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Xu H, Lu X, Yu Y, Zhou Y, Qi T, Zheng Y. Elucidating the molecular landscape of tendinitis: the role of inflammasome-related genes and immune interactions. Front Immunol 2024; 15:1393851. [PMID: 38919626 PMCID: PMC11196777 DOI: 10.3389/fimmu.2024.1393851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Tendinitis, characterized by the inflammation of tendons, poses significant challenges in both diagnosis and treatment due to its multifaceted etiology and complex pathophysiology. This study aimed to dissect the molecular mechanisms underlying tendinitis, with a particular focus on inflammasome-related genes and their interactions with the immune system. Through comprehensive gene expression analysis and bioinformatics approaches, we identified distinct expression profiles of inflammasome genes, such as NLRP6, NLRP1, and MEFV, which showed significant correlations with immune checkpoint molecules, indicating a pivotal role in the inflammatory cascade of tendinitis. Additionally, MYD88 and CD36 were found to be closely associated with HLA family molecules, underscoring their involvement in immune response modulation. Contrary to expectations, chemokines exhibited minimal correlation with inflammasome genes, suggesting an unconventional inflammatory pathway in tendinitis. Transcription factors like SP110 and CREB5 emerged as key regulators of inflammasome genes, providing insight into the transcriptional control mechanisms in tendinitis. Furthermore, potential therapeutic targets were identified through the DGidb database, highlighting drugs that could modulate the activity of inflammasome genes, offering new avenues for targeted tendinitis therapy. Our findings elucidate the complex molecular landscape of tendinitis, emphasizing the significant role of inflammasomes and immune interactions, and pave the way for the development of novel diagnostic and therapeutic strategies.
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Affiliation(s)
- Hongwei Xu
- The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaolang Lu
- The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yang Yu
- The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yifei Zhou
- The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tengfei Qi
- Department of Neurosurgery, Trauma Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yijing Zheng
- The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
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Jomaa Y, Aitisha-Tabesh O, Dgheim D, Faddoul R, Haddad-Zebouni S, Fayad F. Association of calcific rotator cuff tendinopathy with nephrolithiasis and/or cholelithiasis: A case-control study. Medicine (Baltimore) 2024; 103:e38482. [PMID: 38847678 PMCID: PMC11155589 DOI: 10.1097/md.0000000000038482] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/16/2024] [Indexed: 06/10/2024] Open
Abstract
This study aimed to examine the association between calcific rotator cuff tendinopathy (RCT) and nephrolithiasis and/or cholelithiasis. A case-control study was conducted on patients diagnosed with RCT between June 2016 and June 2022. RCT was confirmed by ultrasound, and patients were divided into 2 groups: calcific RCT (case) and non-calcific RCT (control). Data were collected retrospectively from electronic medical records and completed by phone calls, looking for a history of nephrolithiasis and/or cholelithiasis; based on clinical features or incidental findings on abdominal and pelvic imaging. A total of 210 patients with RCT were included. Among the 95 cases of calcific RCT, 43 had a history of lithiasis (45.3%) against 23 (20%) from the non-calcific RCT group (P < .001); 21 patients suffered from nephrolithiasis (22.1%) and 26 had cholelithiasis (27.4%) versus 10 (8.7%) (P = .006) and 16 (13.9%) (P = .015) in the non-calcific RCT group, respectively. Logistic regression showed that the independent predictors of calcific RCT included a history of nephrolithiasis (OR, 4.38; 95% CI: 1.61-11.92, P = .004) and a history of cholelithiasis (OR, 3.83; 95% CI: 1.64-8.94, P = .002). In patients with calcific RCT, the occurrence of lithiasis was significantly associated in the bivariate analysis with higher age, body mass index, fasting blood sugar, and HbA1c (all with P < .05), but only with the presence of another site of calcific tendinopathy than the shoulder (OR, 3.11; 95% CI: 1.12-8.65, P = .03) in the multivariate analysis. Nephrolithiasis and/or cholelithiasis are associated with calcific RCT, and their presence predicts calcific RCT at least 3 times. Further research is required to determine the common risk factors and preventive measures against lithogenesis in patients with calcific RCT, nephrolithiasis, and cholelithiasis.
