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Tuè G, Masuzzo O, Tucci F, Cavallo M, Parmeggiani A, Vita F, Patti A, Donati D, Marinelli A, Miceli M, Spinnato P. Can Secondary Adhesive Capsulitis Complicate Calcific Tendinitis of the Rotator Cuff? An Ultrasound Imaging Analysis. Clin Pract 2024; 14:579-589. [PMID: 38666803 PMCID: PMC11049113 DOI: 10.3390/clinpract14020045] [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: 01/20/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Adhesive capsulitis (AC) of the glenohumeral joint is a recognized cause of pain associated with both active and passive restricted ranges of movement. AC can be subdivided into primary and secondary forms. Trauma, surgery, immobilization, and diabetes mellitus are the leading well-recognized causes of secondary AC. Calcific tendinitis/tendinitis (CT) of the rotator cuff is considered a possible trigger for AC, as reported in a few previous articles. However, there are no original investigations that assess the frequency and characteristics of this association. The aim of our research was to evaluate the presence of AC in a cohort of patients with a known CT condition of the rotator cuff by an ultrasound (US) examination. MATERIALS AND METHODS We prospectively enrolled all the patients admitted at our single institution (October 2022-June 2023) for the preoperative US evaluation of a known CT condition. In these patients, we searched for parameters related to secondary AC. An axillary pouch (AP) thickness equal to or greater than 4 mm (or greater than 60% of the contralateral AP) was considered diagnostic of AC. Moreover, rotator interval (RI) thickness and the presence of effusion within the long-head biceps tendon (LHBT) sheath was also assessed in all patients. RESULTS A total of 78 patients (54F, 24M-mean age = 50.0 and range = 31-71 y.o.) were enrolled in the study. In 26 of those patients (26/78-33.3%), US signs of AC were detected. Notably, the mean AP thickness in patients with AC and CT was 3.96 ± 1.37 mm (Group 1) and 2.08 ± 0.40 mm in patients with CT only (Group 2). RI thickness was significantly greater in patients with superimposed AC: 2.54 ± 0.38 mm in Group 1 and 1.81 ± 0.41 mm in Group 2 (p < 0.00001). Moreover, effusion within the LHBT was significantly more frequently detected in patients with AC: 84.61% in Group 1 versus 15.79% in Group 2-p < 0.00001. CONCLUSION US signs of AC are found in one-third of patients with CT of the rotator cuff, demonstrating that AC represents a frequent complication that should be routinely evaluated during US investigation to provide more personalized treatment strategies.
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Affiliation(s)
- Giovanni Tuè
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Oriana Masuzzo
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesco Tucci
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Cavallo
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Fabio Vita
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Alberto Patti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Danilo Donati
- Physical Therapy and Rehabilitation Unit, Policlinico di Modena, 41125 Modena, Italy
| | - Alessandro Marinelli
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Cucchi D, Di Giacomo G, Compagnoni R, Castricini R, Formigoni C, Radici M, Melis B, Brindisino F, De Giorgi S, De Vita A, Lisai A, Mangiavini L, Candela V, Carrozzo A, Pannone A, Menon A, Giudici LD, Klumpp R, Padua R, Carnevale A, Rosa F, Marmotti A, Peretti GM, Berruto M, Milano G, Randelli P, Bonaspetti G, De Girolamo L. A high level of scientific evidence is available to guide treatment of primary shoulder stiffness: The SIAGASCOT consensus. Knee Surg Sports Traumatol Arthrosc 2024; 32:37-46. [PMID: 38226696 DOI: 10.1002/ksa.12017] [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: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Shoulder stiffness (SS) is a condition characterised by active and passive restricted glenohumeral range of motion, which can occur spontaneously in an idiopathic manner or be associated with a known underlying aetiology. Several treatment options are available and currently no consensus has been obtained on which treatment algorithm represents the best choice for the patient. Herein we present the results of a national consensus on the treatment of primary SS. METHODS The project followed the modified Delphi consensus process, involving a steering, a rating and a peer-review group. Sixteen questions were generated and subsequently answered by the steering group after a thorough literature search. A rating group composed by professionals specialised in the diagnosis and treatment of shoulder pathologies rated the question-answer sets according to the scientific evidence and their clinical experience. RESULTS Recommendations were rated with an average of 8.4 points out of maximum 9 points. None of the 16 answers received a rating of less than 8 and all the answers were considered as appropriate. The majority of responses were assessed as Grade A, signifying a substantial availability of scientific evidence to guide treatment and support recommendations encompassing diagnostics, physiotherapy, electrophysical agents, oral and injective medical therapies, as well as surgical interventions for primary SS. CONCLUSIONS A consensus regarding the conservative and surgical treatment of primary SS could be achieved at a national level. This consensus sets basis for evidence-based clinical practice in the management of primary SS and can serve as a model for similar initiatives and adaptable guidelines in other European countries and potentially on a global scale. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
| | | | - Riccardo Compagnoni
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Roberto Castricini
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Casa di Cura Villa Verde, Fermo, Italy
| | - Chiara Formigoni
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- GIDIF-RBM - Italian Group of Information Specialist from Pharmaceutical Company and Biomedical Research Institutes, Milan, Italy
| | - Mattia Radici
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Barbara Melis
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Unità di Ortopedia e traumatologia dello sport, Casa di cura "Policlinico Città di Quartu", Quartu Sant'Elena, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
| | - Silvana De Giorgi
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari, Bari, Italy
| | - Andrea De Vita
- Concordia Hospital Roma, Rome, Italy
- SIAGASCOT "Shoulder" Committee, Rome, Italy
| | - Andrea Lisai
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Unità Funzionale Chirurgia della Spalla, Humanitas San Pio X, Milan, Italy
| | - Laura Mangiavini
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Candela
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandro Carrozzo
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Antonello Pannone
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Policlinico "Città di Udine", Udine, Italy
| | - Alessandra Menon
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Scuola di Specializzazione in Statistica Sanitaria e Biometria, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Luca Dei Giudici
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Casa di Cura "Villa dei Pini", Civitanova Marche, Italy
| | - Raymond Klumpp
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Department of Orthopaedics and Trauma Surgery, ASST Bergamo Ovest, Treviglio, Italy
| | | | - Arianna Carnevale
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Francesco Rosa
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Humanitas Clinical and Research Center -IRCCS, Rozzano, Italy
| | - Antongiulio Marmotti
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- Department of Orthopaedics and Traumatology, University of Torino, Turin, Italy
| | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Massimo Berruto
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- ASST Spedali Civili, UOC Clinica Ortopedica, Brescia, Italy
| | - Pietro Randelli
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Bonaspetti
- Department of Orthopaedics and Traumatology, Clinica S. Anna, Brescia, Italy
| | - Laura De Girolamo
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Laboratorio di Biotecnologie applicate all'Ortopedia, Milan, Italy
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