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Andrea LC, Svendsen SW, Frost P, Smidt K, Gelineck J, Christiansen DH, Deutch SR, Hansen TB, Haahr JP, Dalbøge A. Radiographic findings in patients suspected of subacromial impingement syndrome: prevalence and reliability. Skeletal Radiol 2024; 53:2477-2490. [PMID: 38652296 PMCID: PMC11410933 DOI: 10.1007/s00256-024-04675-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Aims were to (i) report prevalence and (ii) evaluate reliability of the radiographic findings in examinations of patients suspected of subacromial impingement syndrome (SIS), performed before a patient's first consultation at orthopaedic department. MATERIALS AND METHODS This cross-sectional study examined radiographs from 850 patients, age 18 to 63 years, referred to orthopaedic clinic on suspicion of SIS. Prevalence (%) of radiographic findings were registered. Inter- and intrarater reliability was analysed using expected and observed agreement (%), kappa coefficients, Bland-Altman plots, or intraclass coefficients. RESULTS A total of 850 patients with a mean age of 48.2 years (SD = 8.8) were included. Prevalence of the radiographic findings was as follows: calcification 24.4%, Bigliani type III (hooked) acromion 15.8%, lateral/medial acromial spurs 11.1%/6.6%, acromioclavicular osteoarthritis 12.0%, and Bankart/Hill-Sachs lesions 7.1%. Inter- and intrarater Kappa values for most radiographic findings ranged between 0.40 and 0.89; highest values for the presence of calcification (0.85 and 0.89) and acromion type (0.63 and 0.66). The inter- and intrarater intraclass coefficients ranged between 0.41 and 0.83; highest values for acromial tilt (0.79 and 0.83) and calcification area (0.69 and 0.81). CONCLUSION Calcification, Bigliani type III (hooked) acromion, and acromioclavicular osteoarthritis were prevalent findings among patients seen in orthopaedic departments on suspicion of SIS. Spurs and Bankart/Hill-Sachs lesions were less common. Optimal reliabilities were found for the presence of calcification, calcification area, and acromial tilt. Calcification qualities, acromion type, lateral spur, and acromioclavicular osteoarthritis showed suboptimal reliabilities. Newer architectural measures (acromion index and lateral acromial angle) performed well with respect to reliability.
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Affiliation(s)
- Linda Christie Andrea
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark.
| | - Susanne Wulff Svendsen
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kate Smidt
- Department of Orthopedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - John Gelineck
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - David Høyrup Christiansen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Torben Bæk Hansen
- University Clinic of Hand, Hip and Knee Surgery, Holstebro Regional Hospital, Holstebro, Denmark
| | - Jens Peder Haahr
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
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2
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Muñoz-Poblete C, Inostroza J, Carranza-Leiva J. Biomechanical risk factors and subacromial pain provocation in healthy manufacturing workers. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024:1-7. [PMID: 39028147 DOI: 10.1080/10803548.2024.2371210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Objectives. Work-related musculoskeletal disorders (MSDs) of the shoulder may manifest subclinically. By combining risk assessment and clinical instruments, it may be advisable to recognize workers who may develop more complex MSDs early. This study aimed to evaluate the relationship between biomechanical risk factors and subacromial pain provocation in healthy manufacturing workers. Methods. A cross-sectional descriptive observational study was carried out with workers in the furniture manufacturing industry. The occupational repetitive action (OCRA) checklist was applied to detect risk factors and three clinical tests used to detect subacromial tissue reactivity: the supraspinatus test, the painful arc test and the Hawkins-Kennedy test. Results. The positivity of the clinical tests is higher in the supraspinatus test, followed by the Hawkins-Kennedy test, and lowest in the painful arc test, for both the right and left shoulders. No significant associations were found with the overall OCRA checklist index or specific biomechanical factors. Conclusion. The biomechanical risk factors and the provocation of subacromial pain reviewed in this study were not found to be related. Other physical tests that are more sensitive and adapted to workers at risk of developing musculoskeletal shoulder disorders should be explored.