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Affiliation(s)
- Yara Jomaa
- Department of Anesthesiology, Hotel Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Ouidade Aitisha-Tabesh
- Department of Rheumatology, Lebanese Hospital Geitaoui-UMC, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Dima Dgheim
- Department of Rheumatology, Hotel Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Rafic Faddoul
- ESIB Department, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Soha Haddad-Zebouni
- Department of Radiology, Hotel Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Fouad Fayad
- Department of Rheumatology, Lebanese Hospital Geitaoui-UMC, Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
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Housset V, Martinel V. Intraosseous migration of supraspinatus calcification: benefits of intraoperative ultrasound technique. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:276-283. [PMID: 38706671 PMCID: PMC11065676 DOI: 10.1016/j.xrrt.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
| | - Vincent Martinel
- Groupe Orthopédie Ormeau Pyrénées, Polyclinique de l’Ormeau - ELSAN, Tarbes, France
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ten Hove FL, de Witte PB, Reijnierse M, Navas A. Needling and Lavage in Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Technique. JBJS Essent Surg Tech 2024; 14:e23.00029. [PMID: 38268769 PMCID: PMC10805427 DOI: 10.2106/jbjs.st.23.00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Background Rotator cuff calcific tendinitis (RCCT) is a commonly occurring disease, with a prevalence of up to 42.5% in patients with shoulder pain1,2. RCCT is characterized by hydroxyapatite deposits in the tendons of the rotator cuff and is considered a self-limiting disease that can be treated nonoperatively3. However, in a substantial group of patients, RCCT can have a very disabling and long-lasting course1,4, requiring additional treatment. Ultrasound-guided percutaneous needling and lavage (i.e., barbotage) is a safe and effective treatment option for RCCT5. In the present article, we focus on the 1-needle barbotage technique utilized in combination with an injection of corticosteroids in the subacromial bursa. Description It must be emphasized that symptomatic RCCT should be confirmed before barbotage is performed. Therefore, we recommend a diagnostic ultrasound and/or physical examination prior to the barbotage. Barbotage is performed under ultrasound guidance with the patient in the supine position. After sterile preparation and localization of the calcified deposit(s), local anesthesia in the soft tissue (10 mL lidocaine 1%) is administered. Next, the subacromial bursa is injected with 4 mL bupivacaine (5 mg/mL) and 1 mL methylprednisolone (40 mg/mL) with use of a 21G needle. The deposit(s) are then punctured with use of an 18G needle. When the tip of the needle is in the center of the deposit(s), they are flushed with a 0.9% saline solution and the dissolved calcium re-enters the syringe passively. This process is repeated several times until no more calcium enters the syringe. In the case of solid deposits, it may not be possible to aspirate calcium; if so, an attempt to fragment the deposits by repeated perforations, and thus promote resorption, can be made. Postoperatively, patients are instructed to take analgesics and to cool the shoulder. Alternatives RCTT can initially be treated nonoperatively with rest, nonsteroidal anti-inflammatory drugs, and/or physiotherapy3. If the initial nonoperative treatment fails, extracorporeal shockwave therapy (ESWT), corticosteroid injections, and/or barbotage can be considered8. In severe chronic recalcitrant cases, arthroscopic debridement and/or removal can be performed as a last resort. Rationale Both barbotage and ESWT result in a reduction of calcific deposits, as well as significant pain reduction and improvement of function8. No standard of care has been established until now; however, several prior meta-analyses concluded that barbotage is the most effective treatment option, with superior clinical outcomes after 1 to 2 years of follow-up9-11. No difference in complication rates has been reported between the various minimally invasive techniques. The purpose of barbotage is to stimulate the resorption process, which is promoted by the perforation of the deposits. Clinical outcomes are not associated with the success of the aspiration7,12. Patients with ≥1 larger deposit show greater improvement following barbotage than patients with small deposits12, in contrast with ESWT, in which larger deposits have been associated with worse outcomes. The inferior outcome of barbotage in patients with small deposits remains the subject of debate, but outcomes may be confounded by the fact that patients with smaller deposits might be less symptomatic at baseline and are therefore less likely to demonstrate improvement4. Expected Outcomes In the first weeks after barbotage, there is generally a substantial reduction in symptoms. Symptoms can recur at around 3 months, presumably because the effect of the corticosteroids is temporary5. After 6 months and 1 year, patients show substantial improvement in pain, shoulder function, and quality of life, with results superior to those shown for subacromial injections and ESWT9,10,13,14. At 5 years postoperatively, there are no significant differences in outcomes between barbotage and subacromial injections15. This may demonstrate a self-limiting course in the long term. Important Tips Good candidates for barbotage are those with RCCT who have ≥1 large calcific deposit.If a patient has a solid deposit, the physician can gently rotate and repeatedly puncture the deposit to promote disaggregation and fragmentation.Barbotage generally results in adequate pain relief and functional improvement even in patients in whom calcium deposits cannot be aspirated12. Acronyms and Abbreviations SAI = injection in the subacromial bursaNSAIDs = nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
