1
|
Saran S, Babhulkar JA, Gupta H, Chari B. Imaging of calcific tendinopathy: natural history, migration patterns, pitfalls, and management: a review. Br J Radiol 2024; 97:1099-1111. [PMID: 38346707 PMCID: PMC11135804 DOI: 10.1093/bjr/tqae039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 05/31/2024] Open
Abstract
Calcific tendinopathy is characterized by the deposition of calcium hydroxyapatite crystals in various tendons of the body. Terms like calcium tendinitis, tendinosis, and tendinopathy are used interchangeably. Calcific tendinopathy is a common and well-documented ailment in the literature. Although common, the natural history, aetiology, and progression of calcific tendinitis are poorly understood. The treatment options include conservative and interventional measures. However, these measures cannot be applied as a blanket and are often tailored depending on the stage/phase of the disease. Out of the recognized stages of the disease, the resorptive stage causes the utmost symptoms when the calcium is rather soft and unstable. During this stage, the calcium may migrate beyond expected resorption and get deposited in the adjacent tissues contiguous with the calcium focus. The common destinations include bursal migration, intraosseous migration, muscular migration, and other less common migration sites. Such atypical presentations can lead to dilemmas in the diagnosis, prolongation of the diagnostic pathway, unwarranted apprehension, and treatment delay. Radiologists' role in this situation is to correctly recognize the imaging findings of atypical presentations of calcific tendinopathy and prevent unnecessary diagnostic and interventional studies. In this review article, we describe the pathogenic pathway and natural history of calcific tendinopathy from a radiologist's perspective and discuss different migratory patterns of calcium in calcific tendinopathy not only around the shoulder but also in other areas of the body on different imaging modalities. We also show a few examples of mimics and pitfalls on imaging. Finally, we discuss the appropriate management option of this condition.
Collapse
Affiliation(s)
- Sonal Saran
- Department of Radiodiagnosis, AIIMS, Rishikesh, 249203, India
| | - Joban Ashish Babhulkar
- Department of Radiology, Deenanath Mangeshkar Hospital, Star Imaging and Research Centre, Bharati Vidyapeeth, Pune, 411001, India
| | - Harun Gupta
- Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, United Kingdom
| | - Basavaraj Chari
- Oxford University Hospitals NHS Foundation Trust, OX3 7LD, United Kingdom
| |
Collapse
|
2
|
Cheng C, Liang X, Guo D, Xie D. Application of Artificial Intelligence in Shoulder Pathology. Diagnostics (Basel) 2024; 14:1091. [PMID: 38893618 PMCID: PMC11171621 DOI: 10.3390/diagnostics14111091] [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: 04/02/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Artificial intelligence (AI) refers to the science and engineering of creating intelligent machines for imitating and expanding human intelligence. Given the ongoing evolution of the multidisciplinary integration trend in modern medicine, numerous studies have investigated the power of AI to address orthopedic-specific problems. One particular area of investigation focuses on shoulder pathology, which is a range of disorders or abnormalities of the shoulder joint, causing pain, inflammation, stiffness, weakness, and reduced range of motion. There has not yet been a comprehensive review of the recent advancements in this field. Therefore, the purpose of this review is to evaluate current AI applications in shoulder pathology. This review mainly summarizes several crucial stages of the clinical practice, including predictive models and prognosis, diagnosis, treatment, and physical therapy. In addition, the challenges and future development of AI technology are also discussed.
Collapse
Affiliation(s)
- Cong Cheng
- Department of Orthopaedics, People’s Hospital of Longhua, Shenzhen 518000, China;
- Department of Joint Surgery and Sports Medicine, Center for Orthopedic Surgery, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.L.); (D.G.)
| | - Xinzhi Liang
- Department of Joint Surgery and Sports Medicine, Center for Orthopedic Surgery, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.L.); (D.G.)
| | - Dong Guo
- Department of Joint Surgery and Sports Medicine, Center for Orthopedic Surgery, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.L.); (D.G.)
| | - Denghui Xie
- Department of Joint Surgery and Sports Medicine, Center for Orthopedic Surgery, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.L.); (D.G.)
