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Housset V, Martinel V. Intraosseous migration of supraspinatus calcification: benefits of intraoperative ultrasound technique. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:276-283. [PMID: 38706671 PMCID: PMC11065676 DOI: 10.1016/j.xrrt.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
| | - Vincent Martinel
- Groupe Orthopédie Ormeau Pyrénées, Polyclinique de l’Ormeau - ELSAN, Tarbes, France
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2
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Albishi W, Alaseem A, Aljasser S, Almohideb F, Almalki M, AlFaleh AF. Intraosseous extension of supraspinatus calcific tendonitis in a young patient with severe shoulder pain: a rare case report. J Surg Case Rep 2023; 2023:rjad354. [PMID: 37388507 PMCID: PMC10299904 DOI: 10.1093/jscr/rjad354] [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: 05/02/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023] Open
Abstract
Calcific tendinopathy is one of the causes of shoulder pain and limited range of motion when it affects the rotator cuff tendons. Complications of such a condition are rare and include intraosseous and intramuscular migration. Calcific tendonitis can be classified as acute, subacute or chronic based on the onset of symptoms. The incidence of calcific tendonitis affects females more than males, with the median age of onset being between 40 and 60 years old. Diagnostic modalities include radiographs and computed tomography (CT); however, these are suboptimal when compared to the sensitivity of magnetic resonance imaging. Ninety percent of these cases are treated non-surgically. We present a rare case of a young female patient with right shoulder pain and limited range of motion secondary to the intraosseous migration of calcific tendonitis. The patient's symptoms were resolved after a CT-guided percutaneous bone biopsy of the lesion. Clinical correlation with the aid of imaging and histopathology is a multimodal approach to help diagnose and treat such conditions.
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Affiliation(s)
- Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Alaseem
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sarah Aljasser
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faten Almohideb
- Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mamdouh Almalki
- Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed F AlFaleh
- Correspondence address. Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia. E-mail:
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3
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Kim MJ, Sung MS, Jeong CH, Park HI. Extratendinous migration of calcific tendinitis of the rotator cuff: imaging findings and clinical characteristics with temporal changes. Ultrasonography 2022; 41:553-565. [PMID: 35537817 PMCID: PMC9262673 DOI: 10.14366/usg.21232] [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: 11/08/2021] [Accepted: 02/17/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose The aim of this study was to analyze the imaging findings and clinical characteristics of extratendinous migration of calcific tendinitis of the shoulder with temporal changes. Methods Seventy-six patients with extratendinous calcific tendinitis of the shoulder diagnosed by ultrasonography (US) or magnetic resonance imaging (MRI) were enrolled in this retrospective study. Clinical symptoms and imaging findings (on radiography, US, and MRI) of extratendinous calcific tendinitis during an acute painful attack were analyzed. Temporal changes were analyzed in 28 patients before an acute attack and 40 patients after an acute attack. For comparison, 65 patients with intratendinous calcific tendinitis were included. Results Patients with extratendinous calcific tendinitis had a significantly higher average visual analogue scale (VAS) score (8.8±1.6) than the intratendinous group (6.4±2.2) (P<0.001). The fragmented type (80.5%) was the most common shape on US; sonographic black hole appearance (14.6%) and echogenic fluid (9.8%) were characteristic findings of intrabursal calcifications. In 28 patients with previous radiographs, radiographic type III (78.6%) was dominant and the location of calcific deposits changed (82.1%) during the acute painful attack, which was also perceivable in 12 patients with previous US or MRI. In follow-up radiographs of 40 patients, calcifications shrunk by more than 50% or became invisible in 82.5% of patients, with symptom improvement (VAS score, 8.9±1.5 to 1.9±1.2). Follow-up US and MRI of 16 patients also showed decreased size (56.3%) or disappearance (43.7%) of calcific deposits. Conclusion Extratendinous calcific tendinitis has distinctive imaging features, the temporal changes of which correlate well with clinical symptoms.