| | - Pieter Bas de Witte
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ana Navas
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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González-Martín D, Garrido-Miguel M, de Cabo G, Lomo-Garrote JM, Leyes M, Hernández-Castillejo LE. Rotator cuff debridement compared with rotator cuff repair in arthroscopic treatment of calcifying tendinitis of the shoulder: A systematic review and meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00187-X. [PMID: 37573942 DOI: 10.1016/j.recot.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Although conservative treatment of calcific tendinopathy has a high success rate, arthroscopic excision of the calcific deposit is occasionally necessary. Controversy exists as to whether the remaining rotator cuff defect can be left in situ or should be repaired to achieve better functional outcomes. This study aimed to compare the results of debridement versus debridement combined with suturing in arthroscopic surgery for calcific tendinopathy. METHODOLOGY MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to February 2023 for articles on arthroscopic treatment of calcific tendinopathy. Functional outcomes (VAS, ASES, UCLA, and Constant) and the number of complications were analyzed. The effect size was calculated using Cohen's d-index. RESULTS Twenty-one studies were included, including a total of 1172 patients aged between 44.7 and 55 years. The mean follow-up time was 24.7 months. The combined ES estimates for the total score of the VAS, ASES, UCLA, and Constant scales were very strong (>1.0) for both debridement and combined debridement with suture. The ES estimates for the number of total complications were 1.75 (95% CI: 0.08-3.43, I2 = 0%) for debridement and 9.07 (95% CI: -0.03-18.17, I2 = 50.4%) for combined debridement with suture. CONCLUSIONS Both arthroscopic procedures improve the total score significantly on the EVA, ASES, UCLA, and Constant scales. However, a higher proportion of complications was observed in the group that performed suturing. In this regard, we must consider whether it is really necessary to repair all partial tears after the calcified deposits removal.
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Affiliation(s)
- D González-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Origen, Grupo Recoletas, Valladolid, España; Universidad Europea Miguel de Cervantes, Valladolid, España.
| | - M Garrido-Miguel
- Instituto de Investigación Sanitaria de Castilla-La Mancha, Universidad de Castilla La Mancha, Cuenca, España; Facultad de Enfermería, Universidad de Castilla La Mancha, Albacete, España
| | - G de Cabo
- Servicio de Cirugía Ortopédica y Traumatología, Olympia, Quirón Salud, Madrid, España
| | - J M Lomo-Garrote
- Servicio de Cirugía Ortopédica y Traumatología, Origen, Grupo Recoletas, Valladolid, España
| | - M Leyes
- Servicio de Cirugía Ortopédica y Traumatología, Olympia, Quirón Salud, Madrid, España
| | - L E Hernández-Castillejo
- Instituto de Investigación Sanitaria de Castilla-La Mancha, Universidad de Castilla La Mancha, Cuenca, España
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Philips T, Dejonghe M, Petre D. Arthroscopic treatment of calcific tendinitis without rotator cuff repair using prospectively collected results. Acta Orthop Belg 2023; 89:195-200. [PMID: 37924534 DOI: 10.52628/89.2.9574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The treatment of calcific tendinitis can be either non-operative, which should always be the first step of treatment, or operative. In chronic calcifying tendinitis with insufficient conservative treatment, an arthroscopic excision of the calcification deposit may help, however, there is controversy about how it should be performed. This retrospective study, with prospectively collected results using the Surgical Outcome System™ (SOS, Arthrex®), evaluated the outcome of arthroscopic treatment of calcific tendinitis without rotator cuff repair. Outcome was measured by different scores such as Visual Analogue Scale (VAS), American Shoulder and Elbow Surgeons Evaluation Form (ASES) and Single Assessment Numeric Scale (SANE). 54 patients were included in the analysis (male: 19; female: 35), mean age at surgery was 51 (range, 37-68) years. All scores improved compared with final follow-up. VAS score improved from 5,3 ± 2,2 to 0,9 ± 1,3 (p<0,001). ASES score improved from 53,0 ± 17,0 to 92,2 ± 11,1 (p<0,001) and SANE score from 47,2 ± 17,8 to 92,1 ± 10,6 (p<0,001). Most improvement is seen in the first 3 months postoperatively but gradual progress is to be expected up until 2 years. No frozen shoulders or cuff tears were reported postoperatively. No reoperations were necessary during follow-up. A noticeable fast pain relief and functional recovery are seen when treating a patient with calcific tendinitis without repairing the rotator cuff. There were no patients with frozen shoulder postoperatively.