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Saran S, Babhulkar JA, Gupta H, Chari B. Imaging of calcific tendinopathy: natural history, migration patterns, pitfalls, and management: a review. Br J Radiol 2024; 97:1099-1111. [PMID: 38346707 PMCID: PMC11135804 DOI: 10.1093/bjr/tqae039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 05/31/2024] Open
Abstract
Calcific tendinopathy is characterized by the deposition of calcium hydroxyapatite crystals in various tendons of the body. Terms like calcium tendinitis, tendinosis, and tendinopathy are used interchangeably. Calcific tendinopathy is a common and well-documented ailment in the literature. Although common, the natural history, aetiology, and progression of calcific tendinitis are poorly understood. The treatment options include conservative and interventional measures. However, these measures cannot be applied as a blanket and are often tailored depending on the stage/phase of the disease. Out of the recognized stages of the disease, the resorptive stage causes the utmost symptoms when the calcium is rather soft and unstable. During this stage, the calcium may migrate beyond expected resorption and get deposited in the adjacent tissues contiguous with the calcium focus. The common destinations include bursal migration, intraosseous migration, muscular migration, and other less common migration sites. Such atypical presentations can lead to dilemmas in the diagnosis, prolongation of the diagnostic pathway, unwarranted apprehension, and treatment delay. Radiologists' role in this situation is to correctly recognize the imaging findings of atypical presentations of calcific tendinopathy and prevent unnecessary diagnostic and interventional studies. In this review article, we describe the pathogenic pathway and natural history of calcific tendinopathy from a radiologist's perspective and discuss different migratory patterns of calcium in calcific tendinopathy not only around the shoulder but also in other areas of the body on different imaging modalities. We also show a few examples of mimics and pitfalls on imaging. Finally, we discuss the appropriate management option of this condition.
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Affiliation(s)
- Sonal Saran
- Department of Radiodiagnosis, AIIMS, Rishikesh, 249203, India
| | - Joban Ashish Babhulkar
- Department of Radiology, Deenanath Mangeshkar Hospital, Star Imaging and Research Centre, Bharati Vidyapeeth, Pune, 411001, India
| | - Harun Gupta
- Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, United Kingdom
| | - Basavaraj Chari
- Oxford University Hospitals NHS Foundation Trust, OX3 7LD, United Kingdom
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4
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Nowotny J, Kasten P. Kalkschulter – konservative und operative
Therapie. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2023. [DOI: 10.1055/a-1990-6407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Erkrankungen der Rotatorenmanschette beinhalten ein breites Spektrum, unter denen
die Kalkschulter oder Tendinosis calcarea (TC) eine häufige Pathologie
der Schulter darstellt und eine herausragende Rolle einnimmt. Das
Erscheinungsbild kann dabei enorm variieren. Die Kalkschulter kann als
Zufallsbefund bei der radiologischen Diagnostik auffallen, jedoch auch bis hin
zu einem der stärksten Schulterschmerzen avancieren. Nachfolgend wird
ein Überblick für das diagnostische und therapeutische Vorgehen
gegeben.
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Janvier AJ, Pendleton EG, Mortensen LJ, Green DC, Henstock JR, Canty-Laird EG. Multimodal analysis of the differential effects of cyclic strain on collagen isoform composition, fibril architecture and biomechanics of tissue engineered tendon. J Tissue Eng 2022; 13:20417314221130486. [PMID: 36339372 PMCID: PMC9629721 DOI: 10.1177/20417314221130486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/18/2022] [Indexed: 11/07/2022] Open
Abstract
Tendon is predominantly composed of aligned type I collagen, but additional isoforms are known to influence fibril architecture and maturation, which contribute to the tendon’s overall biomechanical performance. The role of the less well-studied collagen isoforms on fibrillogenesis in tissue engineered tendons is currently unknown, and correlating their relative abundance with biomechanical changes in response to cyclic strain is a promising method for characterising optimised bioengineered tendon grafts. In this study, human mesenchymal stem cells (MSCs) were cultured in a fibrin scaffold with 3%, 5% or 10% cyclic strain at 0.5 Hz for 3 weeks, and a comprehensive multimodal analysis comprising qPCR, western blotting, histology, mechanical testing, fluorescent probe CLSM, TEM and label-free second-harmonic imaging was performed. Molecular data indicated complex transcriptional and translational regulation of collagen isoforms I, II, III, V XI, XII and XIV in response to cyclic strain. Isoforms (XII and XIV) associated with embryonic tenogenesis were deposited in the formation of neo-tendons from hMSCs, suggesting that these engineered tendons form through some recapitulation of a developmental pathway. Tendons cultured with 3% strain had the smallest median fibril diameter but highest resistance to stress, whilst at 10% strain tendons had the highest median fibril diameter and the highest rate of stress relaxation. Second harmonic generation exposed distinct structural arrangements of collagen fibres in each strain group. Fluorescent probe images correlated increasing cyclic strain with increased fibril alignment from 40% (static strain) to 61.5% alignment (10% cyclic strain). These results indicate that cyclic strain rates stimulate differential cell responses via complex regulation of collagen isoforms which influence the structural organisation of developing fibril architectures.
