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Rossetti A, Martinel V, Raoul T, Herve A. Could intraoperative ultrasound improve clinical and radiological outcomes during arthroscopic calcification evacuation of rotator cuff? JSES Int 2024; 8:1029-1032. [PMID: 39280164 PMCID: PMC11401554 DOI: 10.1016/j.jseint.2024.06.001] [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] [Indexed: 09/18/2024] Open
Abstract
Background Martinel et al described an intraoperative ultrasound technique to easier identify calcification (CA) under arthroscopy. Our hypothesis was that intraoperative ultrasound monitoring allowed better evacuation of calcific tendinopathy. Our aim was to determine whether ultrasound monitoring improved the short-term clinical and radiological outcomes of calcific tendinopathy. Methods A prospective, single-center, single-operator, consecutive study conducted between February 2020 and June 2023. The inclusion criterion was surgical treatment for evacuation of symptomatic macro-centimetric CA type A or B. The first 20 patients were operated on using the standard surgical technique and the next 20 under ultrasound control. The mean age at surgery was 49.8 years (minimum: 28 years; maximum: 64 years). Patients were reviewed at 6 weeks and 3 months. The evacuation of the CA was checked at 6 weeks by X-ray. Results In the standard technique group, the mean preoperative Constant score was 41.4/100 (±15.07). Postoperatively, the Constant score was 58.88/100 (±15.28) at 6 weeks and 69.16/100 (±13.86) at 3 months. The mean preoperative Subjective Shoulder Value (SSV) was 39.0% (±18.61). Postoperatively, the SSV was 64.0% (±17.21) at 6 weeks and 79.47% (±16.06) at 3 months. In the ultrasound control group, the preoperative Constant score was 44.48/100 (±14.28) and 58.18/100 (±15.64) at 6 weeks and 66.87/100 (±18.45) at 3 months postoperatively. The mean preoperative SSV was 40.0% (±16.54) and 61.75% (±18.59) at 6 weeks and 76.05% (±19.62) at 3 months postoperatively. There was no significant postoperative difference in Constant score (P = .732) or SSV (P = .566) between the 2 groups. There was a significant difference (P = .004) between the 2 groups in terms of complete evacuation of the CA with the standard technique in 65% of cases (13 patients out of 20) and with intraoperative ultrasound monitoring in 95% of cases (19 patients out of 20). Conclusion There was no significant postoperative difference in Constant score and SSV between the 2 groups in the short term. Evacuation of calcification was significantly better with ultrasound monitoring.
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Affiliation(s)
- Adrien Rossetti
- Department of Orthopedic Surgery, Pontchaillou University Hospital of Rennes, Rennes, France
| | - Vincent Martinel
- Orthopedic Group Ormeau Pyrénées, Polyclinique de l'Ormeau, ELSAN, Tarbes, France
| | - Thomas Raoul
- Department of Orthopaedic Surgery, St Laurent Hospital, Rennes, France
| | - Anthony Herve
- Department of Orthopaedic Surgery, St Laurent Hospital, Rennes, France
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Gessl I, Sakellariou G, Wildner B, Filippou G, Mandl P, D'Agostino MA, Navarro-Compán V. Systematic literature review to inform the EULAR recommendations for the use of imaging in crystal-induced arthropathies in clinical practice. Ann Rheum Dis 2024; 83:1208-1224. [PMID: 38702175 DOI: 10.1136/ard-2023-225247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To summarise current data regarding the use of imaging in crystal-induced arthropathies (CiAs) informing a European Alliance of Associations for Rheumatology task force. METHODS We performed four systematic searches in Embase, Medline and Central on imaging for diagnosis, monitoring, prediction of disease severity/treatment response, guiding procedures and patient education in gout, calcium pyrophosphate dihydrate deposition (CPPD) and basic calcium phosphate deposition (BCPD). Records were screened, manuscripts reviewed and data of the included studies extracted. The risk of bias was assessed by validated instruments. RESULTS For gout, 88 studies were included. Diagnostic studies reported good to excellent sensitivity and specificity of dual-energy CT (DECT) and ultrasound (US), high specificity and lower sensitivity for conventional radiographs (CR) and CT. Longitudinal studies demonstrated sensitivity to change with regard to crystal deposition by US and DECT and inflammation by US and structural progression by CR and CT. For CPPD, 50 studies were included. Diagnostic studies on CR and US showed high specificity and variable sensitivity. There was a single study on monitoring, while nine assessed the prediction in CPPD. For BCPD, 56 studies were included. There were two diagnostic studies, while monitoring by CR and US was assessed in 43 studies, showing a reduction in crystal deposition. A total of 12 studies with inconsistent results assessed the prediction of treatment response. The search on patient education retrieved two studies, suggesting a potential role of DECT. CONCLUSION This SLR confirmed a relevant and increasing role of imaging in the field of CiAs.
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Affiliation(s)
- Irina Gessl
- Division of Rheumatology, Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Garifallia Sakellariou
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | | | - Georgios Filippou
- Rheumatology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Peter Mandl
- Division of Rheumatology, Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Maria Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
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3
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Kim JU, Wang PW. Arthroscopic treatment of chronic calcific tendinitis with intraosseous migration: a case report. Clin Shoulder Elb 2024; 27:263-266. [PMID: 38303590 PMCID: PMC11181074 DOI: 10.5397/cise.2023.00654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 02/03/2024] Open
Abstract
We present a case of calcific tendinitis in the shoulder, where calcifications were observed within both the tendon and the adjacent bone. At the time of acute onset, radiographs (including a plain radiograph) and magnetic resonance imaging revealed calcific tendinitis with intraosseous migration. The patient's symptoms did not improve after 5 months of conservative treatment. The patient underwent arthroscopic debridement of the calcific deposits, and the defect was repaired using the double-row repair technique. The patient's symptoms improved 3 months after arthroscopic treatment. We share our unusual experience with arthroscopic debridement in the treatment of chronic calcific tendinitis with intraosseous migration.
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Affiliation(s)
- Jung Uk Kim
- Department of Orthopedic Surgery, Gangseo Nanoori Hospital, Seoul, Korea
| | - Pei Wei Wang
- Department of Orthopedic Surgery, Gangseo Nanoori Hospital, Seoul, Korea
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Avendano JP, Pereira D. Treatment of Calcific Tendonitis of the Rotator Cuff: An Updated Review. Orthopedics 2023; 46:e326-e332. [PMID: 37672776 DOI: 10.3928/01477447-20230901-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Rotator cuff calcific tendonitis (RCCT) is a disorder that can greatly impair patients' quality of life. A literature review was conducted to find the most effective and newest treatments for RCCT. PubMed and Cochrane Review databases were searched, without strict inclusion/exclusion criteria, for peer-reviewed articles between 1941 and 2021 that discussed RCCT etiology and treatments. If nonoperative measures (non-steroidal anti-inflammatory drugs, physical therapy, and corticosteroids) are unsuccessful, other options include extracorporeal shockwave therapy, ultrasound-guided injection techniques, and minimally invasive surgery. Because RCCT can resolve spontaneously, patients should progress to invasive options only if conservative first-line treatments have failed. [Orthopedics. 2023;46(6):e326-e332.].
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5
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Sánchez Lite I, Toribio Calvo B, Osorio Aira S, Romera de Blas C, Andrés García N. Treatment of calcific tendinopathy of the rotator cuff with ultrasound-guided puncture and aspiration. RADIOLOGIA 2023; 65 Suppl 2:S33-S40. [PMID: 37858351 DOI: 10.1016/j.rxeng.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 07/09/2021] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Calcific tendinopathy of the rotator cuff is a common condition caused by the deposition of calcium crystals in the tendons of the rotator cuff. This study aimed to analyze the effectiveness of ultrasound-guided puncture and aspiration in calcific tendinopathy of the should in 86 patients treated at our center and to determine the factors associated with poor prognosis after this treatment. MATERIAL AND METHODS This retrospective descriptive study included 86 patients with calcific tendinopathy of the rotator cuff treated with ultrasound-guided puncture and aspiration between 2015 and 2019 for whom clinical and radiological variables were collected 1, 3, 6, and 12 months after the procedure. RESULTS One year after treatment, 81.4% patients showed clinical improvement and 96.5% showed radiological improvement. Complications were observed in 34.9%; all complications were mild. CONCLUSIONS Ultrasound-guided puncture and aspiration is an effective treatment for calcific tendinopathy of the shoulder, resulting in a high rate of clinical and radiological improvement and a low rate of minor complications. This technique has additional advantages, such as interaction with the patient and the lack of ionizing radiation.
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Affiliation(s)
- I Sánchez Lite
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - B Toribio Calvo
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - S Osorio Aira
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | - C Romera de Blas
- Graduada en Medicina, Universidad de Valladolid, Valladolid, Spain
| | - N Andrés García
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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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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8
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Youn SM, Rhee SM, Cho SH, Kim CH, Lee JU, Rhee YG. Arthroscopic decompression of calcific tendinitis without cuff repair. Bone Joint J 2023; 105-B:663-667. [PMID: 37257863 DOI: 10.1302/0301-620x.105b6.bjj-2022-1137.r1] [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] [Indexed: 06/02/2023]
Abstract
Aims The aim of this study was to investigate the outcomes of arthroscopic decompression of calcific tendinitis performed without repairing the rotator cuff defect. Methods A total of 99 patients who underwent treatment between December 2013 and August 2019 were retrospectively reviewed. Visual analogue scale (VAS) and American Shoulder and Elbow Surgeons (ASES) scores were reviewed pre- and postoperatively according to the location, size, physical characteristics, and radiological features of the calcific deposits. Additionally, the influence of any residual calcific deposits shown on postoperative radiographs was explored. The healing rate of the unrepaired cuff defect was determined by reviewing the 29 patients who had follow-up MRIs. Results Statistically significant improvement from pre- to postoperation was seen in all VAS and ASES scores for each group, but no statistical differences were seen between the postoperative scores according to the differences in the features of the calcific deposits. When residual calcification was observed postoperatively, the mean ASES and VAS (rest) scores improved significantly to 95.0 (SD 5.6) and 0.0 (SD 0.0), respectively (p = 0.006 and p < 0.001), and did not differ from those who had the complete removal. Of 29 patients who had follow-up MRIs, six (20.7%) showed signs of an interstitial tear. This group's mean postoperative ASES and VAS (rest) scores improved to excellent levels of 96.0 (SD 3.7) and 0.0 (SD 0.0), respectively, and were similar to those of the 23 patients with normal MRI appearances. Conclusion Arthroscopic removal of calcific deposits without repairing the rotator cuff defect resulted in significant improvement in function and pain level, regardless of the deposit's location, size, type, and whether or not complete excision was achieved. Despite leaving the defects unrepaired, in the limited number of patients with follow-up MRIs, 23 of 29 patients (79.3%) showed good healing, and the rest, who had persistent signs of interstitial defects on the MRIs, still had excellent outcomes. The removal of calcific deposits without repairing the cuff defects provided excellent outcomes.
