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You Y, Li Z, Guo J, Zhang T. Case Report: Surgical management of medial collateral ligament calcification. Front Surg 2024; 11:1506867. [PMID: 39687327 PMCID: PMC11646854 DOI: 10.3389/fsurg.2024.1506867] [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] [Received: 10/06/2024] [Accepted: 11/01/2024] [Indexed: 12/18/2024] Open
Abstract
Calcification is a self-limiting disease, characterized by the deposition of calcium, causing severe pain, swelling, and movement disorder. It is mainly found in the shoulder joint but has also been reported in other joints such as the wrist, hip, knee, foot, and ankle. However, calcification of the medial collateral ligament (MCL) has been rarely reported. The patient was a 47-year-old female without any trauma, whose chief complaint was pain and impaired flexion-extension of the affected knee joint. The diagnosis was calcification of the MCL, subsequently demonstrated by imaging examination. Conservative treatment was initially attempted, followed by arthroscopic surgery, and the postoperative pathological results confirmed the calcified tendon. The patient had a favorable prognosis 1 month after the procedure. This study demonstrates that arthroscopic surgery can result in effective and swift recovery of clinical outcomes for patients with calcification of the MCL.
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Affiliation(s)
| | | | - Jie Guo
- Department of Orthopedics, Jinan Central Hospital, Jinan, Shan Dong, China
| | - Tao Zhang
- Department of Orthopedics, Jinan Central Hospital, Jinan, Shan Dong, China
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2
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Papalexis N, Ponti F, Rinaldi R, Peta G, Bruno R, Miceli M, Battaglia M, Marinelli A, Spinnato P. Ultrasound-Guided Treatments for the Painful Shoulder. Curr Med Imaging 2021; 18:693-700. [PMID: 34872482 DOI: 10.2174/1573405617666211206112752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/30/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022]
Abstract
Shoulder pain is an extremely common condition. The painful shoulder may be the result of a wide spectrum of underlying pathological conditions, including calcific tendinopathy of the rotator cuff, subacromial-subdeltoid bursitis, acromioclavicular or glenohumeral arthritis, tenosynovitis of the long biceps tendon, rotator cuff lesions, and many other less common conditions. Ultrasound imaging is an effective tool for the diagnosis and also for the image guidance of treatment of the majority of these conditions. Several ultrasound-guided procedures are effective for pain relief, such as percutaneous irrigation, intra-bursal or intra-articular drugs injection, fluid aspiration, neural block. This review article aims to summarize and discuss the most common treatment possibilities with ultrasound guidance for the painful shoulder.
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Affiliation(s)
- Nicolas Papalexis
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Raffaella Rinaldi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Giuliano Peta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Riccardo Bruno
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Milva Battaglia
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | | | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
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3
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Bautista JM, Fernández-Jara J, Bautista SM, Fernández-Miranda PM, Mora MV, San José BG, Estévez MG, Molina BM, Vázquez PP. Infraspinatus atrophy due to Bennett lesion causing suprascapular nerve palsy. J Ultrason 2021; 21:e177-e181. [PMID: 34258044 PMCID: PMC8264810 DOI: 10.15557/jou.2021.0028] [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: 01/18/2021] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 19-year-old professional volleyball player who presented with right shoulder pain exacerbated during sports activity. On physical examination, infraspinatus atrophy was evident. As the clinical setting suggested suprascapular nerve entrapment syndrome, shoulder MR and later CT were performed. The results showed radiological signs of subacute-chronic infraspinatus muscle denervation and a Bennett lesion of the shoulder, presumably due to chronic repetitive trauma during the classical overhead swing in volleyball. The patient agreed to surgical treatment, and arthroscopic decompression was achieved. After months of rehabilitation, the pain gradually subsided, the infraspinatus muscle recovered its trophism, and the patient progressively returned to her regular sports activity.