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Affiliation(s)
- Adam J Janvier
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Emily G Pendleton
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, USA
| | - Luke J Mortensen
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, USA
| | - Daniel C Green
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK,The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Liverpool, UK
| | - James R Henstock
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK,The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Liverpool, UK,Elizabeth G Canty-Laird, Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Elizabeth G Canty-Laird
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK,Department of Animal and Dairy Science, University of Georgia, Athens, GA, USA
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Minghelli B, Ettro N, Simão J, Maurício K. Work-related self-reported musculoskeletal disorders in hypermarket cashiers: a study in south of Portugal. LA MEDICINA DEL LAVORO 2019; 110:191-201. [PMID: 31268426 PMCID: PMC7812540 DOI: 10.23749/mdl.v110i3.7771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/15/2019] [Indexed: 11/18/2022]
Abstract
Background: Work-related musculoskeletal disorders are a group of painful disorders which arise from work situations with continuous repetitive movements, carried out with speed and without time for recovery. In the performance of their job tasks, supermarket cashiers are exposed to this type of ergonomic stress. Objectives: This study aimed to determine the incidence of self-reported injuries in Portuguese hypermarket cashiers and to identify the related factors. Methods: The sample included 176 hypermarket cashiers, aged between 18 and 65 years (39.57±11.11), 167 (94.9%) of them women. Symptoms and exposure of interest have been collected through an interview-based questionnaire. The presence of carpal tunnel syndrome was assessed by Phalen’s test. Results: One hundred and seventeen (66.5%) cashiers reported an injury during employment, 100 (56.8%) of them reporting an injury in the previous 6 months. A total of 166 injuries were reported, corresponding to 1.14 injuries per 1,000 hours of work. The most common injuries were non-specific pain (30.4%), located in the shoulder (23.2%), cervical (22%) and lumbar spine (22%). Part-time workers showed a 2.25 times greater risk of injury (95% CI: 1.17-4.32; p=0.015) than full-time workers. Cashiers with more than 6 years of employment length had a 3.59 times higher risk of injury (95% CI: 1.84-6.99; p≤0.001) than those who had been working for a shorter period. Conclusions: Our data showed a high rate of reported injuries among hypermarket cashiers, especially among part-time workers and those with the highest length of employment.
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Affiliation(s)
- Beatriz Minghelli
- School of Health Jean Piaget Algarve - Piaget Institute - Portugal; Research in Education and Community Intervention (RECI).
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7
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Raja A, Craig EV, Braman JP. Rotator cuff tendon calcific tendinitis treatment algorithm for primary care musculoskeletal physicians. J Family Med Prim Care 2019; 8:1647-1652. [PMID: 31198731 PMCID: PMC6559092 DOI: 10.4103/jfmpc.jfmpc_110_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Purpose Calcific tendinitis of the shoulder is a common pathology encountered by primary care sports medicine physicians and orthopedic surgeons. Understanding the patient demographics responsible for calcific tendinitis outcomes from various treatment modalities may lead to greater understanding of appropriate management. Methods This was a retrospective study on patients who were diagnosed with calcific tendinitis by imaging (radiographs, MRIs) at our institution from 2014 to 2016. The data collection included patient demographics, clinical signs and symptoms management. Treatment outcomes were assessed by whether symptoms resolved and the number and type of treatment. Results A total of 250 medical records were reviewed out of which 237 were involved in the data analysis. There were 95 male and 141 female patients with a mean age of 54.9 ± 11.5 years. In all, 120 patients complained of right shoulder pain and 117 of left shoulder pain. Smokers had a higher VAS Pain at Rest and Activity of 6.1 ± 3.5 and 8.2 ± 2.4, respectively, with non-smokers scoring a lower VAS Pain Rest score of 4.2 ± 3.1 and 7.9 ± 2.0 (P = 0.18). The VAS Pain Rest score after follow-up from corticosteroid injection, ultrasound-guided injection with needling, and surgery were 3.9 ± 3.0, 3.5 ± 3.0, and 0.7 ± 1.4, respectively. Conclusion An algorithm constructed from our results recommends initial management with a subacromial corticosteroid injection with physical therapy followed by ultrasound-guided injection with needling and PT if the initial treatment fails. Surgical management is considered when the patient is recalcitrant to the first two forms of non-operative treatment.
