienced recurrent symptoms, and (5) 1 month or less of analgesic medication use after the aspiration procedure. We determined that ultrasound-guided aspiration of calcific tendinosis of the shoulder resulted in a successful outcome for 75% (27/36) of patients with a mean 20.2-point improvement in the L'Insalata shoulder rating questionnaire score and a mean 6.4-point improvement in the NRS (p < 0.01). CONCLUSION This retrospective study suggests that ultrasound-guided aspiration and lavage of calcific shoulder deposits appears to be an efficacious therapeutic modality for treatment of calcific tendinosis. Further studies involving prospective randomized controlled trials would be helpful to further assess the long-term efficacy of this procedure as a minimally invasive treatment for calcific tendinosis of the shoulder.
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Affiliation(s)
- Julie T. Lin
- Physiatry Department, Hospital for Special Surgery, New York, NY 10021 USA ,Department of Rehabilitation Medicine, Weill Medical College of Cornell University, New York, NY 10021 USA
| | - Ronald S. Adler
- Division of Ultrasound and Body CT Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,Radiology Department, Weill Medical College of Cornell University, New York, NY 10021 USA
| | - Ana Bracilovic
- Physiatry Department, Hospital for Special Surgery, New York, NY 10021 USA ,Department of Rehabilitation Medicine, Weill Medical College of Cornell University, New York, NY 10021 USA
| | - Grant Cooper
- Physiatry Department, Hospital for Special Surgery, New York, NY 10021 USA ,Department of Rehabilitation Medicine, Weill Medical College of Cornell University, New York, NY 10021 USA
| | - Carolyn Sofka
- Division of Ultrasound and Body CT Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,Radiology Department, Weill Medical College of Cornell University, New York, NY 10021 USA
| | - Gregory E. Lutz
- Physiatry Department, Hospital for Special Surgery, New York, NY 10021 USA ,Department of Rehabilitation Medicine, Weill Medical College of Cornell University, New York, NY 10021 USA
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Zubler C, Mengiardi B, Schmid MR, Hodler J, Jost B, Pfirrmann CWA. MR arthrography in calcific tendinitis of the shoulder: diagnostic performance and pitfalls. Eur Radiol 2006; 17:1603-10. [PMID: 17036154 DOI: 10.1007/s00330-006-0428-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2006] [Revised: 05/27/2006] [Accepted: 08/01/2006] [Indexed: 01/23/2023]
Abstract
The purpose was to assess the diagnostic performance of MR arthrography to diagnose calcific tendinitis of the shoulder and to assess the reasons for diagnostic errors. Standard MR arthrograms of 22 patients with calcific tendinitis and 61 controls were retrospectively analyzed by two independent and blinded radiologists. All cases were consecutively collected from a database. Conventional radiographs were available in all cases serving as gold standard. The supraspinatus was involved in 16, the infraspinatus in four and the subscapularis in two patients. All diagnostic errors were analyzed by two additional readers. Reader 1 correctly detected 12 of the 22 shoulders with and 42 of the 61 shoulders without calcific tendinitis (sensitivity 0.55, specificity 0.66). The corresponding values for reader 2 were 13 of 22 and 40 of 61 cases (sensitivity 0.59, specificity 0.69). Inter-rater agreement (kappa-value) was 0.42. Small size of the calcific deposits and isointensity compared to the surrounding tissue were the most important reasons for false negative results. Normal hypointense areas within the supraspinatus tendon substance and attachment were the main reason for false positive results. In conclusion, MR arthrography is insufficient in the diagnosis of calcific tendinitis. Normal hypointense parts of the rotator cuff may mimic calcific deposits and calcifications may not be detected when they are isointense compared to the rotator cuff. Therefore, MR imaging should not be interpreted without corresponding radiographs.
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Affiliation(s)
- Christoph Zubler
- Radiology, University Hospital Balgrist, Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland
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McShane JM, Nazarian LN, Harwood MI. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:1281-9. [PMID: 16998100 DOI: 10.7863/jum.2006.25.10.1281] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Chronic tendinosis of the common extensor tendon of the lateral elbow can be a difficult problem to treat. We report our experience with sonographically guided percutaneous needle tenotomy to relieve pain and improve function in patients with this condition. METHODS We performed sonographically guided percutaneous needle tenotomy on 58 consecutive patients who had persistent pain and disability resulting from common extensor tendinosis. Under a local anesthetic and sonographic guidance, a needle was advanced into the common extensor tendon, and the tip of the needle was used to repeatedly fenestrate the tendinotic tissue. Calcifications, if present, were mechanically fragmented, and the adjacent bony surface of the apex and face of the epicondyle were abraded. Finally, the fenestrated tendon was infiltrated with a solution containing corticosteroid mixed with bupivacaine. After the procedure, patients were instructed to perform passive stretches and to undergo physical therapy. During a subsequent telephone interview, patients answered questions about their experience, their functioning level, and their perceptions of procedure outcome. RESULTS Fifty-five (95%) of 58 patients were contacted by telephone and agreed to participate in the study. Thirty-five (63.6%) of 55 respondents reported excellent outcomes, 16.4% good, 7.3% fair, and 12.7% poor. The average follow-up time from the date of the procedure to the date of the interview was 28 months (range, 17-44 months). No adverse events were reported; 85.5% stated that they would refer a friend or close relative for the procedure. CONCLUSIONS Sonographically guided percutaneous needle tenotomy for lateral elbow tendinosis is a safe, effective, and viable alternative for patients in whom all other nonsurgical treatments failed.
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Affiliation(s)
- John M McShane
- McShane Sports Medicine, 734 E Lancaster Ave, Villanova, PA 19085, USA.
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Abstract
Ultrasound examination of the shoulder and elbow requires careful technique, appreciation of normal anatomy, and appropriate high-end equipment. Ultrasound provides detailed diagnostic information. Its accuracy is comparable to that of MRI in the assessment of the rotator cuff. Ultrasound is cheaper than MRI and is preferred by patients.
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Affiliation(s)
- Ian Beggs
- Royal Infirmary, Edinburgh EH16 4SA, United Kingdom.
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Abstract
Diagnostic and therapeutic interventional procedures are rapidly expanding and, when guided by imaging, are more efficient then when performed with a blinded technique. Compared to fluoroscopy and CT, ultrasound does not utilize ionizing radiation. It can facilitate needle placement for arthrography, tenography or bursography or it can guide a variety of procedures such as aspiration, arthrocentesis, local steroid injections and needling of tendon calcifications. Technological improvements have increased the precision of ultrasound guidance and have contributed to reduce the risk of complication. Real time scanning allows simultaneous visualization of the target and of needle progression and has diminished the rate of complications, that are infrequent if the operator uses a strict sterile technique and respects the contraindications.
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Affiliation(s)
- D Jacob
- Département d'Imagerie Médicale, CHRU de Dijon, BP 77908, 21079 Dijon.
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