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Affiliation(s)
- Mee Jeong Kim
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Sook Sung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Hoon Jeong
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae-Il Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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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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Paruthikunnan SM, Boily M, Martin MH, Assaf A, Jaffer R. Intra-osseous migration in calcific rotator cuff tendinopathy- a novel depiction of temporal evolution on multimodality imaging. BJR Case Rep 2022; 8:20210156. [PMID: 36177267 PMCID: PMC9499433 DOI: 10.1259/bjrcr.20210156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 11/08/2022] Open
Abstract
We present a case of calcific tendinopathy of the rotator cuff with intraosseous migration of the calcification, treated with ultrasound-guided bursal steroid injection and followed up with multiple imaging modalities for a year following the initial presentation. The radiographs, ultrasound, CT, nuclear scintigraphy, and MRI images demonstrate the temporal evolution of the intraosseous migrated calcium and show how this pathology, in its acute phase, can mimic other pathologies like osteoid osteoma. The follow-up imaging also illustrates how the migrated intraosseous focus of calcification took a much longer time to heal compared to its intratendinous counterpart, possibly leading to the protracted course of recovery. This report also highlights a previously undescribed pattern of healing of the intraosseous migrated calcium on multiple imaging modalities.
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Affiliation(s)
| | - Mathieu Boily
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Marie-Hélène Martin
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Adel Assaf
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Rehana Jaffer
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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6
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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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Zampa V, Aringhieri G, Rossi P, Capanna R, Caramella D. Humeral greater tuberosity osteolysis as a complication of intraosseous calcification migration: natural history depicted by imaging. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021052. [PMID: 33944858 PMCID: PMC8142746 DOI: 10.23750/abm.v92is1.8370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022]
Abstract
Migration of calcification within the bone leading to greater tuberosity osteolysis is a peculiar complication of the calcifying tendinitis of the rotator cuff. The case of a 38-year-old woman complaining of right shoulder pain, which had been going on for one year, is hereby described. The evolution of the infraspinatus tendon calcifying tendinitis leading to osteolysis of the greater tuberosity of the humerus is depicted by imaging and, particularly, by the MR and CT features changing over time. In this paper we focus on the importance of both MR and CT exams in the diagnostic process of the different phases of the disease. The correlation between clinical symptoms and imaging features is also helpful for imaging interpretation: the most painful phase corresponds to the migration of the calcification, whereas pain tends to decrease when the osteolysis develops. Awareness of the existence of this condition may prevent unnecessary invasive procedures.
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Affiliation(s)
- Virna Zampa
- Department of Interventional and Diagnostic Radiology Azienda Ospedaliero-Universitaria Pisana.
| | - Giacomo Aringhieri
- Department of Interventional and Diagnostic Radiology Azienda Ospedaliero-Universitaria Pisana.
| | - Piercarlo Rossi
- Department of Interventional and Diagnostic Radiology Azienda Ospedaliero-Universitaria Pisana.
| | - Rodolfo Capanna
- Department of Orthopedic Surgery Azienda Ospedaliero-Universitaria Pisana.
| | - Davide Caramella
- Department of Interventional and Diagnostic Radiology Azienda Ospedaliero-Universitaria Pisana.
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Relationship between calcific tendinopathy and rotator cuff tear on shoulder magnetic resonance imaging: case-controlled comparison. Pol J Radiol 2020; 85:e8-e13. [PMID: 32180848 PMCID: PMC7064010 DOI: 10.5114/pjr.2020.92709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/02/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose To determine the frequency of rotator cuff tear on the shoulder magnetic resonance imaging (MRI) of patients with rotator cuff calcific tendinopathy and the relationship between rotator cuff tear and calcific tendinopathy. Material and methods In this retrospective case control study, 137 patients with calcific tendinopathy and 137 control group patients without calcific tendinopathy with shoulder pain, whose age, sex, and shoulder laterality values were matched, were compared in terms of rotator cuff tears on their shoulder MRI images. Results The frequency of rotator cuff tear was found to be significantly higher in the control group (37.2%) compared to the calcific tendinopathy group (23.4%) (p < 0.01). Partial thickness was 81.3% in the calcific tendinopathy group and 70.6% in the control group, and no significant difference was observed between the two groups in terms of the size of the rotator cuff tear (p > 0.05). In the calcific tendinopathy group, there was no significant relationship between the localisation of calcification and the rotator cuff tear, and only in 4.4% of the participants were calcification and tear at the same location on the same tendon (p > 0.05, r = 0.04). Conclusions The patients with calcific tendinopathy, who had been admitted with shoulder pain, did not demonstrate an increased risk of rotator cuff tear based on their MRI compared to patients with shoulder pain without calcific tendinopathy. No significant relationship was determined between calcific tendinopathy and rotator cuff tear.