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| |
Collapse
|
3
|
Albano D, Viglino U, Messina C, Fusco S, Gitto S, Lacelli F, Sconfienza LM. US-guided percutaneous irrigation of extra-shoulder calcific tendinitis. Br J Radiol 2024; 97:267-273. [PMID: 38263822 PMCID: PMC11027245 DOI: 10.1093/bjr/tqad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/04/2023] [Accepted: 10/18/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To investigate the efficacy and safety of ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) applied out of the shoulder, comparing its effectiveness to US-PICT of the rotator cuff. METHODS Patients subjected to US-PICT for extra-shoulder calcific tendinitis (Case Group) were compared to those subjected to US-PICT of the rotator cuff (Control Group). We had pre-procedure Visual Analogue Scale (VAS) pain score, 1- and 3-month VAS of patients of the Case Group, pre-procedure and 3-month VAS of patients of the Control Group. RESULTS The Case Group consisted of 41 patients (27 women; mean age: 45 ± 9years): 26 gluteus medius, 5 patellar tendon, 3 rectus femoris, 2 gluteus maximus, 2 common extensor tendon, 1 extensor carpi radialis longus, 1 pes anserinus, and 1 peroneus longus. The Control Group included 41 patients (27 women; mean age: 47 ± 11 years). The mean pre-procedure VAS of the Case Group was 8.8 ± 0.7 with a significant (P < .001) drop at 1 month (4.5 ± 0.6) and 3 months (3.6 ± 0.6). The mean pre-procedure VAS of the Control Group was 8 ± 1.4 and dropped to 3.1 ± 1.6 after 3 months (P < .001). Post-treatment VAS at 3 months was not significantly different between two Groups (P = 0.134). Similarly, the decrease of VAS from baseline to 3 months was not significantly different between the two Groups (P = 0.264). CONCLUSIONS US-PICT is a safe and effective procedure that can be used out of the shoulder. ADVANCES IN KNOWLEDGE This study demonstrated the safety and effectiveness of US-PICT as a valuable therapeutic option for extra-shoulder calcific tendinitis, with similar clinical outcome to the same procedure performed in the rotator cuff. The technique must be adapted in some deeply located calcifications by means of the use of different needles and by thoroughly planning the access point for the procedure.
Collapse
Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan 20161, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan 20122, Italy
| | - Umberto Viglino
- Dipartimento di Scienze della Salute, Scuola di Scienze Mediche e Farmaceutiche, Università di Genova, Genoa 16132, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan 20161, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan 20122, Italy
| | - Stefano Fusco
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan 20122, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Milan 20161, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan 20122, Italy
| | - Francesca Lacelli
- ASL2 Dipartimento di Diagnostica - Radiologia P.O. Ponente, Pietra Ligure 17027, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan 20161, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan 20122, Italy
| |
Collapse
|
4
|
Moosmayer S, Ekeberg OM, Hallgren HB, Heier I, Kvalheim S, Juel NG, Blomquist J, Pripp AH, Brox JI. Ultrasound guided lavage with corticosteroid injection versus sham lavage with and without corticosteroid injection for calcific tendinopathy of shoulder: randomised double blinded multi-arm study. BMJ 2023; 383:e076447. [PMID: 37821122 PMCID: PMC10565688 DOI: 10.1136/bmj-2023-076447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To compare treatment effects between ultrasound guided lavage with corticosteroid injection and sham lavage with and without corticosteroid injection in patients with calcific tendinopathy of the shoulder. DESIGN Pragmatic, three arm, parallel group, double blinded, sham controlled, randomised, superiority trial with repeated measurements over 24 months. SETTING Six hospitals in Norway and Sweden. PARTICIPANTS 220 adults with calcific tendinopathy of the shoulder, persistent for at least three months. INTERVENTIONS Ultrasound guided deposit lavage plus subacromial injection of 20 mg triamcinolone acetonide and 9 mL 1% lidocaine hydrochloride (lavage+steroid); sham lavage plus subacromial injection of 20 mg triamcinolone acetonide and 9 mL 1% lidocaine hydrochloride (sham lavage+steroid); or sham lavage plus subacromial injection of 10 mL 1% lidocaine hydrochloride (sham). All patients received a physiotherapeutic treatment regimen consisting of four home exercises. MAIN OUTCOME MEASURES The primary outcome was the result on the 48 point scale (0=worst; 48=best) of the Oxford Shoulder Score (OSS) at four month follow-up. Secondary outcomes included measurements on the short form of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) and of pain intensity up to 24 months. The influence of the size of the deposit at baseline and of the persistence or disappearance of the deposit was investigated. RESULTS Data from 218 (99%) participants were included in the primary analysis. Differences between groups on the OSS at four months were not significant: lavage+steroid versus sham 0.2 (95% confidence interval -2.3 to 2.8; P=1.0); sham lavage+steroid versus sham 2.0 (-0.5 to 4.6; P=0.35); lavage+steroid versus sham lavage+steroid -1.8 (-4.3 to 0.7; P=0.47). After four months, 143 patients with insufficient treatment effect received supplementary treatment. At 24 months, none of the study procedures was superior to sham. No serious adverse events were reported. CONCLUSIONS This study found no benefit for ultrasound guided lavage with a corticosteroid injection or for sham lavage with a corticosteroid injection compared with sham treatment in patients with calcific rotator cuff tendinopathy of the shoulder. TRIAL REGISTRATION NCT02419040EudraCT 2015-002343-34; Ethical committee Norway 2015-002343-34; Ethical committee Sweden 2015/79-31; Clinicaltrials.gov NCT02419040.