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Affiliation(s)
- Seung-Min Youn
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Gyeonggi-do, South Korea
| | - Sung M Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Soong-Hwan Cho
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Gyeonggi-do, South Korea
| | - Cheol-Hwan Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Gyeonggi-do, South Korea
| | - Jong-Ung Lee
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Gyeonggi-do, South Korea
| | - Yong G Rhee
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Gyeonggi-do, South Korea
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9
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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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Hohmann E, Tetsworth K. Arthroscopic treatment and subacromial decompression of calcific tendinitis without removal of the calcific deposit results in rapid resolution of symptoms and excellent clinical outcomes in commercial airline pilots and cabin crew. Arch Orthop Trauma Surg 2023; 143:919-926. [PMID: 35175373 DOI: 10.1007/s00402-022-04339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The purpose of this study was to report the results of subacromial arthroscopic decompression (SAD) without removal of the calcific deposits in patients with calcifying tendinitis. METHODS All patients between 2016 and 2019 were included if they were aged between 18 and 60 years and had an isolated calcific deposit. The Constant-Murley score (CMS), Disabilities of the Arm, Shoulder and Hand (Quick DASH) score, the Shoulder Pain and Disability Index (SPADI), the simple shoulder test (SST), and the single assessment numeric evaluation (SANE) were used for assessment. Time to return to work was recorded. RESULTS 24 patients (13 pilots, 11 cabin crew) with a mean age of 47.1 ± 7.8 years were included. Quick Dash improved from 68.8 preoperative, to 8.4 at 3 months, and 0.1 at 24 months. CMS improved from 37.4 preoperative, to 83 at 3 months, and 94 at 24 months. SPADI improved from 73.8 preoperative, to 5.4 at 3 months, and 1 at 24 months. SST improved from 22.5 preoperative, to 94.2 at 3 months, and 100 at 24 months. SANE improved from 33.5 preoperative, to 78.7 at 3 months, and 95.6 at 24 months. MCID, SCB, and PASS reached values above 83% at 3 months and 100% at 6 months, with the exception of SANE which reached 29% at 3 months and plateaued to 96% at 6 months. The mean time to return to work was 7.1 ± 2.1 weeks. Pilots returned at a mean of 6.9 ± 1.8 weeks; cabin crew returned to work at a mean of 7.8 ± 2.5 weeks. CONCLUSIONS The results of this study suggest excellent short- and mid-term clinical outcomes can be achieved in patients with calcific tendinitis undergoing arthroscopic debridement and subacromial decompression without removal of calcific deposits. In this patient population, early surgical intervention was a potentially viable alternative to nonoperative treatment, and allowed early return to work.
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Affiliation(s)
- Erik Hohmann
- Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates. .,School of Medicine, Faculty of Health Sciences, University of Pretoria, Cnr Bophelo and Dr Savage Road, Gezina, Pretoria, 0001, South Africa.
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia.,Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia.,Limb Reconstruction Center, Macquarie University Hospital, Macquarie Park, Australia.,Orthopaedic Research Centre of Australia, Brisbane, Australia
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Zhao F, Wu J, Wang D, Li P, Tian W, Li W, Chai B, Zhang Y. The effect of subacromial decompression on the curative effect of arthroscopic treatment of shoulder calcific tendinitis. Front Surg 2023; 9:1043794. [PMID: 36684344 PMCID: PMC9852624 DOI: 10.3389/fsurg.2022.1043794] [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: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023] Open
Abstract
Objective To observe and analyze the surgical efficacy of arthroscopic debridement of calcified deposits and arthroscopic debridement combined with subacromial decompression in patients with supraspinatus tendon calcific myositis. To observe the effect of Subacromial decompression on the efficacy of arthroscopic treatment of shoulder calcific tendinitis. Patients and methods From 2016 to 2021, 48 cases of shoulder arthroscopic debridement due to supraspinatus calcific tendinitis met the inclusion criteria and were included, with 24 cases assigned to the arthroscopic debridement group and 24 cases to the arthroscopic debridement combined with subacromial decompression group. Changes between preoperative and postoperative shoulder pain and shoulder function were statistically analyzed. Results The 24 patients in the arthroscopic debridement group were better than the arthroscopic debridement combined with subacromial decompression group in terms of short-term postoperative shoulder pain and shoulder joint function recovery (P < 0.05). There was no significant difference in the postoperative long-term shoulder pain and shoulder function recovery between the two groups (P > 0.05). Conclusions Compared with arthroscopic debridement combined with subacromial decompression, arthroscopic debridement alone is a better surgical option for the treatment of calcific tendinitis.
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Affiliation(s)
| | | | | | | | | | | | | | - Yuming Zhang
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China
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Pang L, Li T, Li Y, Cao Y, Li J, Zhu J, Tang X. Combined arthroscopic rotator cuff repair leads to better clinical outcomes than isolated removal of calcific deposits for shoulder calcific tendinitis: A 2- to 5-year follow-up study. Front Surg 2022; 9:912779. [PMID: 36061068 PMCID: PMC9428341 DOI: 10.3389/fsurg.2022.912779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The optimal treatment procedure for shoulder calcific tendinitis (CT) remains controversial. This study aimed to assess the efficacy of arthroscopic treatment for CT, and to compare the clinical outcomes following combined rotator cuff repair and isolated removal of calcific deposits. Methods This retrospective cohort study included 46 patients (47 shoulders) with confirmed shoulder CT, and the diameter of the calcific deposit was over 1 cm. All patients suffered from CT for a mean period of 17.82 months and had a poor response to conservative treatment. With 12 males and 34 females included, the mean age was 53.94 years. After failed conservative treatment, 23 shoulders underwent combined rotator cuff repair (repair group), and 24 shoulders underwent isolated removal of calcific deposits (debridement group). The clinical outcomes were evaluated at baseline, 3, 6, and 12 months after the surgery and annually thereafter. The efficacy measures included the visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score and radiographic outcomes. Results Remarkable improvement in clinical outcomes at the final follow-up (2- to 5-year) compared with those at baseline were observed (p < 0.0001 for all outcomes). Compared with isolated removal of calcific deposits, combined rotator cuff repair led to worse postoperative 3- and 6-month VAS (p = 0.004 and p = 0.026, respectively), and 3-month ASES scores (p = 0.012). However, better VAS (p = 0.035 and p = 0.007, respectively) and ASES (p = 0.034 and p = 0.020, respectively) scores at 24-month and final follow-up were found in the repair group. All these differences reached the minimal clinical important difference (MCID). MRI scans at the final follow-up showed significantly better outcomes in patients with rotator cuff repair (p = 0.021). Conclusions Arthroscopic removal of calcific deposits is safe and effective for treating CT. Compared with isolated debridement, combined rotator cuff repair led to worse short-term (<12 months) but better medium- (12-48 months) to long-term (≥48 months) improvements in pain, function and integrity of tendons.
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Affiliation(s)
- Long Pang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yinghao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- West China Medical School, Sichuan University, Chengdu, China
| | - Yuanyinuo Cao
- West China Medical School, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Intraosseous calcific tendinitis of the rotator cuff yields similar outcomes to those of intratendinous lesions despite worse preoperative scores. Knee Surg Sports Traumatol Arthrosc 2022; 30:2485-2491. [PMID: 35044474 DOI: 10.1007/s00167-022-06870-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the surgical outcomes of arthroscopic removal of intraosseous deposits in patients with intraosseous calcific tendinitis of the rotator cuff. METHODS This study involved a retrospective review of 96 patients operated on from 2004 to 2019. Patients were divided into two groups according to the location of calcific deposits. Group I had pure tendinous involvement (n = 71), and Group II had tendinous and intraosseous involvement (n = 25). The mean follow-up time was 6.4 ± 3.9 years. There were 71 patients (46 women, 25 men) in Group I, and the mean age was 49.3 ± 8.2 years (range 30-65 years). In group II, there were 25 patients (18 women, 7 men); the mean age was 47.3 ± 11.2 years (range 28-70 years). RESULTS The mean preoperative VAS pain score was 8.8 ± 1.4 in Group I compared to 9.5 ± 0.5 in group II (p = 0.017). The median preoperative Constant and Oxford scores were 42 (20-65) and 22 (8-34) in Group I and 25.5 (22-46) and 10 (8-16) in group II, respectively (p < 0.001). There was no difference in postoperative pain scores (Group I: 0.7 ± 1.6 and group II: 0.5 ± 0.6, p = 0.926), Constant scores [Group I: 100 (80-100) and group II: 100 (90-100), (n.s).] and Oxford scores [Group I: 48 (28-48) and group II: 46.5 (4-48), (n.s.)] between the two groups. The number of preoperative injections was higher in Group II (p = 0.05). There was no correlation between the size of the soft tissue calcific deposit and the preoperative pain, Constant, and Oxford scores (n.s.). CONCLUSION Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement. LEVEL OF EVIDENCE III.