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Miranda I, Sánchez-Alepuz E, Díaz-Martínez J, Collado-Sánchez A, Peregrín-Nevado I. Calcific tendinopathy of the shoulder with intraosseous extension: experience with arthroscopic treatment and review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Miranda I, Sánchez-Alepuz E, Díaz-Martínez JV, Collado-Sánchez A, Peregrín-Nevado I. Calcific tendinopathy of the shoulder with intraosseous extension: experience with arthroscopic treatment and review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:13-21. [PMID: 31734180 DOI: 10.1016/j.recot.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/28/2019] [Accepted: 09/23/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIM Calcific tendinitis of the rotator cuff is a common cause of shoulder pain. The aim of the present study was to show a rare presentation of calcific tendinopathy of the shoulder, the intraosseous extension, which can be mistaken for a bone tumour or an infectious disease. MATERIAL AND METHODS Two clinical cases of calcific tendinopathy of the shoulder with intraosseous extension and a review of the literature are presented. RESULTS Cortical erosion, osteolytic lesion in the greater tuberosity and perilesional oedema were observed in both cases. Good results were achieved with shoulder arthroscopy including lesion debridement and reinsertion of the tendon in the greater tuberosity with an anchor. CONCLUSIONS In the presence of an osteolytic lesion with perilesional oedema in the greater tuberosity, the intraosseous expansion of a calcifying tendinopathy should be included in the differential diagnosis. In our cases the arthroscopic treatment was successful.
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Affiliation(s)
- I Miranda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital IMED Valencia, Burjassot, Valencia, España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - E Sánchez-Alepuz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital IMED Valencia, Burjassot, Valencia, España; Servicio de Cirugía Ortopédica y Traumatología, Unión de Mutuas, Valencia, España
| | - J V Díaz-Martínez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital IMED Valencia, Burjassot, Valencia, España
| | - A Collado-Sánchez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital IMED Valencia, Burjassot, Valencia, España; Servicio de Cirugía Ortopédica y Traumatología, Mutua Universal, Valencia, España
| | - I Peregrín-Nevado
- Servicio de Cirugía Ortopédica y Traumatología, Hospital IMED Valencia, Burjassot, Valencia, España
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Hutchinson JL, Gusberti D, Saab G. Changing appearance of intraosseous calcific tendinitis in the shoulder with time: A case report. Radiol Case Rep 2019; 14:1267-1271. [PMID: 31462951 PMCID: PMC6706614 DOI: 10.1016/j.radcr.2019.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 02/07/2023] Open
Abstract
We report a case of a 66-year-old woman who presented with acute shoulder pain. Initial radiographs revealed a sclerotic intraosseous lesion in the greater tuberosity with associated cortical erosions and subacromial calcification. The diagnosis of intraosseous calcific tendinitis was confirmed with additional magnetic resonance imaging and nuclear medicine imaging. Within 3 months of conservative measures, the patient's symptoms improved but the radiographic appearance had become more aggressive with a wider zone of transition. After 1 year, the imaging findings continued to change, with the development of subcortical cysts. Correct diagnosis of this uncommon manifestation of tendinitis requires knowledge of how its appearance changes with time.