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Sabzevari S, Charles S, Reddy RP, Curley AJ, Kaarre J, Prasad A, Lin A. Greater tuberosity osteolysis following calcific supraspinatus tendinitis can be addressed by arthroscopic débridement and single-row rotator cuff repair: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:242-246. [PMID: 37588427 PMCID: PMC10426495 DOI: 10.1016/j.xrrt.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Soheil Sabzevari
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shaquille Charles
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rajiv P. Reddy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew J. Curley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Janina Kaarre
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amitesh Prasad
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Calcific Tendinopathy of the Shoulder: A Retrospective Comparison of Traditional Barbotage Versus Percutaneous Ultrasonic Barbotage. Clin J Sport Med 2022; 32:458-466. [PMID: 35533134 DOI: 10.1097/jsm.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to compare a traditional barbotage technique with percutaneous ultrasonic barbotage (PUB) for the treatment of rotator cuff (RC) calcific tendinopathy. DESIGN Three-year retrospective review. SETTING Participants aged 18 to 75 presenting at 2 highly specialized outpatient orthopedic referral centers with symptomatic RC calcific tendinopathy. PATIENTS There were 75 patients included (23 patients in the traditional barbotage group; 52 patients in the PUB group) with an average age of 55.3(6.5) and 55.9(9.8), respectively. There was no significant difference in demographics between groups. INTERVENTIONS Traditional barbotage or PUB. MAIN OUTCOME MEASURES Primary outcome measure was pain rated on the Numeric Pain Rating Scale (NPRS) with secondary outcomes investigating patient satisfaction. RESULTS The barbotage and PUB group demonstrated a significant improvement in pain (barbotage 2.4, P = 0.01; PUB = 2.6, P < 0.001) with no statistically significant difference between the 2 treatment modalities (95% CI: -1.8 to 2.2; P = 0.83, P = 0.83). Median follow-up for NPRS recordings was 17-weeks in the barbotage group and 8-weeks in the PUB group ( P = 0.004). Both groups demonstrated similar patient-reported satisfaction, without major complications. CONCLUSION The traditional barbotage and PUB procedures improved pain with a high patient satisfaction rate. LEVEL OF EVIDENCE Level III.
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Magnetic resonance imaging evaluation of the correlation between calcific tendinitis and rotator cuff injury. BMC Med Imaging 2022; 22:24. [PMID: 35135484 PMCID: PMC8826678 DOI: 10.1186/s12880-022-00746-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to evaluate the incidence of calcific tendinitis (CaT) in rotator cuff tears (RCTs) and to assess the correlation between CaT and RCTs with magnetic resonance imaging (MRI). METHODS The MRI of 108 patients with rotator cuff CaT admitted to our hospital from January 2019 to January 2021 were retrospectively analyzed. Another retrospective analysis was made of 108 patients with similar age, gender, occupation, and shoulder injury side to those in the first group. The incidence of RCTs and their correlation with CaT were assessed based on an MRI of shoulder joints. RESULTS There was a statistical difference (p < 0.05) in the incidence of RCTs between the CaT group (23.4%) and the control group (37.2%). No significant difference was observed in the size of the RCTs between the two groups (P = 0.422). In the CaT group, 17.4% of patients had complete tears, compared with 26.3% in the control group. There was no significant correlation between the calcification site and RCTs in the CaT group, and only 3.7% of patients suffered calcification and a tear in the exact location of the same tendon (P > 0.05, r = 0.03). CONCLUSIONS Compared with patients with shoulder pain without CaT, patients with rotator cuff CaT suffered no increased risk of RCTs on MRI, so CaT and RCTs may have different pathological causes, and there is no significant correlation between the two.