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Catapano M, Robinson DM, Schowalter S, McInnis KC. Clinical evaluation and management of calcific tendinopathy: an evidence-based review. J Osteopath Med 2022; 122:141-151. [PMID: 35119231 DOI: 10.1515/jom-2021-0213] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/29/2021] [Indexed: 11/15/2022]
Abstract
Calcific tendinopathy (CT) is an important musculoskeletal condition most commonly seen in the shoulder girdle, accounting for 10-42% of all shoulder pain. Despite the high prevalence within the shoulder region, CT has been demonstrated in many tendons throughout the axial and appendicular skeleton. Unlike degenerative tendinopathies, CT appears to be a self-limiting condition that affects otherwise-healthy tendon with deposition of calcium hydroxyapatite crystals between healthy tenocytes. In patients with functionally limiting symptoms or pain, the clinical course may be accelerated through a multitude of treatments including physical therapy and pain management, extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage (UGPL), and operative debridement. Currently, the most efficacious and frequently utilized treatment for shoulder CT is UGPL due to its ability to effectively reduce calcium burden and pain while limiting soft-tissue damage. However, more evidence regarding the treatment and course of CT is needed before determining the most appropriate treatment at all potential sites of CT.
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Affiliation(s)
- Michael Catapano
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
| | - David M Robinson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
| | - Kelly C McInnis
- Department of Physical Medicine and Rehabilitation and Division of Sports Medicine, Massachusetts General Hospital and Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
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15
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Compagnoni R, Menon A, Radaelli S, Lanzani F, Gallazzi MB, Tassi A, Randelli PS. Long-term evolution of calcific tendinitis of the rotator cuff: clinical and radiological evaluation 10 years after diagnosis. J Orthop Traumatol 2021; 22:42. [PMID: 34698958 PMCID: PMC8548447 DOI: 10.1186/s10195-021-00604-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Calcific tendinitis of the shoulder has a tendon involvement that could evolve to rotator cuff tear and shoulder osteoarthritis. This study aimed to evaluate the prevalence of glenohumeral osteoarthritis and rotator cuff tears in patients affected by calcific tendinitis at a minimum follow-up of 10 years after diagnosis. METHODS Patients diagnosed with calcific tendinitis of the shoulder with a minimum follow-up of 10 years were contacted and invited for a clinical and radiological evaluation. Information on the demographics, affected and dominant side, bilateral shoulder pain, type of treatment, habits, systemic or musculoskeletal diseases, reoperation of the index shoulder, and subjective satisfaction was collected. The clinical evaluation was performed using Constant-Murley score (CMS), American Shoulder and Elbow Surgeons Score (ASES), and numerical rating scale (NRS); isometric strength in forwarding flexion and abduction was also measured. Each patient also underwent an ultrasound examination to evaluate rotator cuff tendon integrity and a shoulder radiograph to evaluate osteoarthritis. RESULTS Seventy-nine patients were available for a phone interview, and 35 agreed to be examined. The mean age was 58.89 (± 7.9) years at follow-up. The prevalence of glenohumeral osteoarthritis was 17.14% in the study population, with significant progression in 14.29% of the cases, without rotator cuff full-thickness tears. x-Ray examination showed residual calcifications in 31 patients, with a mean diameter of 5.54 mm. In 30 cases, there was a reduction of the diameter; in 4 cases, the calcification increased in size; and in 1 case, the size did not change. The mean ASES score was 74.1 (± 22.7) in the group with calcifications larger than 2 mm and 89.4 (± 8.2) in patients with smaller calcifications (p = 0.08) without correlation with the type of treatment performed. CONCLUSIONS Calcific tendinitis is a self-resolving disease without rotator cuff tears at long-term follow-up or degenerative glenohumeral progression. LEVEL OF EVIDENCE 3, cohort study.
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Affiliation(s)
- Riccardo Compagnoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1a Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1a Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Simone Radaelli
- U.O.C. Week Surgery di Ortopedia e Traumatologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Francesco Lanzani
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1a Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Mauro B. Gallazzi
- U.O.C. Radiodiagnostica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alberto Tassi
- U.O.C. Week Surgery di Ortopedia e Traumatologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Pietro S. Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1a Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
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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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Sánchez Lite I, Toribio Calvo B, Osorio Aira S, Romera de Blas C, Andrés García N. Treatment of calcific tendinopathy of the rotator cuff with ultrasound-guided puncture and aspiration. RADIOLOGIA 2021; 65:S0033-8338(21)00124-7. [PMID: 34456048 DOI: 10.1016/j.rx.2021.07.005] [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: 10/19/2019] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Calcific tendinopathy of the rotator cuff is a common condition caused by the deposition of calcium crystals in the tendons of the rotator cuff. This study aimed to analyze the effectiveness of ultrasound-guided puncture and aspiration in calcific tendinopathy of the should in 86 patients treated at our center and to determine the factors associated with poor prognosis after this treatment. MATERIAL AND METHODS This retrospective descriptive study included 86 patients with calcific tendinopathy of the rotator cuff treated with ultrasound-guided puncture and aspiration between 2015 and 2019 for whom clinical and radiological variables were collected 1, 3, 6, and 12 months after the procedure. RESULTS One year after treatment, 81.4% patients showed clinical improvement and 96.5% showed radiological improvement. Complications were observed in 34.9%; all complications were mild. CONCLUSIONS Ultrasound-guided puncture and aspiration is an effective treatment for calcific tendinopathy of the shoulder, resulting in a high rate of clinical and radiological improvement and a low rate of minor complications. This technique has additional advantages, such as interaction with the patient and the lack of ionizing radiation.
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Affiliation(s)
- I Sánchez Lite
- Servicio de Radiodiagnóstico. Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - B Toribio Calvo
- Servicio de Radiodiagnóstico. Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - S Osorio Aira
- Servicio de Radiodiagnóstico. Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - C Romera de Blas
- Graduada en Medicina. Universidad de Valladolid, Valladolid, España
| | - N Andrés García
- Servicio de Radiodiagnóstico. Hospital Clínico Universitario de Valladolid, Valladolid, España
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18
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Robinson DM, Schowalter S, McInnis KC. Update on Evaluation and Management of Calcific Tendinopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00317-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Is routine gleno-humeral exploration a risk factor for adhesive capsulitis after arthroscopic removal of rotator cuff calcifications? A comparative retrospective study in 340 cases. Orthop Traumatol Surg Res 2021; 107:102915. [PMID: 33812092 DOI: 10.1016/j.otsr.2021.102915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 11/29/2020] [Accepted: 12/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Arthroscopic surgery has earned its place as the reference standard treatment for rotator cuff calcific tendinopathy refractory to conservative medical treatment. Adhesive capsulitis of the shoulder is the most common complication (12%). Standard practice involves routine gleno-humeral exploration before calcification removal. The objective of this study was to identify risk factors for adhesive capsulitis. HYPOTHESIS The development of adhesive capsulitis is associated with gleno-humeral exploration. METHODS We conducted a multicentre, multi-surgeon, retrospective cohort study of 340 consecutive patients who underwent arthroscopic removal of rotator cuff calcifications between 1 January 2012 and 1 January 2018. We collected epidemiological data (age, sex, work-related physical activity), the history of previous treatments (local injections, needling), the type and location of the calcifications as assessed radiologically, the clinical findings (Constant score before and 6 months after surgery, diagnosis of adhesive capsulitis defined as shoulder pain with motion range limitation in all directions), and the surgical details (type of anaesthesia, gleno-humeral exploration). RESULTS Of the 340 patients, 251 underwent routine gleno-humeral exploration and 89 did not. Adhesive capsulitis developed in 40 (12%) patients. By multivariate analysis, gleno-humeral exploration was an independent risk factor for adhesive capsulitis (p=0.022; odds ratio, 5.60). Of the 251 gleno-humeral explorations, 8% identified concomitant lesions and only 4% led to a curative procedure. CONCLUSION Given our results and the data in the literature, we believe that routine gleno-humeral exploration during the arthroscopic treatment of rotator cuff calcific tendinopathy is inadvisable. LEVEL OF EVIDENCE III; case-control study.
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20
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Arthroscopic Excision of Infraspinatus Calcific Tendinitis With Double-Row Margin Convergence Repair. Arthrosc Tech 2021; 10:e1455-e1467. [PMID: 34258190 PMCID: PMC8252855 DOI: 10.1016/j.eats.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/08/2021] [Indexed: 02/03/2023] Open
Abstract
Calcific rotator cuff tendinitis is a common cause of shoulder pain. It is thought to be an active cell-mediated process although the exact pathophysiology remains unclear. It commonly affects the supraspinatus tendon. The condition is generally self-limiting and can be managed with appropriate nonoperative treatment; however, some cases may need surgical excision. Complete removal of the calcific deposits may result in large significant defects. Infraspinatus calcific deposits were seldomly described. This report illustrates a double-row suture bridge technique with margin convergence of a large cuff defect after excision of calcific deposits within the infraspinatus tendon.
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21
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Medancic N, Spanic M, Marinic TB, Klobucar H, Cicak N. Arthroscopic removal of arch-shaped rotator cuff calcifying tendinitis without rotator cuff repair and acromioplasty is an excellent treatment regarding pain relief and function. INTERNATIONAL ORTHOPAEDICS 2021; 45:1003-1007. [PMID: 33495892 DOI: 10.1007/s00264-020-04930-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study is to evaluate clinical outcome for arthroscopic removal of calcium deposit without acromioplasty and rotator cuff repair for patients with ultrasound-diagnosed arch-shaped calcifying tendinitis of the rotator cuff (type I), homogenic (x-ray) with chronic pain. METHODS We retrospectively reviewed 50 patients with homogenous, arch-shaped calcifying tendinitis, suffering from chronic pain and who underwent arthroscopic treatment and 50 patients with the same type of tendinitis treated conservatively. All patients had calcium deposit located in supraspinatus tendon, pre-operatively and post-operatively evaluated by ultrasound. Clinical outcome was assessed by using Quick DASH, UCLA, and VAS score. RESULTS There were 29 male and 71 female patients; none had bilateral involvement. We divided patients into group A-operatively treated-and group B-conservatively treated-by shock wave therapy. Patients from group A had higher improvement of all used tests, QDash (from 19.3 to 2.7), UCLA (from 10 to 34), and VAS score (from 3 to 0) when compared with group B. CONCLUSION Patients with arch-shaped calcium deposits and acoustic shadow have better results after arthroscopic treatment than the conservative one. There was no need for acromioplasty or tendon repair. The lack of performing the same did not have any impact on the post-operative rehabilitation and recovery.