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Affiliation(s)
- Jeffrey Lawrence Hutchinson
- Department of Medical Imaging, Grey Bruce Health Services, 1800 8th Street East, Owen Sound, ON N4K 6M9, Canada
| | - Daniel Gusberti
- Department of Family Medicine, Grey Bruce Health Services, Owen Sound, Ontario, Canada
| | - George Saab
- Department of Medical Imaging, Grey Bruce Health Services, 1800 8th Street East, Owen Sound, ON N4K 6M9, Canada
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12
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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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Chianca V, Albano D, Messina C, Midiri F, Mauri G, Aliprandi A, Catapano M, Pescatori LC, Monaco CG, Gitto S, Pisani Mainini A, Corazza A, Rapisarda S, Pozzi G, Barile A, Masciocchi C, Sconfienza LM. Rotator cuff calcific tendinopathy: from diagnosis to treatment. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:186-196. [PMID: 29350647 PMCID: PMC6179075 DOI: 10.23750/abm.v89i1-s.7022] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/15/2022]
Abstract
Rotator cuff calcific tendinopathy (RCCT) is a very common condition caused by the presence of calcific deposits in the rotator cuff (RC) or in the subacromial-subdeltoid (SASD) bursa when calcification spreads around the tendons. The pathogenetic mechanism of RCCT is still unclear. It seems to be related to cell-mediated disease in which metaplastic transformation of tenocytes into chondrocytes induces calcification inside the tendon of the RC. RCCT is a frequent finding in the RC that may cause significant shoulder pain and disability. It can be easily diagnosed with imaging studies as conventional radiography (CR) or ultrasound (US). Conservative management of RCCT usually involves rest, physical therapy, and oral NSAIDs administration. Imaging-guided treatments are currently considered minimally-invasive, yet effective methods to treat RCCT with about 80% success rate. Surgery remains the most invasive treatment option in chronic cases that fail to improve with other less invasive approaches. (www.actabiomedica.it)
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14
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Intraosseous migration of tendinous calcifications: two case reports. Skeletal Radiol 2018; 47:131-136. [PMID: 28889228 DOI: 10.1007/s00256-017-2769-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/17/2017] [Accepted: 08/25/2017] [Indexed: 02/02/2023]
Abstract
Calcific tendinopathy of the rotator cuff is a common cause of shoulder pain. Inflammation of the rotator cuff tendons may be complicated by adjacent bone erosion and subsequent migration of calcific deposits within the bone resulting in marrow inflammation. Bone marrow involvement is not readily visible using X-ray and ultrasound (US) and further testing is necessary. Magnetic resonance imaging (MRI) is a highly sensitive technique that can detect a focal bone T1 and T2-weighted hypointensity with bone marrow edema-like signal and cortical erosion. These findings can mislead the radiologist by suggesting an infectious or neoplastic lesion, often requiring further evaluation with computed tomography (CT) and biopsy. We report two cases of patients with shoulder pain in which different radiological approaches were used with pathological confirmation in one of them. In the first case, MRI revealed significant bone involvement in the head of the humerus and cortical erosion of the greater tuberosity. A CT examination and a biopsy was necessary for a final diagnosis of inflammatory bone reaction from intraosseous migration of tendinous calcifications. In the second case, similar MRI findings prompted re-evaluation of imaging to make a diagnosis of intraosseous migration of tendinous calcifications, obviating the need to perform CT and biopsy. We illustrate MRI signs of this complication that we think would allow to narrow the differential diagnosis potentially avoiding biopsy and additional CT examinations.
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15
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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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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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Nogueira-Barbosa MH, Gregio-Junior E, Lorenzato MM. Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series. Radiol Bras 2016; 48:353-7. [PMID: 26811551 PMCID: PMC4725395 DOI: 10.1590/0100-3984.2014.0077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective The present study was aimed at investigating bone involvement secondary to
rotator cuff calcific tendonitis at ultrasonography. Materials and Methods Retrospective study of a case series. The authors reviewed shoulder
ultrasonography reports of 141 patients diagnosed with rotator cuff calcific
tendonitis, collected from the computer-based data records of their
institution over a four-year period. Imaging findings were retrospectively
and consensually analyzed by two experienced musculoskeletal radiologists
looking for bone involvement associated with calcific tendonitis. Only the
cases confirmed by computed tomography were considered for descriptive
analysis. Results Sonographic findings of calcific tendinopathy with bone involvement were
observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58
years; 42% female). Cortical bone erosion adjacent to tendon calcification
was the most common finding, observed in 7/7 cases. Signs of intraosseous
migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The
findings were confirmed by computed tomography. Calcifications associated
with bone abnormalities showed no acoustic shadowing at ultrasonography,
favoring the hypothesis of resorption phase of the disease. Conclusion Preliminary results of the present study suggest that ultrasonography can
identify bone abnormalities secondary to rotator cuff calcific tendinopathy,
particularly the presence of cortical bone erosion.