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Affiliation(s)
| | | | | | | | - María Valencia Mora
- Department of Traumatology, Hospital Universitario Fundación Jiménez Díaz, Spain
| | | | | | - Blanca Mur Molina
- Department of Rehabilitation, Hospital Universitario Ramón y Cajal, Madrid, Spain
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4
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Draghi F, Cocco G, Lomoro P, Bortolotto C, Schiavone C. Non-rotator cuff calcific tendinopathy: ultrasonographic diagnosis and treatment. J Ultrasound 2020; 23:301-315. [PMID: 31197633 PMCID: PMC7441123 DOI: 10.1007/s40477-019-00393-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/31/2019] [Indexed: 12/13/2022] Open
Abstract
Calcific tendinopathy is a condition that is related to the deposition of calcium, mostly hydroxyapatite crystals, within the tendons. The shoulder and the hip are commonly affected joints, but calcific tendinopathy may occur in any tendon of the body. While there is an extensive literature on the ultrasound diagnosis of calcific tendinopathy of the shoulder, there are only sporadic reports on other sites. This review combines the experience of our centers and a thorough analysis of the literature from the last 45 years (1972-2017) in order to highlight the localizations beyond the rotator cuff, their ultrasound characteristics and therapeutic possibilities.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Giulio Cocco
- Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
| | - Pascal Lomoro
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Chandra Bortolotto
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy.
| | - Cosima Schiavone
- Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
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5
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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 2019; 18:16-22. [PMID: 32189877 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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6
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Sconfienza LM, Adriaensen M, Albano D, Allen G, Aparisi Gómez MP, Bazzocchi A, Beggs I, Bignotti B, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gielen J, Gitto S, Gupta H, Klauser AS, Lalam R, Martin S, Martinoli C, Mauri G, McCarthy C, McNally E, Melaki K, Messina C, Mirón Mombiela R, Neubauer B, Olchowy C, Orlandi D, Plagou A, Prada Gonzalez R, Rutkauskas S, Snoj Z, Tagliafico AS, Talaska A, Vasilevska-Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Obradov M. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part I, shoulder. Eur Radiol 2019; 30:903-913. [PMID: 31529252 DOI: 10.1007/s00330-019-06419-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 07/07/2019] [Accepted: 08/08/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Image-guided interventional procedures around the shoulder are commonly performed in clinical practice, although evidence regarding their effectiveness is scarce. We report the results of a Delphi method review of evidence on literature published on image-guided interventional procedures around the shoulder with a list of clinical indications. METHODS Forty-five experts in image-guided musculoskeletal procedures from the ESSR participated in a consensus study using the Delphic method. Peer-reviewed papers regarding interventional procedures around the shoulder up to September 2018 were scored according to the Oxford Centre for Evidence-based Medicine levels of evidence. Statements on clinical indications were constructed. Consensus was considered as strong if more than 95% of experts agreed and as broad if more than 80% agreed. RESULTS A total of 20 statements were drafted, and 5 reached the highest level of evidence. There were 10 statements about tendon procedures, 6 about intra-articular procedures, and 4 about intrabursal injections. Strong consensus was obtained in 16 of them (80%), while 4 received broad consensus (20%). CONCLUSIONS Literature evidence on image-guided interventional procedures around the shoulder is limited. A strong consensus has been reached for 80% of statements. The ESSR recommends further research to potentially influence treatment options, patient outcomes, and social impact. KEY POINTS • Expert consensus produced a list of 20 evidence-based statements on clinical indications of image-guided interventional procedures around the shoulder. • The highest level of evidence was reached for five statements. • Strong consensus was obtained for 16 statements (80%), while 4 received broad consensus (20%).
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, 20161, Milan, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, the Netherlands
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, 20161, Milan, Italy.,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127, Palermo, Italy
| | - Georgina Allen
- St Luke's Radiology Oxford Ltd, Oxford, UK.,University of Oxford, Oxford, UK
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, 1023, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre, 46015, Valencia, Spain
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Ian Beggs
- Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Bianca Bignotti
- Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Vito Chianca
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, 20161, Milan, Italy
| | - Angelo Corazza
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, 20161, Milan, Italy.,Department of Neurosciences, University of Genova, Genoa, Italy
| | - Danoob Dalili
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Nuffield Orthopaedic Hospital, Oxford, UK
| | - Miriam De Dea
- UOC Radiologia, Ospedale di Feltre, AULSS 1 Dolomiti, Veneto, Italy
| | - Jose Luis Del Cura
- Department of Radiology, Donostia University Hospital, Begiristain Doktorea Pasealekua, 109, 20014, Donostia/San Sebastian, Spain.,University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Francesco Di Pietto
- Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, CE, Italy
| | - Eleni Drakonaki
- Department of Musculoskeletal Radiology, Private Ultrasound Institution, Heraklion, Greece
| | - Fernando Facal de Castro
- IBERORAD 1895 S.L., 08021, Barcelona, Spain.,Department of Radiology, General University Hospital of Valencia, Valencia, Spain