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Affiliation(s)
- Nenad Medancic
- AKROMION, Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2, 49217, Krapinske Toplice, Croatia.
| | - Mario Spanic
- AKROMION, Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2, 49217, Krapinske Toplice, Croatia
| | - Tea Budimir Marinic
- AKROMION, Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2, 49217, Krapinske Toplice, Croatia
| | - Hrvoje Klobucar
- AKROMION, Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2, 49217, Krapinske Toplice, Croatia
| | - Nikola Cicak
- AKROMION, Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2, 49217, Krapinske Toplice, Croatia
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Kim MS, Kim IW, Lee S, Shin SJ. Diagnosis and treatment of calcific tendinitis of the shoulder. Clin Shoulder Elb 2020; 23:210-216. [PMID: 33330261 PMCID: PMC7726362 DOI: 10.5397/cise.2020.00318] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022] Open
Abstract
Calcific tendinitis is the leading cause of shoulder pain. Among patients with calcific tendinitis, 2.7%-20% are asymptomatic, and 35%-45% of patients whose calcific deposits are inadvertently discovered develop shoulder pain. If symptoms are present, complications such as decreased range of motion of the shoulder joint should be minimized while managing pain. Patients with acute calcific tendinitis respond well to conservative treatment and rarely require surgery. In contrast, patients with chronic calcific tendinitis often do not respond to conservative treatment and do require surgery. Clinical improvement takes time, even after surgical treatment. This review article summarizes the processes related to the diagnosis and treatment of calcific tendinitis with the aim of helping clinicians choose appropriate treatment options for their patients.
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Affiliation(s)
- Min-Su Kim
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - In-Woo Kim
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sanghyeon Lee
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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Bechay J, Lawrence C, Namdari S. Calcific tendinopathy of the rotator cuff: a review of operative versus nonoperative management. PHYSICIAN SPORTSMED 2020; 48:241-246. [PMID: 31893972 DOI: 10.1080/00913847.2019.1710617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Calcific tendinopathy of the shoulder involves calcification and degeneration of the rotator cuff tendon near its insertion point on the greater tuberosity. The purpose of this review is to analyze recent literature evaluating the clinical outcomes of non-operative and operative treatment for calcific tendinopathy of the shoulder. Conservative management, extracorporeal shockwave therapy (ESWT), ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT), and surgical intervention will be reviewed.
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Affiliation(s)
- Joseph Bechay
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital , Philadelphia, PA, USA
| | - Cassandra Lawrence
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital , Philadelphia, PA, USA
| | - Surena Namdari
- Rothman Orthopaedic Institute, Rothman Orthopaedic Institute , Philadelphia, PA, USA
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Altamimi LA, Kholinne E, Kim H, Park D, Jeon IH. Arthroscopic Excision of Heterotopic Ossification in the Supraspinatus Muscle. Clin Shoulder Elb 2020; 23:37-40. [PMID: 33330232 PMCID: PMC7714324 DOI: 10.5397/cise.2020.00024] [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: 01/18/2020] [Accepted: 02/11/2020] [Indexed: 11/25/2022] Open
Abstract
Heterotopic ossification is formation of bone in atypical extra-skeletal tissues and usually occurs spontaneously or following neurologic injury with unknown cause. We report a 46-year-old female with right shoulder pain and restricted range of motion (ROM) for 3 months without history of trauma. Magnetic resonance imaging (MRI) showed a lesion within the rotator cuff supraglenoid. Excisional biopsy from a previous institution revealed a heterotopic ossificans (HO ). Following repeat MRI and bone scan, histopathology from arthroscopic resection confirmed an HO. The patient demonstrated improved pain and ROM at follow-up. Idiopathic HO rarely occurs in the shoulder joint, and resection of HO should be delayed until maturation of the lesion to avoid recurrence. The current case showed that arthroscopic HO resection provides an excellent surgical view to ensure complete lesion removal and minimize soft tissue damage at the supraglenoid area. Furthermore, the minimally invasive procedure of arthroscopy may reduce rehabilitation time and facilitate early return to work.
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Affiliation(s)
| | - Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.,Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyojune Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dongjun Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
BACKGROUND Many surgical procedures are intended to return patients to sport early, but it is unknown how realistic these expectations are after shoulder surgery. PURPOSE To determine which of the commonly performed surgical interventions in the shoulder best facilitated return to sport, and which did not, by 6 months postoperatively. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The study was a retrospective analysis of prospectively collected data from patients who underwent shoulder surgery from a single surgeon over 12 years. To be included, at least 20 patients needed to have undergone that procedure and complete a questionnaire evaluating their shoulder's function preoperatively and 6 months postoperatively. The primary outcome was a change in the response to the question, "What is your current level of sport?" RESULTS A total of 2261 surgical procedures in 13 categories met the inclusion criteria. Capsular release was the only procedure associated with improved patient-reported sporting level at 6 months (d = 0.18 [95% CI, 0.05-0.30]; P = .009). This represented a mean improvement of 41% from the preoperative sporting level. Bankart repair was associated with the greatest decrease in patient-reported sporting level at 6 months (mean decline of 21%) (d = -0.17 [95% CI, -0.34 to -0.01]; P = .034), followed by rotator cuff repair (mean decline of 13%) (d = -0.06 [95% CI, -0.03 to -0.10]; P = .0004). There were no significant changes in sporting level at 6 months postoperatively for rotator cuff repair with acromioplasty, polytetrafluoroethylene (PTFE) patch repair, acromioplasty, superior labral anterior to posterior (SLAP) repair, total shoulder arthroplasty, reverse total shoulder arthroplasty, rotator cuff repair with capsular release, rotator cuff repair with stabilization, calcific debridement, or hemiarthroplasty. CONCLUSION Capsular release was the only surgical procedure that provided a significant improvement in patient-reported sporting level in a relatively short period of time (6 months). Patients who underwent rotator cuff repair and Bankart repair were the only surgical groups that reported a significant decline in sporting level 6 months postoperatively.
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Affiliation(s)
- Amy Weber
- Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, Australia
| | - Ragu Paraparan
- Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, Australia
| | - Patrick H. Lam
- Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, Australia
| | - George A.C. Murrell
- Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, Australia
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Pakos E, Gkiatas I, Rakkas G, Papadopoulos D, Gelalis I, Vekris M, Korompilias A. Calcific deposit needling in combination with extracorporeal shock wave therapy (ESWT): A proposed treatment for supraspinatus calcified tendinopathy. SICOT J 2018; 4:45. [PMID: 30339523 PMCID: PMC6195344 DOI: 10.1051/sicotj/2018043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/10/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Calcified tendinopathy of the rotator cuff is one of the most common conditions concerning the shoulder pathology. It is characterized by a reactive calcification that affects the tendons being part of the rotator cuff. The reported prevalence varies from 2.7% to 22%. Most of the patients can be treated effectively with non-operative measures such as anti-inflammatory drugs, subacromial injection of steroid, physiotherapy, extracorporeal shock wave therapy (ESWT) and needle aspiration irrigation. Results of a treatment combining some of these methods have not been reported. Objectives: The purpose of this study is to present the radiological as well as the clinical results of our proposed protocol which combines drilling of the calcium deposits with xylocaine under ultrasound guidance, with a specific program of physiotherapy for 1 month without the use of NSAIDs. Methods: Sixty-six consecutive patients (68 shoulders) were treated for calcified tendinitis of supraspinatus, which was diagnosed clinically and radiologically, with needle drilling using xylocaine under ultrasound guidance. After the drilling the patient followed a physiotherapy protocol with ESWT which included five visits within a month. After the end of the physiotherapy, the patients were evaluated clinically and radiologically. The Visual Analogue Scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were measured before and after the end of the therapy. Results: All the patients showed clinical improvement of the symptoms at the follow-up. The mean VAS score showed improvement from 8.1 to 3.3 whereas the mean DASH score was 27 and after the end of the therapy 5. Radiologically all but one calcific deposits were disappeared. Conclusions: The ultrasound-guided drilling of the calcific deposit using xylocaine, in combination with physiotherapy using ESWT provides a reliable alternative treatment for the calcific tendinitis of the supraspinatus
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Affiliation(s)
- Emilios Pakos
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
| | - Ioannis Gkiatas
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
| | | | | | - Ioannis Gelalis
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
| | - Marios Vekris
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
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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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Lee TK, Shin SJ. Functional Recovery of the Shoulder after Arthroscopic Treatment for Chronic Calcific Tendinitis. Clin Shoulder Elb 2018; 21:75-81. [PMID: 33330156 PMCID: PMC7726381 DOI: 10.5397/cise.2018.21.2.75] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/14/2018] [Accepted: 03/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background We investigated the resolution of pain and functional recovery of shoulder after arthroscopic removal of calcific deposits in patients with chronic calcific tendinitis. Methods We enrolled 39 patients who were treated arthroscopically for chronic calcific tendinitis that had been non-responsive to at least 6 months of conservative treatment. We evaluated clinical outcome in terms of the American Shoulder Elbow Surgeons (ASES), the Constant score, the visual analogue score (VAS) for pain. We used plain radiography to measure the size of the calcific deposits. We also analyzed the clinical outcomes in terms of whether or not a cuff repair was performed or the degree of removal of calcific deposits. Results We found that complete resolution of pain took on average 5.7 months after the arthroscopic treatment. The ASES and the Constant score significantly improved from the 3-month follow-up, however it took 6 months until the scores reached on average 80 points or above. We found that these clinical outcomes at the final follow-up did not significantly differ by whether or not cuff repair was performed. Similarly, we found that the clinical outcomes did not significantly differ by the degree of calcium removal. Conclusions We found that arthroscopic removal of calcification leads to improved clinical outcomes in patients with chronic calcific tendinitis. However, our findings show it takes at least 6 months for the clinical improvement to become statistically significant. We also found that concomitant cuff repairs or the degree of removal of calcification does not affect the clinical outcome of the arthroscopic treatment.