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Affiliation(s)
- Avais Raja
- TRIA Orthopaedic Center, 8100 Northland Drive, Minneapolis, MN, USA
| | - Edward V Craig
- TRIA Orthopaedic Center, 8100 Northland Drive, Minneapolis, MN, USA
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8
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Sansone V, Maiorano E, Galluzzo A, Pascale V. Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment. Orthop Res Rev 2018; 10:63-72. [PMID: 30774461 PMCID: PMC6209365 DOI: 10.2147/orr.s138225] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Calcific tendinopathy (CT) of the shoulder is a common, painful condition characterized by the presence of calcium deposits in the rotator cuff tendons. Current theories indicate that CT may be the result of a cell-mediated process in which, after a stage of calcium deposition, calcifications are spontaneously resorbed. However, in a minority of cases, this self-healing process is somehow disrupted, resulting in symptoms. Recent literature shows an emerging role of biological and genetic factors underlying CT. This new evidence could supplement the classic mechanical theory of rotator cuff tendinopathy complicated by calcium precipitation, and it may also explain why the majority of the therapies currently in use are only able to provide partially satisfactory outcomes. This review aims to summarize the current knowledge about the pathological processes underlying CT of the shoulder and thereby justify the quest for advanced biological treatments of this condition when it becomes symptomatic.
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Affiliation(s)
- Valerio Sansone
- Department of Orthopaedics, University of Milan, .,Department of Orthopaedics, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy,
| | | | | | - Valerio Pascale
- Department of Orthopaedics, University of Milan, .,Department of Orthopaedics, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy,
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9
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Kottwitz MU, Rolli Salathé C, Buser C, Elfering A. Emotion Work and Musculoskeletal Pain in Supermarket Cashiers: A Test of a Sleep-Mediation Model. SCANDINAVIAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2017. [DOI: 10.16993/sjwop.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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10
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van der Molen HF, Foresti C, Daams JG, Frings-Dresen MHW, Kuijer PPFM. Work-related risk factors for specific shoulder disorders: a systematic review and meta-analysis. Occup Environ Med 2017; 74:745-755. [PMID: 28756414 DOI: 10.1136/oemed-2017-104339] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/24/2017] [Accepted: 06/17/2017] [Indexed: 02/06/2023]
Abstract
The objective of this systematic review and meta-analysis is to examine which work-related risk factors are associated with specific soft tissue shoulder disorders. We searched the electronic databases of Medline and Embase for articles published between 2009 and 24 March 2016 and included the references of a systematic review performed for the period before 2009. Primary cross-sectional and longitudinal studies were included when outcome data were described in terms of clinically assessed soft tissue shoulder disorders and at least two levels of work-related exposure were mentioned (exposed vs less or non-exposed). Two authors independently selected studies, extracted data and assessed study quality. For longitudinal studies, we performed meta-analyses and used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the evidence for the associations between risk factors and the onset of shoulder disorders. Twenty-seven studies met the inclusion criteria. In total, 16 300 patients with specific soft tissue shoulder disorders from a population of 2 413 722 workers from Denmark, Finland, France, Germany and Poland were included in the meta-analysis of one case-control and six prospective cohort studies. This meta-analysis revealed moderate evidence for associations between shoulder disorders and arm-hand elevation (OR=1.9, 95% CI 1.47 to 2.47) and shoulder load (OR=2.0, 95% CI 1.90 to 2.10) and low to very low evidence for hand force exertion (OR=1.5, 95% CI 1.25 to 1.87), hand-arm vibration (OR=1.3, 95% CI 1.01 to 1.77), psychosocial job demands (OR=1.1, 95% CI 1.01 to 1.25) and working together with temporary workers (OR=2.2, 95% CI 1.2 to 4.2). Low-quality evidence for no associations was found for arm repetition, social support, decision latitude, job control and job security. Moderate evidence was found that arm-hand elevation and shoulder load double the risk of specific shoulder disorders. Low to very-low-quality evidence was found for an association between hand force exertion, hand-arm vibration, psychosocial job demands and working together with temporary workers and the incidence of specific shoulder disorders.