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jan Gielen
- University of Antwerp, University of Antwerp Hospital (UZA), Antwerp, Belgium
| | | | | | - Andrea S Klauser
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Silvia Martin
- Hospital Son Llatzer, Palma de Mallorca, Spain.,Universidad de las Islas Baleares, Palma, Spain
| | - Carlo Martinoli
- DISSAL Department of Health Sciences, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Catherine McCarthy
- Nuffield Orthopaedic Hospital, Oxford, UK.,Oxford Musculoskeletal Radiology, Oxford, UK
| | | | - Kalliopi Melaki
- Medical School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Rebeca Mirón Mombiela
- Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain.,Herlev og Gentofte Hospital Radiologisk Afdeling, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark
| | | | - Cyprian Olchowy
- Department of Oral Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | | | - Athena Plagou
- Department of Radiology, Private Institution of Ultrasonography, Athens, Greece
| | | | - Saulius Rutkauskas
- Institute of Sport Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania
| | - Ziga Snoj
- Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia
| | - Alberto Stefano Tagliafico
- Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.,Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy
| | | | - Violeta Vasilevska-Nikodinovska
- Medical Faculty, University "Ss.Cyril and Methodius", Skopje, North Macedonia; University Surgical Clinic "St.Naum Ohridski", Skopje, North Macedonia
| | - Jelena Vucetic
- Department of Radiology, General University Hospital of Valencia, Valencia, Spain.,Herlev og Gentofte Hospital Radiologisk Afdeling, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark
| | - David Wilson
- St Luke's Radiology Oxford Ltd, Oxford, UK.,University of Oxford, Oxford, UK
| | - Federico Zaottini
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.,Varelli Institute, Naples, Italy
| | - Marina Obradov
- Sint Maartenskliniek, 6500GM, 9011, Nijmegen, the Netherlands
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7
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Bianchi S, Becciolini M. Ultrasound Appearance of the Migration of Tendon Calcifications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2493-2506. [PMID: 30653700 DOI: 10.1002/jum.14933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/12/2018] [Accepted: 12/26/2018] [Indexed: 06/09/2023]
Abstract
Calcific tendinopathy (CTe) is a frequent disorder related to the deposition of calcium hydroxyapatite crystals within tendons. Ultrasound has been shown to be an excellent imaging modality for the evaluation of CTe. During the resorptive phase of CTe, calcium deposits may migrate inside the tendons or in neighboring tissues and lead to local inflammation and severe pain. In this pictorial essay, we describe the ultrasound appearance of a spectrum of CTe migrations. Knowledge of the different migration patterns can help sonologists in their detection and in establishing the correct diagnosis.
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8
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Pagnini F, D'Amuri FV, Bevilacqua A, Sabatino V, Russo U, Zappia M, Natella R, Palumbo P, Pradella S, Miele V, De Filippo M. Ultrasound-guided percutaneous irrigation of calcific tendinopathy: technical developments. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:95-100. [PMID: 31085978 PMCID: PMC6625565 DOI: 10.23750/abm.v90i5-s.8333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 12/26/2022]
Abstract
Rotator cuff calcific tendinopathy (RCCT) is a common and painful shoulder disease characterised by deposition of calcium into the rotator cuff’s tendond. Different therapeutic options have been proposed, but the ultrasound-guided percutaneous irrigation (US-PICT) is been proved as an effective and safe first-line treatment. It can be performed with a single- of a double-needle tecnique, using warm saline solution to improve the dissolution of the calcific deposit. The procedure is ended with an intrabursal injection of local anaesthetics and slow-release steroids to improve the pain relief and to prevent complications. US-PICT leads to significative improvement in the shoulder funtion and pain relief in the short and long term, with a low complications rate. (www.actabiomedica.it)
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Affiliation(s)
- Francesco Pagnini
- Department of Medicine and Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Parma, Italy.
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9
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Galletti L, Ricci V, Andreoli E, Galletti S. Treatment of a calcific bursitis of the medial collateral ligament: a rare cause of painful knee. J Ultrasound 2019; 22:471-476. [PMID: 30811015 DOI: 10.1007/s40477-018-0353-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/11/2018] [Indexed: 12/14/2022] Open
Abstract
Medial knee pain is common in clinical practice and can be caused by various conditions. In rare cases, it can even be by calcific bursitis of the medial collateral ligament (MCL). Treatment of calcific bursitis and/or calcification of the MCL classically includes observation, local injections, shockwave therapy and surgical resection. We report a case of nontraumatic medial knee pain poorly responsive to conservative treatments. Ultrasound (US) imaging revealed a massive lobed hyperechoic formation with partial acoustic shadow in the MCL context compatible with calcific bursitis, and magnetic resonance imaging (MRI) confirmed the presence of the bursa's calcific deposit surrounded by hyperintense signal compatible with pericalcific edema. We performed a double-needle ultrasound-guided percutaneous lavage (UGPL), which is today a fairly common treatment for many musculoskeletal disorders, such as rotator cuff calcific tendinopathy and elbow extensor tendons pathology, but regarding the knee, it is not part of ordinary care. This report shows the clinical and imaging presentation of calcific bursitis of the MCL and describes in detail the technique to perform the UGPL with a system of two needles, two syringes and a double connection to ensure a correct lavage of the calcium deposit without significant intrabursal pressure increase and consequently without pain during the procedure.