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Topalović I, Nešić D. Application of shock wave therapy in the treatment of calcific tendinopathies. MEDICINSKI PODMLADAK 2022. [DOI: 10.5937/mp73-35808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Tendons are the soft tissue that connects muscles to bones. They are made of collagen and elastin, they are strong and solid, and have no possibility of contraction. Their strength helps us to move. Recovery of tendon injuries is long-lasting and can take more than six months. If a tendon is shed during a time injury, calcification occurs at the site of the injury and the disease is called calcifying tendinopathy. The very existence of calcifications is an indication for treatment with a mechanical shock wave (Shock wave). Mechanical shock waves can act in focus or radially. The difference between focused and radial waves is primarily in their physical basis. Focused shock waves differ from radial shock waves in terms of therapeutic depth of penetration into the tissue. The basic biological effect of a mechanical shock wave is stimulating. The energy of the mechanical shock wave acts at the cellular level by stimulating the reduction of inflammation and pain in the tissue. Using mechanical shock wave in the treatment of calcified tendinopathies, a safe method for breaking calcifications was obtained. Shock wave can be applied to using: different frequency, different number of strokes, as well as different strength of strokes in their studies. The choice of parameters for the application depends on whether it is calcified or non-calcified tendinopathy. Indications for the use are: painful shoulder, heel spur, plantar fasciitis, tennis elbow, Achilles tendon tendinopathy, jumping knee, patellar tendinitis, myalgia, myogelosis and muscular tendon overstrain syndrome. Contraindications for the use are: the existence of prostheses, knees and hips, as well as various orthopedic material, pacemaker, as well as the presence of chronic diseases such as multiple sclerosis, amyotrophic lateral sclerosis or tumors. The application of a mechanical shock wave is new, non-invasive method, easy to apply, always reduces pain and practically without side effects. This method has a special role in the treatment of chronic inflammation of diseased tendons, with or without calcification. The only dilemma in the application of a mechanical shock wave can be in the number of applications as well as the time break between the applications of two consecutive mechanical shock waves therapy.
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Lorbach O, Haupert A, Berger C, Brockmeyer M. Clinical and Structural Results of Rotator Cuff Repair Compared With Rotator Cuff Debridement in Arthroscopic Treatment of Calcifying Tendinitis of the Shoulder. Am J Sports Med 2021; 49:3196-3201. [PMID: 34528841 DOI: 10.1177/03635465211037690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic treatment of calcifying tendinitis of the shoulder reveals good to excellent results. However, whether the tendon needs to be repaired after removal of the calcific deposit or simply debrided remains unclear. PURPOSE To evaluate the structural and clinical results after arthroscopic calcific deposit removal with additional rotator cuff repair or rotator cuff debridement. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 44 patients (46 shoulders) were enrolled in this retrospective cohort study with a mean follow-up of 58.4 months. Patients underwent arthroscopic removal of a calcific deposit and bursectomy after failed nonoperative treatment. A total of 22 patients received additional rotator cuff repair irrespective of the degree of debridement (the repair group), whereas 22 patients received a simple rotator cuff debridement without additional repair (the debridement group). Groups were comparable in sex, age, and size and consistency of the deposits according to the Gärtner and Bosworth classifications. Clinical evaluation was performed by the Constant score, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, and numerical rating scales for pain, function, and satisfaction. In 29 patients (14 in the debridement group and 15 in the repair group), additional magnetic resonance imaging at follow-up was performed to evaluate the structural results using the Sugaya classification. RESULTS All patients were satisfied with the results of surgery; 100% of the repair group and 95.7% of the debridement group reported they would undergo the surgical procedure again. Comparison of the clinical results showed significantly better results in the repair group versus the debridement group for the Constant score (86.2 vs 80.6, respectively; P = .04), the ASES score (98.3 vs 88.9; P = .004), the Simple Shoulder Test (11.6 vs 10; P = .005), and the numerical rating scales for pain (0.1 vs 0.8; P = .007), function (9.6 vs 8.8; P = .008), and satisfaction (9.8 vs 9.1; P = .036). Comparison of the postoperative tendon integrity showed 80% Sugaya grade I in the rotator cuff repair group and 64% Sugaya grade II in the debridement group, with a statistically significant difference in favor of the repair group (P = .004). Postoperative clinical evaluation revealed no positive O'Brien tests in the repair group, whereas approximately one-third of the debridement group showed a positive O'Brien test during examination. CONCLUSION Arthroscopic removal of calcific deposits with rotator cuff debridement or cuff repair showed good to excellent clinical and structural midterm results. However, patients who underwent additional repair of the tendon defect had significantly better clinical results as well as better structural results in terms of tendon integrity.