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Affiliation(s)
- Marcello H Nogueira-Barbosa
- PhD, Associate Professor of Radiology at Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Everaldo Gregio-Junior
- MD, Radiologist, Fellow at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
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Malghem J, Omoumi P, Lecouvet F, Vande Berg B. Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series. Skeletal Radiol 2015; 44:1403-12. [PMID: 25975184 DOI: 10.1007/s00256-015-2165-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 02/02/2023]
Abstract
Calcium hydroxyapatite crystal deposition is a common disorder, which sometimes causes acute pain as calcifications dissolve and migrate into adjacent soft tissue. Intraosseous calcium penetration has also been described. We illustrate the appearance of these lesions using a series of 35 cases compiled by members of the French Society of Musculoskeletal Imaging (Société d'Imagerie Musculo-Squelettique, SIMS). The first group in our series (7 cases) involved calcification-related cortical erosions of the humeral and femoral diaphyses, in particular at the pectoralis major and gluteus maximus insertions. A second group (28 cases) involved the presence of calcium material in subcortical areas. The most common site was the greater tubercle of the humerus, accompanying a calcifying tendinopathy of the supraspinatus. In addition, an extensive intramedullary diffusion of calcium deposits was observed in four of these cases, associated with cortical erosion in one case and subcortical lesions in three cases. Cortical erosions and intraosseous migration of calcifications associated with calcific tendinitis may be confused with neoplasm or infection. It is important to recognize atypical presentations of hydroxyapatite deposition to avoid unnecessary investigation or surgery.
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Affiliation(s)
- Jacques Malghem
- Département de radiologie et d'imagerie médicale, Université Catholique de Louvain, Cliniques St- Luc, Avenue Hippocrate 10, B-1200, Bruxelles, Belgium,
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20
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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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Greis AC, Derrington SM, McAuliffe M. Evaluation and nonsurgical management of rotator cuff calcific tendinopathy. Orthop Clin North Am 2015; 46:293-302. [PMID: 25771323 DOI: 10.1016/j.ocl.2014.11.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Rotator cuff calcific tendinopathy is a common finding that accounts for about 7% of patients with shoulder pain. There are numerous theories on the pathogenesis of rotator cuff calcific tendinopathy. The diagnosis is confirmed with radiography, MRI or ultrasound. There are numerous conservative treatment options available and most patients can be managed successfully without surgical intervention. Nonsteroidal anti-inflammatory drugs and multiple modalities are often used to manage pain and inflammation; physical therapy can help improve scapular mechanics and decrease dynamic impingement; ultrasound-guided needle aspiration and lavage techniques can provide long-term improvement in pain and function in these patients.
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Affiliation(s)
- Ari C Greis
- Department of Physical Medicine and Rehabilitation, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
| | - Stephen M Derrington
- Department of Physical Medicine and Rehabilitation, Thomas Jefferson University, 25 South 9th Street, Philadelphia, PA 19107, USA
| | - Matthew McAuliffe
- Department of Physical Medicine and Rehabilitation, Thomas Jefferson University, 25 South 9th Street, Philadelphia, PA 19107, USA
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22
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The shoulder. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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DE Carli A, Pulcinelli F, Rose GD, Pitino D, Ferretti A. Calcific tendinitis of the shoulder. JOINTS 2014; 2:130-6. [PMID: 25606556 DOI: 10.11138/jts/2014.2.3.130] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Calcific tendinitis is a common disease that predominantly affects individuals aged between 40 and 60 years. Women seem to be more affected than men. Various factors have been suggested to play a role in this condition, such as abnormal activity of the thyroid gland, metabolic diseases (e.g. diabetes), and genetic predisposition. Various etiological hypotheses have been advanced: the degenerative and multiphasic theories are the two most accredited ones. Clinically, calcific tendinitis is characterized by severe, disabling pain which occurs spontaneously, usually in the morning. There can be concomitant stiffness, giving rise to a frozen shoulder-like clinical picture. Conventional radiography of the shoulder is the most appropriate imaging approach. Most cases resolve spontaneously. Many conservative treatments have been reported in the literature, showing varying levels of evidence of efficacy. Arthroscopic surgery is the orthopedic specialist's last option. It is to be noted that post-surgical pain can persist for many weeks after the operation. Finally, it is important not to forget the variant characterized by osteolytic involvement of the greater tuberosity, which has been associated with a worse clinical outcome, both after conservative treatment and after surgery.