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Affiliation(s)
- Tae Kyoung Lee
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sang Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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Electroacupuncture for the Treatment of Calcific Tendonitis. A Pilot Study. J Acupunct Meridian Stud 2018; 11:47-53. [PMID: 29436373 DOI: 10.1016/j.jams.2017.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 12/20/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022] Open
Abstract
Current treatment for calcific tendonitis consists of arm rest, antiinflammatory medications, and corticosteroid injections. If unsuccessful, a lot of clinicians suggest several physiotherapy modalities, such as shockwave therapy and electrotherapy. The purpose of our study was to assess the efficacy of electroacupuncture, as a substitute for failed medical treatment in calcific tendonitis. In a pilot study, we prospectively followed 10 patients treated with electroacupuncture for calcific tendonitis who failed to respond to medical treatment. Its efficacy was assessed by evaluating the level of pain, the Beck Depression Inventory, the range of active elbow mobility, and by repeated radiological evaluation of the course of calcific deposits. All clinical and radiological observations were recorded before and within 6 months after the onset of treatment. After electroacupuncture treatment (2 Hz, 180 mA for 30-60 seconds at GB21, GB34, LI4, LI 14, LI15, TW5, TW14, Chien Chien SI9, SI12, S37, S38), the visual analog score decreased notably, and the range of motion returned to normal. Radiological evaluation demonstrated almost complete absorption of calcific deposits within 6 months, after treatment. We conclude that electroacupuncture relieved skeletal pain, improved the quality of patient's life, and contributed to total regression of the calcific depositions in followed patients. So, electroacupuncture may be a valuable treatment option for calcific tendonitis, when medical treatment fails to relieve symptoms.
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Chou WY, Wang CJ, Wu KT, Yang YJ, Ko JY, Siu KK. Prognostic factors for the outcome of extracorporeal shockwave therapy for calcific tendinitis of the shoulder. Bone Joint J 2017; 99-B:1643-1650. [PMID: 29212688 DOI: 10.1302/0301-620x.99b12.bjj-2016-1178.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/12/2017] [Indexed: 12/22/2022]
Abstract
AIMS We conducted a study to identify factors that are prognostic of the outcome of extracorporeal shockwave therapy (ESWT) for calcific tendinitis of the shoulder. PATIENTS AND METHODS Since 1998, patients with symptomatic calcific tendinitis of the rotator cuff have been treated with ESWT using an electrohydraulic mode shockwave device. One year after ESWT, patients were grouped according to the level of resorption of calcification. RESULTS Of 241 symptomatic shoulders, complete resorption (CR) of calcification occurred in 134 (CR group). The remaining 107 shoulders had incomplete resorption (ICR) (ICR group). Gartner type I calcification was most common (64.5%) in the ICR group. The mean duration of symptoms before ESWT was significantly longer in the ICR group. Overall, 81% of the CR group and 23.4% of the ICR group were symptom free. There was a strong relationship between subsidence of symptoms and remission of calcification. Poor prognosis was significantly related to Gartner type I calcification, calcification extent > 15 mm and duration of symptoms > 11 months. CONCLUSION Patients with calcific tendinitis of the shoulder who have the factors identified for a poor outcome after ESWT should undergo a different procedure. Cite this article: Bone Joint J 2017;99-B:1643-50.
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Affiliation(s)
- W-Y Chou
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - C-J Wang
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - K-T Wu
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Y-J Yang
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - J-Y Ko
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - K-K Siu
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Lang G, Izadpanah K, Kubosch EJ, Maier D, Südkamp N, Ogon P. Examination of concomitant glenohumeral pathologies in patients treated arthroscopically for calcific tendinitis of the shoulder and implications for routine diagnostic joint exploration. BMC Musculoskelet Disord 2017; 18:476. [PMID: 29162079 PMCID: PMC5697060 DOI: 10.1186/s12891-017-1839-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/14/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Glenohumeral exploration is routinely performed during arthroscopic removal of rotator cuff calcifications in patients with calcific tendinitis of the shoulder (CTS). However, evidence on the prevalence of intraarticular co-pathologies is lacking and the benefit of glenohumeral exploration remains elusive. The aim of the present study was to assess and quantify intraoperative pathologies during arthroscopic removal of rotator cuff calcifications in order to determine whether standardized diagnostic glenohumeral exploration appears justified in CTS patients. METHODS One hundred forty five patients undergoing arthroscopic removal of calcific depots (CD) that failed conservative treatment were included in a retrospective cohort study. Radiographic parameters including number/localization of calcifications and acromial types, intraoperative arthroscopic findings such as configuration of glenohumeral ligaments, articular cartilage injuries, and characteristics of calcifications and sonographic parameters (characteristics/localization of calcification) were recorded. RESULTS One hundred forty five patients were analyzed. All CDs were removed by elimination with a blunt hook probe via "squeeze-and-stir-technique" assessed postoperatively via conventional X-rays. Neither subacromial decompression nor refixation of the rotator cuff were performed in any patient. Prevalence of glenohumeral co-pathologies, such as partial tears of the proximal biceps tendon (2.1%), superior labral tears from anterior to posterior (SLAP) lesions (1.4%), and/or partial rotator cuff tears (0.7%) was low. Most frequently, glenohumeral articular cartilage was either entirely intact (ICRS grade 0 (humeral head/glenoid): 46%/48%) or showed very mild degenerative changes (ICRS grade 1: 30%/26%). Two patients (1.3%) required intraarticular surgical treatment due to a SLAP lesion type III (n = 1) and an intraarticular rupture of CD (n = 1). CONCLUSIONS Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of CTS due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment. Exploration of the glenohumeral joint in arthroscopic removal of CD should only be performed in case of founded suspicion of relevant concomitant intraarticular pathologies.
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Affiliation(s)
- Gernot Lang
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Kaywan Izadpanah
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Eva Johanna Kubosch
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Dirk Maier
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Norbert Südkamp
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Peter Ogon
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
- Center of Orthopedic Sports Medicine Freiburg, Breisacher Strasse 84, 79110 Freiburg, Germany
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Hashiguchi H, Iwashita S, Okubo A, Takai S. Arthroscopic Removal and Tendon Repair for Refractory Rotator Cuff Calcific Tendinitis of the Shoulder. J NIPPON MED SCH 2017; 84:19-24. [PMID: 28331139 DOI: 10.1272/jnms.84.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate clinical and radiological outcomes of arthroscopic treatment for refractory rotator cuff calcific tendinitis of the shoulder. METHODS Subjects were 37 patients (35 women and 2 men; mean age, 47.8 years; age range 34-61 years) who had undergone arthroscopic treatment for calcific tendinitis of the shoulder. Despite sufficient nonsurgical treatments, all patients had residual calcific deposit with persistent or recurrent pain. Before surgery, all patients underwent 3-directional radiographs of the shoulder and three-dimensional computed tomography to determine the location and size of calcific deposit. Arthroscopic surgery was performed with the patient under general anesthesia in the lateral decubitus position. A 2-cm single longitudinal incision was made with a radiofrequency hook blade on the tendon surface above calcific deposit. Calcific deposit was removed as much as possible with a curette and a motorized shaver. The incised tendon was repaired with a side-to-side suture with strong sutures. The Japanese Orthopaedic Association shoulder score was used to evaluate clinical outcomes. The extent of calcific deposit removal was evaluated with radiographs obtained before surgery, 1 week after the surgery and at the final follow-up examination. RESULTS The mean follow-up duration was 30.4 (range, 13-72) months. The mean shoulder score significantly improved from 69.7 (range, 58-80) points before surgery to 97.8 (range, 89-100) points at the final follow-up examination. Postoperative radiographs in all patients, showed that the calcific deposit was resolved or reduced and those from 1 week after surgery to the final examination showed no evidence of recurrence or enlargement of calcific deposit. The calcific deposit had completely resolved in 34 patients but remained in 3 patients. CONCLUSION When treating calcific tendinitis of the shoulder, it is important to accurately determine the size and location of calcific deposit by radiographs and 3-dimensional computed tomography. Satisfactory clinical and radiological outcomes can be expected after reliable removal of calcific deposit through a single longitudinal incision and side-to-side repair with strong sutures, in association with an appropriate rehabilitation program.
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Affiliation(s)
- Hiroshi Hashiguchi
- Department of Orthopaedic Surgery, Nippon Medical School Chiba Hokusoh Hospital
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Klontzas ME, Vassalou EE, Karantanas AH. Calcific tendinopathy of the shoulder with intraosseous extension: outcomes of ultrasound-guided percutaneous irrigation. Skeletal Radiol 2017; 46:201-208. [PMID: 27909786 DOI: 10.1007/s00256-016-2538-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/13/2016] [Accepted: 11/15/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Rotator cuff calcific tendinopathy (RCCT) with intraosseous extension is a rare complication of tendinous and peritendinous involvement. The purpose of our study is to evaluate the outcome of ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in patients with intraosseous involvement. MATERIALS AND METHODS From January 2011 to June 2014, patients with a clinical and imaging diagnosis of RCCT were prospectively categorised in two groups based on imaging findings: group A (10 patients) with intraosseous RCCT and group B (control group 35 patients) without osseous involvement. US-PICT followed by subacromial injection was applied to all patients in groups A and B. During a 1-year follow-up, treatment outcome in terms of pain and functional improvement was evaluated at 3 weeks, 3 months, 6 months, and 1 year, with the use of a four-grade scale. The study has been approved by our hospital's ethics committee. RESULTS Mean improvement scores of group A were significantly lower than those of group B at all time points (p < 0.0001). Improvement of group B was noted mainly within the first 3 months post-treatment (p = 0.016). CONCLUSION Outcomes of ultrasound-guided treatment in cases of RCCT with intraosseous extension are significantly less favourable than in purely tendinous or peritendinous disease.