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Affiliation(s)
- Olaf Lorbach
- Department of Shoulder Surgery and Sports Traumatology, Schoen-Clinic Lorsch, Lorsch, Germany.,Department of Orthopaedic Surgery, Saarland University, Homburg (Saar), Germany
| | - Alexander Haupert
- Department of Orthopaedic Surgery, Saarland University, Homburg (Saar), Germany
| | - Catharina Berger
- Department of Orthopaedic Surgery, Saarland University, Homburg (Saar), Germany
| | - Matthias Brockmeyer
- Department of Orthopaedic Surgery, Saarland University, Homburg (Saar), Germany
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Ultrasound-Guided Lavage and Aspiration for Calcific Rotator Cuff Tendinosis. Am J Phys Med Rehabil 2020; 99:e149-e151. [PMID: 32149816 DOI: 10.1097/phm.0000000000001415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Iovane A, Di Gesù M, Mantia F, Thomas E, Messina G. Ultrasound-guided percutaneous treatment of a calcific acromioclavicular joint: A case report. Medicine (Baltimore) 2020; 99:e18645. [PMID: 31895827 PMCID: PMC6946315 DOI: 10.1097/md.0000000000018645] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Calcific tendinopathy is one of the most frequent causes of nontraumatic shoulder pain. However, intra-articular calcifications appear to be an infrequent condition. We herein report a rare case study of an intra-articular calcification of the acromioclavicular joint. PATIENT CONCERNS A 46-year-old man presented with an acute pain in the anterior superior region of the left shoulder which also radiated to the left cervical region. The man during the physical evaluation also presented severe functional limitation of the shoulder movements in all planes of motion. DIAGNOSES The diagnosis was carried out through a radiographic and an echotomographic examination, highlighting the intra-articular calcific formation associated to a reactive inflammatory reaction. INTERVENTIONS An ultrasound-guided percutaneous treatment following the guidelines for calcific tendinopathy of the shoulder was carried out. OUTCOMES The posttreatment was satisfactory with the disappearance of the pain and the recovery of the shoulder movements in all planes of motion. LESSONS We can affirm that the ultrasound-guided percutaneous treatment in patients with calcification of the acromion-clavicular joint represents a valid and nonpainful therapeutic treatment.
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Affiliation(s)
- Angelo Iovane
- Sport and Exercise Research Unit, Department of Psychological, Pedagogical and Educational Sciences, University of Palermo
| | | | | | - Ewan Thomas
- Sport and Exercise Research Unit, Department of Psychological, Pedagogical and Educational Sciences, University of Palermo
| | - Giuseppe Messina
- Sport and Exercise Research Unit, Department of Psychological, Pedagogical and Educational Sciences, University of Palermo
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Calcium hydroxyapatite deposition disease: Imaging features and presentations mimicking other pathologies. Eur J Radiol 2019; 120:108653. [PMID: 31550638 DOI: 10.1016/j.ejrad.2019.108653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Calcium hydroxyapatite depositional disease (HADD) is usually asymptomatic and self-limiting; however, when there is an associated inflammatory process or HADD occurs in an unusual location, it may mimic trauma, infection, or neoplasm. The purpose of this article is to review the imaging features of HADD and how to distinguish it from more worrisome entities that can have similar appearances. CONCLUSION An understanding of the presentations of HADD is important to allow early and confident diagnosis. In particular, familiarity with presentations that resemble more ominous pathologies is essential to avoid costly and time-consuming workup or intervention.
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