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Affiliation(s)
- Lisa Galletti
- Physical Medicine and Rehabilitation Unit, San Giovanni in Persiceto, Bologna, Italy.
| | - Vincenzo Ricci
- Department of Biomedical and Neuromotor Science, Physical Medicine and Rehabilitation Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Ernesto Andreoli
- Physical Medicine and Rehabilitation Unit, University Hospital Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Bologna, Italy
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10
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Sánchez Barrancos IM, Manso García S, Lozano Gago P, Hernández Rodríguez T, Conangla Ferrín L, Ruiz Serrano AL, González Santisteban R. [Usefulness and reliabitlity of musculoskeletal point of care ultrasound in family practice (2): Muscle injuries, osteoarthritis, rheumatological diseases and eco-guided procedures]. Aten Primaria 2019; 51:105-117. [PMID: 30591207 PMCID: PMC6837044 DOI: 10.1016/j.aprim.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 11/30/2022] Open
Abstract
This article is a continuation of the review initiated in the previous issue about the usefulness of musculoskeletal point of care ultrasound in Primary Care, completing the scenarios of muscle injuries, osteoarthritis, rheumatological diseases and eco-guided procedures.
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Affiliation(s)
- Ignacio Manuel Sánchez Barrancos
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; Consultorio Local de Membrilla, Centro de Salud Manzanares 2, Gerencia de Atención Integrada de Manzanares, Ciudad Real, España.
| | | | - Pedro Lozano Gago
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; Departamento de Salud Alicante -San Joan, Centro de Salud Mutxamel, Alicante, España
| | - Trinidad Hernández Rodríguez
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; Sector Sanitario Alcañiz, Centro de Salud Andorral, Terue, España
| | - Laura Conangla Ferrín
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; EAP Badalona2. Centre Dalt La Villa. Badalona. Barcelona, España
| | - Antonio Lorenzo Ruiz Serrano
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Ciudad Real 3, Gerencia de Atención Integrada de Ciudad Real, Ciudad Real, España
| | - Roberto González Santisteban
- Miembro del Grupo de Trabajo de Ecografía de la Sociedad Española de Medicina Familiar y Comunitaria; Comarca Interior de Osakidetza, Consultorio de Ayala (Luyando-Respladiza), Álava, España
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11
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Cocco G, Ricci V, Boccatonda A, Iannetti G, Schiavone C. Migration of calcium deposit over the biceps brachii muscle, a rare complication of calcific tendinopathy: Ultrasound image and treatment. J Ultrasound 2018; 21:351-354. [PMID: 30415399 DOI: 10.1007/s40477-018-0336-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022] Open
Abstract
Calcific tendinopathy is characterized by the deposition of calcium, mostly hydroxyapatite crystals, in tendons. Women are more frequently affected than men, with prevalence in the fourth and fifth decades of life. This condition has been reported between 2.5 and 7.5% of healthy shoulders in adults, but other tendons may also be affected. A complication of this condition is the migration of calcium deposits from tendons, usually the supraspinatus, into the subacromial-subdeltoid bursa. We reported a rare complication of calcific tendinopathy, that is, calcium deposits migrated from the long head of the biceps tendon over the proximal tract of the biceps brachii muscle.