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Affiliation(s)
- Henk F van der Molen
- Coronel Institute of Occupational Health, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.,Netherlands Center for Occupational Diseases, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Chiara Foresti
- School of Occupational Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Joost G Daams
- Coronel Institute of Occupational Health, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.,Netherlands Center for Occupational Diseases, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Coronel Institute of Occupational Health, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.,Netherlands Center for Occupational Diseases, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.,Netherlands Center for Occupational Diseases, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
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11
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Meroni R, Piscitelli D, Valerio S, Boria P, Perin C, De Vito G, Cornaggia CM, Cerri CG. Ultrasonography of the shoulder: asymptomatic findings from working-age women in the general population. J Phys Ther Sci 2017; 29:1219-1223. [PMID: 28744052 PMCID: PMC5509596 DOI: 10.1589/jpts.29.1219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/27/2017] [Indexed: 12/19/2022] Open
Abstract
[Purpose] The aim of this study was to estimate the prevalence of abnormal shoulder
ultrasonographic findings in a sample of asymptomatic women. [Subjects and Methods] A
secondary analysis of a cross-sectional study was performed. We recruited 305 women (aged
18–56 years). All the subjects had a structured interview screening for self-reported
symptoms and underwent a shoulder ultrasonographic examination, in which both shoulders
were examined. The radiologist was blinded to the clinical history of the participants.
All detectable shoulder abnormalities were collected. [Results] Of the subjects, 228
(74.75%) were asymptomatic at both shoulders, and 456 asymptomatic shoulders were
analyzed. Lack of uniformity (supraspinatus, infraspinatus, subscapularis, and biceps
brachii long head) was found in 28 shoulders (6.14%), 19 (4.17%) on the dominant side and
9 (1.97%) on the non-dominant side. Tendinosis (supraspinatus, infraspinatus,
subscapularis, and biceps brachii long head) was found in 19 shoulders (5.32%), 12 (2.63%)
on the dominant side and 7 (1.53%) on the non-dominant side. Calcification and other
abnormal findings were reported. [Conclusion] The most common abnormalities were
calcifications within the rotator-cuff tendons and humeral head geodes; other degenerative
findings were less common.
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Affiliation(s)
- Roberto Meroni
- School of Medicine and Surgery, University of Milano Bicocca, Italy
| | | | | | - Paola Boria
- Occupational Medicine, Private Practice, Italy
| | - Cecilia Perin
- School of Medicine and Surgery, University of Milano Bicocca, Italy
| | - Giovanni De Vito
- School of Medicine and Surgery, University of Milano Bicocca, Italy
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12
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Hopkins C, Fu SC, Chua E, Hu X, Rolf C, Mattila VM, Qin L, Yung PSH, Chan KM. Critical review on the socio-economic impact of tendinopathy. Asia Pac J Sports Med Arthrosc Rehabil Technol 2016; 4:9-20. [PMID: 29264258 PMCID: PMC5730665 DOI: 10.1016/j.asmart.2016.01.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 12/16/2022] Open
Abstract
There are currently no studies that determine the total burden that tendinopathy places on patients and society. A systematic search was conducted to understand the impact of tendinopathy. It demonstrated that the current prevalence is underestimated, particularly in active populations, such as athletes and workers. Search results demonstrate that due to the high prevalence, impact on patients' daily lives and the economic impact due to work-loss, treatments are significantly higher than currently observed. A well-accepted definition by medical professionals and the public will improve documentation and increase awareness, in order to better tackle the disease burden.