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Affiliation(s)
- Michail E Klontzas
- Department of Medical Imaging, University Hospital and Department of Radiology, University of Crete, 71110, Heraklion, Crete, Greece.,Department of Chemical Engineering, Imperial College London, London, UK
| | - Evangelia E Vassalou
- Department of Medical Imaging, University Hospital and Department of Radiology, University of Crete, 71110, Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital and Department of Radiology, University of Crete, 71110, Heraklion, Crete, Greece.
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Oh DG, Yoo KT. The effects of therapeutic exercise using PNF on the size of calcium deposits, pain self-awareness, and shoulder joint function in a calcific tendinitis patient: a case study. J Phys Ther Sci 2017; 29:163-167. [PMID: 28210065 PMCID: PMC5300831 DOI: 10.1589/jpts.29.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/14/2016] [Indexed: 02/07/2023] Open
Abstract
[Purpose] The purpose of this case study was to identify the effects of independent and
intensive therapeutic exercise using Proprioceptive neuromuscular facilitation on the size
of calcium deposits, pain self-awareness, and shoulder joint function in a patient with
calcific tendonitis. [Subject and Methods] The subject was a 42-year-old female patient
with calcific tendonitis and acute pain who had difficulty with active movement and
problems with general function. The independent and intensive Proprioceptive neuromuscular
facilitation exercise was applied for 40 min twice a day five times a week for two weeks
for a total of 20 times. An X-ray, the visual analog scale, a simple shoulder test, the
Constant-Murley Scale, and passive range of motion was used to evaluate the patient’s
change. [Results] The size of the calcium deposit, the visual analog scale score, and the
simple shoulder test score decreased. The Constant-Murley Scale score and the passive
range of motion were increased. [Conclusion] The results of this study suggested that
intensive and independent therapeutic short-term exercise without any other exercise
reduced pain and produced positive effects in shoulder function in a patient with the
calcific tendonitis, which could confirm the importance of therapeutic exercise in the
treatment of calcific tendonitis.
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Affiliation(s)
| | - Kyung-Tae Yoo
- Department of Physical Therapy, Namseoul University, Republic of Korea
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Verhaegen F, Debeer P. Arthroscopic Removal of Rotator Cuff Calcifications: Operative Technique. JBJS Essent Surg Tech 2016; 6:e38. [PMID: 30233931 DOI: 10.2106/jbjs.st.16.00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction In this article, we present our operative technique for the removal of rotator cuff calcifications. Indications & Contraindications Step 1 Setup and Patient Positioning Perform the shoulder arthroscopy with the patient in the beach-chair position with a shoulder positioner. Step 2 Glenohumeral Inspection Perform an arthroscopic inspection of the glenohumeral joint to exclude concomitant lesions. Step 3 Subacromial Inspection and Identification of Subacromial Landmarks Ensure that subacromial placement of the arthroscope and identification of the subacromial landmarks are correct as they are necessary for localization of the rotator cuff calcification. Step 4 Identification and Removal of Rotator Cuff Calcification With a spinal needle, localize and needle the rotator cuff calcification. Results In our series, all patients undergoing arthroscopic calcification removal exhibited significant improvement in the Constant score (p = 0.003), Quick DASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) (p < 0.001), and Simple Shoulder Test (p < 0.001) at 1 year after the operation8. Pitfalls & Challenges
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Affiliation(s)
- Filip Verhaegen
- Department of Development and Regeneration, Division of Orthopaedics, University Hospitals Leuven, Pellenberg, Belgium
| | - Philippe Debeer
- Department of Development and Regeneration, Division of Orthopaedics, University Hospitals Leuven, Pellenberg, Belgium
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Ranalletta M, Rossi LA, Sirio A, Bruchmann G, Maignon GD, Bongiovanni SL. Return to Sports After Arthroscopic Treatment of Rotator Cuff Calcifications in Athletes. Orthop J Sports Med 2016; 4:2325967116669310. [PMID: 27826596 PMCID: PMC5084521 DOI: 10.1177/2325967116669310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Arthroscopic treatment of calcific deposits of rotator cuff tears has been described with successful results in the general population. However, despite the high frequency of this condition, there is no information in the literature regarding arthroscopic treatment of rotator cuff calcifications in athletes. PURPOSE To analyze the time to return to sport, clinical outcomes, and complications of complete arthroscopic removal of intratendinous calcific deposits and repair of the tendon lesion without acromioplasty in athletes. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study retrospectively evaluated 24 consecutive patients with a mean age of 36.2 years. The mean follow-up was 59 months (range, 24-108 months). Patients completed a questionnaire focused on the time to return to sport and treatment course. Pre- and postoperative functional assessment was performed using the Constant score and University of California Los Angeles (UCLA) score. Pain was assessed by visual analog scale (VAS). Radiographs and magnetic resonance imaging (MRI) were performed to evaluate the recurrence of calcifications and the indemnity of the supraspinatus tendon repair. RESULTS Of the 24 patients, 23 (95.8%) were able to return to sports; 91.3% returned to the same level. The mean time to return to play was 5.3 months (range, 3-9 months): 26% of patients (6/23) returned to sports in less than 4 months, 61% (14/24) returned between 4 and 6 months, and 13% (3/24) returned after the sixth month. The mean Constant score increased from 26.9 preoperatively to 89.7 postoperatively (P < .001), and the UCLA score increased from 17.3 preoperatively to 33.2 postoperatively (P < .001). Significant improvement was obtained for pain (mean VAS, 8.4 [before surgery] vs 0.6 [after]; P < .001). The overall majority (91.6%) of patients were satisfied with their result. MRI examination at last follow-up (79% of patients) showed no tendon tears. CONCLUSION In athletes with calcifying tendinitis of the supraspinatus tendon with failed nonoperative treatment, complete arthroscopic removal of calcific deposits and tendon repair without acromioplasty results in significant pain relief and improvement in functional outcomes. Most patients return to the same level of proficiency regardless of the type of sport and the level of competition before injury, with 91.6% of patients satisfied with their results.
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Affiliation(s)
- Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof Dr Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Luciano A Rossi
- Department of Orthopedics and Traumatology, Prof Dr Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Adrian Sirio
- Department of Orthopedics and Traumatology, Prof Dr Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Guillermina Bruchmann
- Department of Orthopedics and Traumatology, Prof Dr Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gastón D Maignon
- Department of Orthopedics and Traumatology, Prof Dr Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Santiago L Bongiovanni
- Department of Orthopedics and Traumatology, Prof Dr Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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El Rassi G, Matta J, Haidamous G, Brogard P, Clavert P, Kempf JF, Irani J. Arthroscopic treatment of non-homogeneous calcifying tendinitis of the rotator cuff. SPRINGERPLUS 2016; 5:190. [PMID: 27026886 PMCID: PMC4769244 DOI: 10.1186/s40064-016-1792-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022]
Abstract
The purpose of this study is to investigate the clinical outcome of arthroscopic treatment for patients with non-homogeneous infiltrated calcifying tendinitis of the rotator cuff (type III), and to assess the optimal method for this arthroscopic treatment. We retrospectively reviewed the charts of 81 patients who underwent arthroscopic treatment for non-homogeneous infiltrated calcifying tendinitis of the rotator cuff (type III). Patients were divided into two groups: Group A (n = 31) consisted of patients who underwent excision of calcification, and Group B comprised patients who underwent acromioplasty alone (n = 50). The clinical outcome of treatment was assessed using Constant-Murley score. Twenty-three of the 81 patients were males and 58 were females. The mean duration of symptoms from onset to the first clinic visit was 3.88 years (SD ± 3.06 years). The right side was involved in 47 patients, the left side in 34 patients, and none had bilateral involvement. Patients from Group B had higher 16 improvement of their Constant-Murley score (from 48.96 to 88.06) when 17 compared to group A (from 45.39 to 67.23). Treatment of type III calcifying tendinitis is different than type I and II. Subacromial decompression may be considered in all patients suffering from type III non-homogeneous infiltrated calcifying tendinitis of the shoulder.
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Affiliation(s)
- George El Rassi
- Department of Orthopaedic Surgery, Saint George Hospital, P.O. Box 166378, Ashrafieh, Beirut, 1100 2807 Lebanon
| | - Jihad Matta
- Department of Orthopaedic Surgery, Saint George Hospital, P.O. Box 166378, Ashrafieh, Beirut, 1100 2807 Lebanon
| | - Georges Haidamous
- Department of Orthopaedic Surgery, Saint George Hospital, P.O. Box 166378, Ashrafieh, Beirut, 1100 2807 Lebanon
| | - Patrik Brogard
- Department of Orthopaedic Surgery, Illkirch Hospital, Strasbourg, France
| | - Philipe Clavert
- Department of Orthopaedic Surgery, Illkirch Hospital, Strasbourg, France
| | | | - Jihad Irani
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
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Jaeger M, Berndt T, Rühmann O, Lerch S. Patients With Impingement Syndrome With and Without Rotator Cuff Tears Do Well 20 Years After Arthroscopic Subacromial Decompression. Arthroscopy 2016; 32:409-15. [PMID: 26507160 DOI: 10.1016/j.arthro.2015.08.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 07/20/2015] [Accepted: 08/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To present the long-term outcome of arthroscopic subacromial decompression (ASD) for patients with impingement syndrome with or without rotator cuff tears as well as with or without calcific tendinitis in a follow-up of 20 years. METHODS We included 95 patients after a mean follow-up of 19.9 (19.5 to 20.5) years. All patients underwent ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning without cuff repair. The Constant score was used to assess the functioning of the shoulder. In addition, we defined a combined failure end point of a poor Constant score and revision surgery. RESULTS Revision surgery was performed in14.7% of the patients. The combined end point showed successful results in 78.8% of all cases. All patients with isolated impingement syndrome achieved successful results. Those with partial-thickness tears had successful outcomes in 90.9% of all cases, and patients with full-thickness tears had successful outcomes in 70.6% of all cases. The tendinitis calcarea group showed the poorest results, with a 65.2% success rate. CONCLUSIONS Our long-term results show that patients with impingement syndrome who received ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning do well 20 years after the index surgery. ASD without cuff repair even appears to be a safe, efficacious, and sustainable procedure for patients with partial rotator cuff tears. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Moritz Jaeger
- Clinic of Orthopedics, Traumatology and Sports Medicine, Klinikum Agnes Karll Laatzen, Klinikum Region Hannover, Laatzen, Germany.