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Affiliation(s)
- Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy.
| | - Vincenzo Ricci
- Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Andrea Boccatonda
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Giovanni Iannetti
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Cosima Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
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Silvestri E, Barile A, Albano D, Messina C, Orlandi D, Corazza A, Zugaro L, Masciocchi C, Sconfienza LM. Interventional therapeutic procedures in the musculoskeletal system: an Italian Survey by the Italian College of Musculoskeletal Radiology. Radiol Med 2017; 123:314-321. [PMID: 29249079 DOI: 10.1007/s11547-017-0842-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/04/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE To perform an online survey among all members of the Italian College of Musculoskeletal Radiology to understand how therapeutic musculoskeletal procedures are performed in daily practice in Italy. METHODS We administered an online survey to all 2405 members about the use of therapeutic musculoskeletal procedures in their institutions asking 16 different questions. Subgroup analysis was performed between general and orthopaedic hospitals with Mann-Whitney U and χ 2 statistics. RESULTS A total of 129/2405 answers (5.4% of members) were included in our analysis. A median of 142.5 (25th-75th percentiles: 50-535.5; range 10-5000) therapeutic musculoskeletal procedures per single institution was performed in 2016. Arthropathic pain was the main indication. The most common procedures were joint injection, bursal/tendon injection, and irrigation of calcific tendinopathy. Ultrasound-guided procedures were mainly performed in ultrasonography rooms (77.4%) rather than in dedicated interventional rooms (22.6%). Conversely, fluoroscopic procedures were performed almost with the same frequency in interventional radiology suites (52.4%) and in general radiology rooms (47.6%). In most institutions (72%), autologous blood or components were not used. The median number of therapeutic musculoskeletal procedures performed in orthopaedic hospitals was significantly higher than in general hospitals (P = 0.002), as well as for the use of autologous preparations (P = 0.004). CONCLUSION Joint injection, bursal/tendon injection, and irrigation of calcific tendinopathy were the most common therapeutic musculoskeletal procedures, being arthropathic pain the main indication. The percentage of procedures and the use of autologous preparations were significantly higher in orthopaedic hospitals than in general hospitals.
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Affiliation(s)
- Enzo Silvestri
- Unit of Radiology, Ospedale Evangelico Internazionale, Piazzale Gianasso 5, 16100, Genoa, Italy.,S.C. Diagnostica per Immagini e Ecografia Interventistica, Ospedale Evangelico Internazionale di Genova, Salita Superiore San Rocchio 31/A, 16122, Genoa, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Domenico Albano
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Davide Orlandi
- Unit of Radiology, Ospedale Evangelico Internazionale, Piazzale Gianasso 5, 16100, Genoa, Italy.,S.C. Diagnostica per Immagini e Ecografia Interventistica, Ospedale Evangelico Internazionale di Genova, Salita Superiore San Rocchio 31/A, 16122, Genoa, Italy
| | - Angelo Corazza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Luigi Zugaro
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
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Becciolini M, Bonacchi G, Galletti S. Intramuscular migration of calcific tendinopathy in the rotator cuff: ultrasound appearance and a review of the literature. J Ultrasound 2016; 19:175-81. [PMID: 27635162 DOI: 10.1007/s40477-016-0202-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/10/2016] [Indexed: 11/30/2022] Open
Abstract
Calcific tendinopathy of the shoulder is a common condition caused by calcium hydroxyapatite crystals, affecting the tendons of the rotator cuff. Among uncommon complication, one is the migration of the calcium in the subacromion-subdeltoid bursa. More rare is the intraosseous migration. We present four cases of an even more rare condition, not well described in literature yet, the intramuscular migration of calcium.
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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: 5.7] [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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Della Valle V, Bassi EM, Calliada F. Migration of calcium deposits into subacromial-subdeltoid bursa and into humeral head as a rare complication of calcifying tendinitis: sonography and imaging. J Ultrasound 2015; 18:259-63. [PMID: 26261476 DOI: 10.1007/s40477-015-0163-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/25/2015] [Indexed: 11/28/2022] Open
Abstract
Calcifying tendinitis of the shoulder is a common condition characterized by the deposition of calcium, predominantly hydroxyapatite crystals, in the rotator cuff. A rare complication of this condition is the migration of calcium deposits from tendons, usually the supraspinatus, into the subacromial-subdeltoid bursa or into the humeral greater tuberosity. These complications are responsible for intense acute shoulder pain and functional disability. Patient anamnesis and clinical symptoms must be considered to make the diagnosis, but imaging, particularly sonography, is often necessary, showing a typical presentation related to the locations of calcium deposits. We present sonographic and other imaging features of subacromial-subdeltoid bursitis and humeral osteitis related to the migration of calcium.
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Affiliation(s)
- Valeria Della Valle
- IRCCS Foundation, San Matteo Medical Center, Institute of Radiology, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Emilio Maria Bassi
- IRCCS Foundation, San Matteo Medical Center, Institute of Radiology, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Fabrizio Calliada
- IRCCS Foundation, San Matteo Medical Center, Institute of Radiology, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
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