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Affiliation(s)
- Chelsea Hopkins
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eldrich Chua
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaorui Hu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Christer Rolf
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Ville M. Mattila
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Ling Qin
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Translational Medicine Research and Development Centre, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai-Ming Chan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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13
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Sansone V, Consonni O, Maiorano E, Meroni R, Goddi A. Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders. Skeletal Radiol 2016; 45:49-55. [PMID: 26306389 DOI: 10.1007/s00256-015-2240-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 07/12/2015] [Accepted: 08/16/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide new epidemiological data regarding the prevalence, distribution and macroscopic features of shoulder rotator cuff calcific tendinopathy (calcific tendinopathy), and to identify the characteristics of calcific deposits associated with shoulder pain. MATERIALS AND METHODS Three hundred and two female volunteers (604 shoulders) who had been referred to a gynaecological clinic participated in the study. The subjects underwent a high-resolution ultrasonography of both shoulders, and those with a diagnosis of calcific tendinopathy compiled a standardized questionnaire relating to shoulder symptoms. We determined the prevalence of symptomatic and asymptomatic rotator cuff calcific tendinopathy, and compared differences in distribution and macroscopic features of the symptomatic and asymptomatic calcifications. RESULTS The prevalence of calcific tendinopathy was 17.8% (103 shoulders). Ninety-five shoulders (15.7%) were symptomatic; of these, calcific tendinopathy was found in 34 shoulders (33%) on imaging. Of the 509 asymptomatic (84.3%) shoulders, calcific tendinopathy was observed in 69 cases (67%). Among tendons, supraspinatus (53.4%) and infraspinatus (54.6%) were the most frequently involved. The majority of calcific deposits were of maximum diameter between 2 and 5 mm (77.9%), and were linear in form (69.9%). The involvement of multiple tendons and a location in the supraspinatus tendon were found to be significantly correlated with pain (p = 0.023, p = 0.043 respectively), as were age (p = 0.041) and an excessive body mass index (p = 0.024). CONCLUSION In this sample from the general population of working age females, both intrinsic factors (location in supraspinatus, multiple tendon involvement) and extrinsic variables (age, abnormally high BMI) were correlated with pain in calcific tendinopathy. LEVEL OF EVIDENCE Level III, cross-sectional study, prevalence study.
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Affiliation(s)
- Valerio Sansone
- Orthopaedic Department of the Università degli Studi di Milano, Milan, Italy. .,Istituto Ortopedico Galeazzi IRCCS, Via Riccardo Galeazzi 4, 20161, Milano, Italy.
| | - Olmo Consonni
- Orthopaedic Department of the Università degli Studi di Milano, Milan, Italy
| | - Emanuele Maiorano
- Orthopaedic Department of the Università degli Studi di Milano, Milan, Italy
| | - Roberto Meroni
- Department of Surgery and Interdisciplinary Medicine, Program in Physical Therapy, University of Milano-Bicocca, Milan, Italy
| | - Alfredo Goddi
- SME - Diagnostic Imaging Medical Centre, Varese, Italy
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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: 24] [Impact Index Per Article: 2.7] [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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15
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Nörenberg D, Ebersberger HU, Walter T, Ockert B, Knobloch G, Diederichs G, Hamm B, Makowski MR. Diagnosis of Calcific Tendonitis of the Rotator Cuff by Using Susceptibility-weighted MR Imaging. Radiology 2015; 278:475-84. [PMID: 26347995 DOI: 10.1148/radiol.2015150034] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of susceptibility-weighted imaging (SWI) and standard shoulder joint magnetic resonance (MR) sequences in comparison to that of conventional radiography for the identification of calcifications in the rotator cuff in patients with calcific tendonitis. MATERIALS AND METHODS The institutional review board approved this prospective study. Written informed consent was obtained from all subjects. Fifty-four patients clinically suspected of having calcific tendonitis of the rotator cuff were included. On radiographs (the standard of reference), 27 patients had positive calcification findings, and 27 did not. Standard MR sequences and SWI, including magnitude and phase imaging, were performed. The diameter of calcifications was measured to assess intermodality correlations. Sensitivity, specificity, and intra- and interobserver agreement were calculated. Phantom measurements were performed to assess the detection limit of SWI. RESULTS Fifty-six calcifications were detected with radiography in 27 patients. Most (55 calcifications, 98%) could be identified as calcifications by using SWI. Standard T1- and T2-weighted sequences were used to identify 33 calcifications (59%). SWI yielded a sensitivity of 98% (95% confidence interval [CI]: 0.943, 1) and specificity of 96% (95% CI: 0.886, 1) for the identification of calcifications when compared with radiography. Standard rotator cuff MR sequences yielded a sensitivity of 59% (95% CI: 0.422, 0.758) and specificity of 67% (95% CI: 0.493, 0.847). Diameter measurements demonstrated a high correlation between SWI and radiography (R(2) = 0.90), with overestimation of lesion diameter at SWI (mean ± standard deviation for SWI, 7.6 mm ± 5.4; for radiography, 5.3 mm ± 5.1). SWI yielded higher interobserver agreement (R(2) = 0.99, P < .001; 95% CI: 0.989, 0.996) compared with standard MR sequences (R(2) = 0.67, P = .62; 95% CI: 0.703, 0.899). In phantom experiments, SWI and computed tomography were used to identify small calcifications that were missed at radiography. CONCLUSION SWI enables the reliable detection of calcifications in the rotator cuff in patients with calcific tendonitis by using conventional radiography as a reference and offers better sensitivity and specificity than standard rotator cuff MR sequences.