| | - Thomas Berndt
- Clinic of Orthopedics, Traumatology and Sports Medicine, Klinikum Agnes Karll Laatzen, Klinikum Region Hannover, Laatzen, Germany
| | - Oliver Rühmann
- Clinic of Orthopedics, Traumatology and Sports Medicine, Klinikum Agnes Karll Laatzen, Klinikum Region Hannover, Laatzen, Germany
| | - Solveig Lerch
- Clinic of Orthopedics, Traumatology and Sports Medicine, Klinikum Agnes Karll Laatzen, Klinikum Region Hannover, Laatzen, Germany
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Merolla G, Singh S, Paladini P, Porcellini G. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment. J Orthop Traumatol 2016; 17:7-14. [PMID: 26163832 PMCID: PMC4805635 DOI: 10.1007/s10195-015-0367-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/25/2015] [Indexed: 12/21/2022] Open
Abstract
Calcific tendinitis is a painful shoulder disorder characterised by either single or multiple deposits in the rotator cuff tendon. Although the disease subsides spontaneously in most cases, a subpopulation of patients continue to complain of pain and shoulder dysfunction and the deposits do not show any signs of resolution. Although several treatment options have been proposed, clinical results are controversial and often the indication for a given therapy remains a matter of clinician choice. Herein, we report on the current state of the art in the pathogenesis, diagnosis and treatment of calcific tendinitis of the rotator cuff.
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Affiliation(s)
- Giovanni Merolla
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy.
- Biomechanics Laboratory "Marco Simoncelli", D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy.
| | - Sanjay Singh
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy
| | - Paolo Paladini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy
| | - Giuseppe Porcellini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy
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Castagna A, DE Giorgi S, Garofalo R, Conti M, Tafuri S, Moretti B. Calcifying tendinitis of the shoulder: arthroscopic needling versus complete calcium removal and rotator cuff repair. A prospective comparative study. JOINTS 2016; 3:166-72. [PMID: 26904521 DOI: 10.11138/jts/2015.3.4.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE the aim of the present study was to verify the differences in the clinical outcomes of two arthroscopic techniques used to treat calcifying tendinitis of the shoulder: needling versus complete removal of the calcium deposit and tendon repair. METHODS from September 2010 to September 2012, 40 patients with calcifying tendinitis of the rotator cuff were arthroscopically treated by the same surgeon using one of the two following techniques: needling (Group 1) and complete removal of the calcium deposit and tendon repair with suture anchors (Group 2). Both groups followed the same rehabilitation program. The two groups were compared at 6 and 12 months of follow-up for the presence of residual calcifications and for the following clinical outcomes: Constant score, American Shoulder and Elbow Surgeons Evaluation Form (ASES) shoulder score, University of California Los Angeles (UCLA) shoulder rating scale, Simple Shoulder Test (SST) and Visual Analogue Scale (VAS). RESULTS all the clinical scores (Constant, ASES, UCLA, SST and VAS scores) improved significantly between baseline and postoperative follow-up, both at 6 and at 12 months. No differences at final follow-up were found between the two groups. CONCLUSIONS both the techniques were effective in solving the symptoms of calcifying tendinitis of the shoulder. Clinical scores improved in both groups. Residual calcifications were found in only a few cases and were always less than 10 mm. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Alessandro Castagna
- Shoulder and Elbow Service, IRCCS Humanitas Institute, Rozzano, Milan, Italy
| | - Silvana DE Giorgi
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Italy
| | - Raffaele Garofalo
- Shoulder Service, MIULLI Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Marco Conti
- Shoulder and Elbow Service, IRCCS Humanitas Institute, Rozzano, Milan, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, University of Bari, Italy
| | - Biagio Moretti
- Shoulder and Elbow Service, IRCCS Humanitas Institute, Rozzano, Milan, Italy
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Verhaegen F, Brys P, Debeer P. Rotator cuff healing after needling of a calcific deposit using platelet-rich plasma augmentation: a randomized, prospective clinical trial. J Shoulder Elbow Surg 2016; 25:169-73. [PMID: 26775091 DOI: 10.1016/j.jse.2015.10.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 10/05/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic needling of a rotator cuff calcification is a highly reliable operation in terms of pain relief and return of function. However, during the needling process, a cuff defect is created. Little is known about the evolution of this defect. METHODS We conducted a prospective, randomized controlled clinical trial to investigate the evolution of the aforementioned defect and the role of platelet-rich plasma (PRP) augmentation in this healing process. Patients were randomized to either group 1 (PRP, n = 20) or group 2 (no PRP [control group], n = 20). Patients in group 1 received a perioperative PRP infiltration at the rotator cuff defect, whereas the control group did not. Patients were assessed clinically preoperatively and postoperatively at 6 weeks, 3 and 6 months, and 1 year. The Constant score, Simple Shoulder Test, and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) were used as outcome measures. The evolution of the cuff defect was evaluated on sonography at 3 and 6 months and with magnetic resonance imaging after 1 year. RESULTS All patients improved significantly after surgery (P < .05). There was no difference in clinical outcome or rotator cuff healing between groups. We observed a high rate of persistent rotator cuff defects after 1 year in both groups. The presence of residual cuff defects did not influence the clinical outcome. CONCLUSION Arthroscopic needling is an operation with a predictive, good clinical outcome. We found a high rate of persistent rotator cuff defects after 1 year. This study could not identify any beneficial effect of the addition of PRP on rotator cuff healing. LEVEL OF EVIDENCE Level II; Randomized Controlled Trial; Treatment Study.
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Affiliation(s)
- Filip Verhaegen
- Department of Development and Regeneration, KU Leuven, Division of Orthopaedics, University Hospitals Leuven, Pellenberg, Belgium.
| | - Peter Brys
- Department of Radiology, University Hospitals Leuven, Pellenberg, Belgium
| | - Philippe Debeer
- Department of Development and Regeneration, KU Leuven, Division of Orthopaedics, University Hospitals Leuven, Pellenberg, Belgium
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ElShewy MT. Calcific tendinitis of the rotator cuff. World J Orthop 2016; 7:55-60. [PMID: 26807357 PMCID: PMC4716572 DOI: 10.5312/wjo.v7.i1.55] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/05/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Calcific tendinitis within the rotator cuff tendon is a common shoulder disorder that should be differentiated from dystrophic calcification as the pathogenesis and natural history of both is totally different. Calcific tendinitis usually occurs in the fifth and sixth decades of life among sedentary workers. It is classified into formative and resorptive phases. The chronic formative phase results from transient hypoxia that is commonly associated with repeated microtrauma causing calcium deposition into the matrix vesicles within the chondrocytes forming bone foci that later coalesce. This phase may extend from 1 to 6 years, and is usually asymptomatic. The resorptive phase extends from 3 wk up to 6 mo with vascularization at the periphery of the calcium deposits causing macrophage and mononuclear giant cell infiltration, together with fibroblast formation leading to an aggressive inflammatory reaction with inflammatory cell accumulation, excessive edema and rise of the intra-tendineous pressure. This results in a severely painful shoulder. Radiological investigations confirm the diagnosis and suggest the phase of the condition and are used to follow its progression. Although routine conventional X-ray allows detection of the deposits, magnetic resonance imaging studies allow better evaluation of any coexisting pathology. Various methods of treatment have been suggested. The appropriate method should be individualized for each patient. Conservative treatment includes pain killers and physiotherapy, or “minimally invasive” techniques as needling or puncture and aspiration. It is almost always successful since the natural history of the condition ends with resorption of the deposits and complete relief of pain. Due to the intolerable pain of the acute and severely painful resorptive stage, the patient often demands any sort of operative intervention. In such case arthroscopic removal is the best option as complete removal of the deposits is unnecessary.
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Louwerens JKG, Veltman ES, van Noort A, van den Bekerom MPJ. The Effectiveness of High-Energy Extracorporeal Shockwave Therapy Versus Ultrasound-Guided Needling Versus Arthroscopic Surgery in the Management of Chronic Calcific Rotator Cuff Tendinopathy: A Systematic Review. Arthroscopy 2016; 32:165-75. [PMID: 26382637 DOI: 10.1016/j.arthro.2015.06.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/17/2015] [Accepted: 06/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The objectives of this comprehensive quantitative review of the treatment of calcific tendinopathy of the rotator cuff were to investigate if there is a sustainable positive effect on outcomes after treatment with high-energy extracorporeal shockwave therapy (ESWT) or ultrasound (US)-guided needling and to compare these results with those of treatment with arthroscopic surgery. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this review. A systematic literature search was conducted in December 2014 to identify relevant clinical articles in peer-reviewed journals with at least 6 months' follow-up. Each article was scored using the Coleman Methodology Score. The primary endpoints were functional outcome and radiologic change in the size of the calcific deposit. RESULTS Twenty-two studies were included (1,258 shoulders). The mean Coleman Methodology Score for the included studies was 77.1 ± 9.1. Overall, good to excellent clinical outcomes were achieved after treatment with either high-energy ESWT, US-guided needling, or arthroscopic surgery, with an improvement in the Constant-Murley score ranging between 26.3 and 41.5 points after 1 year. No severe side effects or long-term complications were encountered. CONCLUSIONS Patients can achieve good to excellent clinical outcomes after high-energy ESWT, US-guided needling, and arthroscopy for calcific tendinopathy of the shoulder. Side effects and post-treatment complications should be taken into account when a decision is being made for each individual patient. Physicians should consider high-energy ESWT and US-guided needling as minimally invasive treatment options when primary conservative treatment fails. Arthroscopy can safely be used as a very effective but more invasive secondary option, although the extent of deposit removal and the additional benefit of subacromial decompression remain unclear. LEVEL OF EVIDENCE Level IV, systematic review of Level I, II, and IV studies.