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Affiliation(s)
- Angelo DE Carli
- II Faculty of Medicine and Surgery, "Sapienza" University of Rome, S. Andrea University Hospital, Rome, Italy
| | - Ferdinando Pulcinelli
- II Faculty of Medicine and Surgery, "Sapienza" University of Rome, S. Andrea University Hospital, Rome, Italy
| | - Giacomo Delle Rose
- Shoulder and Elbow Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Dario Pitino
- Department of Orthopaedics, University of Catania, Vittorio Emanuele Hospital, Catania, Italy
| | - Andrea Ferretti
- II Faculty of Medicine and Surgery, "Sapienza" University of Rome, S. Andrea University Hospital, Rome, Italy
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Diagnosis and Clinical Manifestations of Calcium Pyrophosphate and Basic Calcium Phosphate Crystal Deposition Diseases. Rheum Dis Clin North Am 2014; 40:207-29. [DOI: 10.1016/j.rdc.2014.01.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Barber FA, Cowden CH. Arthroscopic treatment of calcific tendonitis. Arthrosc Tech 2014; 3:e237-40. [PMID: 24904767 PMCID: PMC4044535 DOI: 10.1016/j.eats.2013.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 11/07/2013] [Indexed: 02/03/2023] Open
Abstract
Calcific tendonitis, or calcifying tendonitis, is a common disorder characterized by the multifocal accumulation of basic calcium phosphate crystals within the rotator cuff tendons. In most cases, the multifocal calcifications are located 1 to 2 cm from the insertion of the supraspinatus tendon on the greater tuberosity. The initial treatment should be nonoperative including oral anti-inflammatory medication and physical therapy. If this is unsuccessful, arthroscopic debridement of the deposit is effective. The technique used is an arthroscopic localization and debridement without associated subacromial decompression. The rotator cuff should be evaluated for partial- and full-thickness tears before and after the debridement of calcifications. If a partial- or full-thickness rotator cuff tendon tear is identified, it should be treated in a fashion consistent with those without associated calcium deposits. In our hands, tears 5 mm or greater in depth are repaired using a tendon-to-tendon or tendon-to-bone technique. Tears with less depth are debrided and then left alone. Arthroscopic debridement of calcific tendonitis can yield excellent functional results and high patient satisfaction.
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Affiliation(s)
- F. Alan Barber
- Address correspondence to F. Alan Barber, M.D., Plano Orthopedic Sports Medicine and Spine Center, 5228 W Plano Pkwy, Plano, TX 75093, U.S.A
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A Simple Technique to Restore Needle Patency During Percutaneous Lavage and Aspiration of Calcific Rotator Cuff Tendinopathy. PM R 2013; 5:242-4. [DOI: 10.1016/j.pmrj.2013.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/06/2013] [Indexed: 11/20/2022]
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Oliva F, Via AG, Maffulli N. Physiopathology of intratendinous calcific deposition. BMC Med 2012; 10:95. [PMID: 22917025 PMCID: PMC3482552 DOI: 10.1186/1741-7015-10-95] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/23/2012] [Indexed: 01/22/2023] Open
Abstract
In calcific tendinopathy (CT), calcium deposits in the substance of the tendon, with chronic activity-related pain, tenderness, localized edema and various degrees of decreased range of motion. CT is particularly common in the rotator cuff, and supraspinatus, Achilles and patellar tendons. The presence of calcific deposits may worsen the clinical manifestations of tendinopathy with an increase in rupture rate, slower recovery times and a higher frequency of post-operative complications. The aetiopathogenesis of CT is still controversial, but seems to be the result of an active cell-mediated process and a localized attempt of the tendon to compensate the original decreased stiffness. Tendon healing includes many sequential processes, and disturbances at different stages of healing may lead to different combinations of histopathological changes, diverting the normal healing processes to an abnormal pathway. In this review, we discuss the theories of pathogenesis behind CT. Better understanding of the pathogenesis is essential for development of effective treatment modalities and for improvement of clinical outcomes.
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Affiliation(s)
- Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome 'Tor Vergata' School of Medicine, Viale Oxford 81, Rome, Italy
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Abstract
Calcific tendinopathy (CT) of the tendons of the rotator cuff is common in white populations, with a reported prevalence varying from 2.7% to 22%, mostly affecting women between 30 and 50 years. Although CT shows a strong tendency toward self-healing by spontaneous resorption of the deposits, it does not always follow this typical pattern. The etiopathogenesis of CT is still unknown. Many pathogenetic theories have been proposed, and clinical associations between CT and diabetes and thyroid disorders have been reported. The choice of therapeutic approach should depend on the evolution of the condition.
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29
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Dalton SE. The shoulder. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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