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Affiliation(s)
- Dominik Nörenberg
- From the Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany (D.N., T.W., G.K., G.D., B.H., M.R.M.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (H.U.E.); Department of Trauma and Orthopedic Surgery, Shoulder and Elbow Service (B.O.), and Department of Clinical Radiology (D.N.), Munich University Hospitals, Campus Grosshadern, Munich, Germany; and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (M.R.M.)
| | - Hans U Ebersberger
- From the Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany (D.N., T.W., G.K., G.D., B.H., M.R.M.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (H.U.E.); Department of Trauma and Orthopedic Surgery, Shoulder and Elbow Service (B.O.), and Department of Clinical Radiology (D.N.), Munich University Hospitals, Campus Grosshadern, Munich, Germany; and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (M.R.M.)
| | - Thula Walter
- From the Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany (D.N., T.W., G.K., G.D., B.H., M.R.M.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (H.U.E.); Department of Trauma and Orthopedic Surgery, Shoulder and Elbow Service (B.O.), and Department of Clinical Radiology (D.N.), Munich University Hospitals, Campus Grosshadern, Munich, Germany; and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (M.R.M.)
| | - Ben Ockert
- From the Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany (D.N., T.W., G.K., G.D., B.H., M.R.M.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (H.U.E.); Department of Trauma and Orthopedic Surgery, Shoulder and Elbow Service (B.O.), and Department of Clinical Radiology (D.N.), Munich University Hospitals, Campus Grosshadern, Munich, Germany; and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (M.R.M.)
| | - Gesine Knobloch
- From the Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany (D.N., T.W., G.K., G.D., B.H., M.R.M.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (H.U.E.); Department of Trauma and Orthopedic Surgery, Shoulder and Elbow Service (B.O.), and Department of Clinical Radiology (D.N.), Munich University Hospitals, Campus Grosshadern, Munich, Germany; and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (M.R.M.)
| | - Gerd Diederichs
- From the Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany (D.N., T.W., G.K., G.D., B.H., M.R.M.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (H.U.E.); Department of Trauma and Orthopedic Surgery, Shoulder and Elbow Service (B.O.), and Department of Clinical Radiology (D.N.), Munich University Hospitals, Campus Grosshadern, Munich, Germany; and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (M.R.M.)
| | - Bernd Hamm
- From the Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany (D.N., T.W., G.K., G.D., B.H., M.R.M.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (H.U.E.); Department of Trauma and Orthopedic Surgery, Shoulder and Elbow Service (B.O.), and Department of Clinical Radiology (D.N.), Munich University Hospitals, Campus Grosshadern, Munich, Germany; and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (M.R.M.)
| | - Marcus R Makowski
- From the Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany (D.N., T.W., G.K., G.D., B.H., M.R.M.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (H.U.E.); Department of Trauma and Orthopedic Surgery, Shoulder and Elbow Service (B.O.), and Department of Clinical Radiology (D.N.), Munich University Hospitals, Campus Grosshadern, Munich, Germany; and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (M.R.M.)
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