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Affiliation(s)
- Jan K G Louwerens
- Research Center Linnaeus Institute, Spaarne Hospital, Hoofddorp, Netherlands; Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands.
| | - Ewout S Veltman
- Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands
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Clement ND, Watts AC, Phillips C, McBirnie JM. Short-Term Outcome After Arthroscopic Bursectomy Debridement of Rotator Cuff Calcific Tendonopathy With and Without Subacromial Decompression: A Prospective Randomized Controlled Trial. Arthroscopy 2015; 31:1680-7. [PMID: 26188787 DOI: 10.1016/j.arthro.2015.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 05/21/2015] [Accepted: 05/29/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To conduct a prospective randomized controlled trial to assess whether arthroscopic bursectomy and debridement of the calcific deposit, with or without subacromial decompression, influences the functional outcome of patients with calcific tendonitis. METHODS During a 4-year period, 80 patients were recruited who presented to the study center with refractory calcific tendonitis of the shoulder. Forty patients were randomized to have a subacromial decompression, and 40 were randomized not to have a subacromial decompression in combination with bursectomy and arthroscopic removal of the calcific deposit. All surgery was performed by one surgeon who was blinded to the functional assessment of the patients. Patient demographics, body mass index (BMI), and length of symptoms were recorded at the time of randomization. Patients were asked to complete a pain visual analog score (VAS), short form (SF-12), disability arm shoulder and hand (DASH), and Constant score (CS) preoperatively and at 1 year postoperatively. RESULTS There were 21 male and 59 female patients with a mean age of 49 (range, 32 to 75) years. The mean time of follow-up was 13 (range, 12 to 15) months. There were no significant differences in gender, age, BMI, length of symptoms, or preoperative outcome measures assessed between the groups. Overall, for both groups there was a significant improvement in the pain VAS (P < .001), DASH (P < .001), and CS (P < .001) at 1 year compared with preoperative scores. There were no significant differences demonstrated between the groups for improvement in the pain VAS (P = .57), DASH (P = .93), SF-12 physical component score (P = .58), or CS (P = .27) at 1 year. CONCLUSIONS This study has demonstrated that the short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression. LEVEL OF EVIDENCE Level I therapeutic study, randomized controlled trial.
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Affiliation(s)
| | - Adam C Watts
- Wrightington Hospital, Appley Bridge, Wigan, United Kingdom
| | - Christine Phillips
- Shoulder Unit, Royal Infirmary of Edinburgh, Little France, United Kingdom
| | - Julie M McBirnie
- Shoulder Unit, Royal Infirmary of Edinburgh, Little France, United Kingdom
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Merolla G, Bhat MG, Paladini P, Porcellini G. Complications of calcific tendinitis of the shoulder: a concise review. J Orthop Traumatol 2015; 16:175-83. [PMID: 25697847 PMCID: PMC4559544 DOI: 10.1007/s10195-015-0339-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/30/2015] [Indexed: 01/01/2023] Open
Abstract
UNLABELLED Calcific tendinitis (CT) of the rotator cuff (RC) muscles in the shoulder is a disorder which remains asymptomatic in a majority of patients. Once manifested, it can present in different ways which can have negative effects both socially and professionally for the patient. The treatment modalities can be either conservative or surgical. There is poor literature evidence on the complications of this condition with little consensus on the treatment of choice. In this review, the literature was extensively searched in order to study and compile together the complications of CT of the shoulder and present it in a clear form to ease the understanding for all the professionals involved in the management of this disorder. Essentially there are five major complications of CT: pain, adhesive capsulitis, RC tears, greater tuberosity osteolysis and ossifying tendinitis. All the above complications have been explained right from their origin to the control measures required for the relief of the patient. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Giovanni Merolla
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, AUSL della Romagna Ambito Territoriale di Rimini, Rimini, Italy,
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46
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Isolated acromioplasty for calcific tendinitis produces good results at 3-year follow-up. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Ranalletta M, Rossi LA, Bongiovanni SL, Tanoira I, Piuzzi N, Maignon G. Arthroscopic Removal and Rotator Cuff Repair Without Acromioplasty for the Treatment of Symptomatic Calcifying Tendinitis of the Supraspinatus Tendon. Orthop J Sports Med 2015; 3:2325967115577957. [PMID: 26665052 PMCID: PMC4622339 DOI: 10.1177/2325967115577957] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Calcified rotator cuff tendinitis is a common cause of chronic shoulder pain that leads to significant pain and functional limitations. Although most patients respond well to conservative treatment, some eventually require surgical treatment. Purpose: To evaluate the clinical outcome with arthroscopic removal of calcific deposit and rotator cuff repair without acromioplasty for the treatment of calcific tendinitis of the supraspinatus tendon. Study Design: Case series; Level of evidence, 4. Methods: This study retrospectively evaluated 30 consecutive patients with a mean age of 49.2 years. The mean follow-up was 35 months (range, 24-88 months). Pre- and postoperative functional assessment was performed using the Constant score, University of California Los Angeles (UCLA) score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH). Pain was assessed by visual analog scale (VAS). Radiographs and magnetic resonance imaging (MRI) were performed to evaluate the recurrence of calcifications and the indemnity of the supraspinatus tendon repair. Results: Significant improvement was obtained for pain (mean VAS, 8.7 before surgery to 0.8 after; P < .001). The mean Constant score increased from 23.9 preoperatively to 85.3 postoperatively (P < .001), the mean Quick DASH score decreased from 47.3 preoperatively to 8.97 postoperatively (P < .001), and the UCLA score increased from 15.8 preoperatively to 32.2 postoperatively (P < .001). MRI examination at last follow-up (70% of patients) showed no tendon tears, and 96.2% of patients were satisfied with their results. Conclusion: Arthroscopic removal and rotator cuff repair without acromioplasty can lead to good results in patients with symptomatic calcifying tendonitis of the supraspinatus tendon.
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Affiliation(s)
| | | | | | | | - Nicolas Piuzzi
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gastón Maignon
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Izadpanah K, Jaeger M, Maier D, Südkamp NP, Ogon P. Preoperative planning of calcium deposit removal in calcifying tendinitis of the rotator cuff - possible contribution of computed tomography, ultrasound and conventional X-Ray. BMC Musculoskelet Disord 2014; 15:385. [PMID: 25413969 PMCID: PMC4246434 DOI: 10.1186/1471-2474-15-385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 10/27/2014] [Indexed: 12/25/2022] Open
Abstract
Background The purpose of the present study was to investigate the accuracy of Ultrasound (US), conventional X-Ray (CX) and Computed Tomography (CT) to estimate the total count, localization, morphology and consistency of Calcium deposits (CDs) in the rotator cuff. Methods US, CX and CT imaging was performed pre-operatively in 151 patients who underwent arthroscopic removal of CDs in the rotator cuff. In all procedures: (1) total CD counts were determined, (2) the CDs appearance in each image modality was correlated to the intraoperative consistency and (3) CDs were localized in their relation to the acromion using US, CX and CT. Results Using US158 CDs, using CT 188 CDs and using CX 164 CDs were identified. Reliable localization of the CDs was possible with all used diagnostic modalities. CT revealed 49% of the CDs to be septated, out of which 85% were uni- and 15% multiseptated. CX was not suitable for prediction of CDs consistency. US reliably predicted viscous-solid CDs consistency only when presenting with full sound extinction (PPV 84.6%) . CT had high positive and negative predictive values for detection of liquid-soft (PPV 92.9%) and viscous-solid (PPV 87.8%) CDs. Conclusion US and CX are sufficient for preoperative planning of CD removal with regards to localization and prediction of consistency if the deposits present with full sound extinction. This is the case in the majority of the patients. However, in patients with missing sound extinction CT can be recommended if CDs consistency of the deposits should be determined. Satellite deposits or septations are regularly present, which is of importance if complete CD removal is aspired. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-385) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kaywan Izadpanah
- Department of Orthopaedic and Trauma Surgery, University Hospital Freiburg, Hugstetter 55, 79106 Freiburg im Breisgau, Germany.
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Abstract
Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical débridement. These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial.
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50
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Kim YS, Lee HJ, Kim YV, Kong CG. Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. J Shoulder Elbow Surg 2014; 23:1640-6. [PMID: 25219475 DOI: 10.1016/j.jse.2014.06.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/02/2014] [Accepted: 06/09/2014] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Ultrasound (US)-guided needling with subacromial corticosteroid injection is more effective than extracorporeal shock wave therapy (ESWT) for function restoration and pain relief in patients with calcific tendinitis of the shoulder. METHODS Fifty-four patients diagnosed with unilateral painful calcific tendinitis were randomly allocated to a US needling or ESWT group. The US needling group underwent US-guided needling and received a subacromial corticosteroid injection. The ESWT group received ESWT 3 times a week. All patients were prospectively evaluated; American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale for pain scores were recorded before the procedure and at 6 weeks, 12 weeks, 6 months, 12 months, and the last follow-up. The size and morphology of the deposits were evaluated by radiography. RESULTS The average follow-up period was 23.0 months. At last follow-up, the mean size of the deposits was significantly different between the 2 groups (P = .001); it decreased to 0.5 mm from 14.8 mm in the US needling group and to 5.6 mm from 11.0 mm in the ESWT group. There were also significant improvements in clinical outcomes in both groups after treatment (P < .05). At 1-year follow-up, the US needling group had significantly better scores than the ESWT group with regard to the American Shoulder and Elbow Surgeons assessment (90.3 and 74.6, respectively; P = .001), Simple Shoulder Test (83.3 and 70.8, respectively; P = .015), and visual analog scale for pain (1.4 and 3.3, respectively; P = .003).The initial calcium deposit sizes and clinical outcomes were weakly correlated in both groups (P > .05). CONCLUSION Both treatment modalities for calcific tendinitis improved clinical outcomes and eliminated calcium deposits. US-guided needling treatment, however, was more effective in function restoration and pain relief in the short term.
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Affiliation(s)
- Yang-Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hyo-Jin Lee
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yoon-vin Kim
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Chae-Gwan Kong
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
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