Collapse
Affiliation(s)
- Stefan Moosmayer
- Department of Orthopedic Surgery, Martina Hansens Hospital, Gjettum, Norway
| | - Ole Marius Ekeberg
- Department of Physical Medicine and Rehabilitation, Helse Fonna HF Stord Hospital, Stord, Norway
| | | | - Ingar Heier
- Department of Physical Medicine and Rehabilitation, Vestfold Hospital, Stavern, Norway
| | - Synnøve Kvalheim
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Jesper Blomquist
- Department of Orthopedic Surgery, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Are Hugo Pripp
- Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital and Oslo Metropolitan University, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Ullevaal, Oslo, Norway
| |
Collapse
|
5
|
Warren AT, Ahmed A, Raja AE. Ischiofemoral Impingement Due to an Undiagnosed Pelvic Avulsion Fracture. Curr Sports Med Rep 2023; 22:353-357. [PMID: 37800746 DOI: 10.1249/jsr.0000000000001108] [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: 10/07/2023]
Abstract
ABSTRACT Ischial tuberosity (IT) avulsion fractures are an uncommon cause of injuries in athletes. In this case, a 26-year-old female suffering from posterior right hip pain for over a decade presented with debility and a decrease in athletic function. Notable history included a hamstring strain while sprinting in elementary school. Clinical examination suggested hamstring tendinopathy and ischiofemoral impingement (IFI). Magnetic resonance imaging (MRI) revealed a chronic, fragmented, IT apophyseal avulsion fracture with ischial bursitis and edema within the fragmented bone, suggesting the development of heterotopic ossification (HO). Diagnostic ultrasound revealed signs of IFI, not evident on MRI. Ultrasound-guided corticosteroid injection in her ischial bursa and ischiofemoral space provided complete relief. The patient was able to resume her activities of daily living and sports-related activities without pain. Although interventional treatments may provide temporary pain relief, a multimodal approach is required for the treatment of HO.
Collapse
Affiliation(s)
- Alec T Warren
- Rowan-Virtua School of Osteopathic Medicine, Sewell, NJ
| | - Abubakar Ahmed
- Temple University Hospital Physical Medicine and Rehabilitation Residency Program, Philadelphia, PA
| | - Altamash E Raja
- Department of Rehabilitation Medicine, Rowan-Virtua School of Osteopathic Medicine, Sewell, NJ
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Wang H, Dai GC, Li YJ, Chen MH, Lu PP, Zhang YW, -Zhang M, Cao MM, Rui YF. Targeting Senescent Tendon Stem/Progenitor Cells to Prevent or Treat Age-Related Tendon Disorders. Stem Cell Rev Rep 2022; 19:680-693. [PMID: 36520409 DOI: 10.1007/s12015-022-10488-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/01/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
Age-related tendon disorder, a primary motor system disease, is characterized by biological changes in the tendon tissue due to senescence and seriously affects the quality of life of the elderly. The pathogenesis of this disease is not well-understood. Tendon stem/progenitor cells (TSPCs) exhibit multi-differentiation capacity. These cells are important cellular components of the tendon because of their roles in tendon tissue homeostasis, remodeling, and repair. Previous studies revealed alterations in the biological characteristics and tenogenic differentiation potential of TSPCs in senescent tendon tissue, in turn contributing to insufficient differentiation of TSPCs into tenocytes. Poor tendon repair can result in age-related tendinopathies. Therefore, targeting of senescent TSPCs may restore the tenogenic differentiation potential of these cells and achieve homeostasis of the tendon tissue to prevent or treat age-related tendinopathy. In this review, we summarize the biological characteristics of TSPCs and histopathological changes in age-related tendinopathy, as well as the potential mechanisms through which TSPCs contribute to senescence. This information may promote further exploration of innovative treatment strategies to rescue TSPCs from senescence.
Collapse
Affiliation(s)
- Hao Wang
- Department of Orthopaedics, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Trauma Center, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
| | - Guang-Chun Dai
- Department of Orthopaedics, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Trauma Center, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
| | - Ying-Juan Li
- Department of Orthopaedics, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Trauma Center, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
| | - Min-Hao Chen
- Department of Orthopaedics, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Trauma Center, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
| | - Pan-Pan Lu
- Department of Orthopaedics, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Trauma Center, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
| | - Yuan-Wei Zhang
- Department of Orthopaedics, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Trauma Center, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
| | - Ming -Zhang
- Department of Orthopaedics, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
| | - Mu-Min Cao
- Department of Orthopaedics, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
- Trauma Center, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China
| | - Yun-Feng Rui
- Department of Orthopaedics, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China.
- Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China.
- Trauma Center, School of Medicine, Zhongda Hospital, Southeast University, No. 87 Ding Jia Qiao, 210009, Nanjing, Jiangsu, PR China.
| |
Collapse
|
8
|
Dong S, Li J, Zhao H, Zheng Y, Chen Y, Shen J, Yang H, Zhu J. Risk Factor Analysis for Predicting the Onset of Rotator Cuff Calcific Tendinitis Based on Artificial Intelligence. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8978878. [PMID: 35449743 PMCID: PMC9017518 DOI: 10.1155/2022/8978878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/31/2022] [Indexed: 12/19/2022]
Abstract
Background Symptomatic rotator cuff calcific tendinitis (RCCT) is a common shoulder disorder, and approaches combined with artificial intelligence greatly facilitate the development of clinical practice. Current scarce knowledge of the onset suggests that clinicians may need to explore this disease thoroughly. Methods Clinical data were retrospectively collected from subjects diagnosed with RCCT at our institution within the period 2008 to 2020. A standardized questionnaire related to shoulder symptoms was completed in all cases, and standardized radiographs of both shoulders were extracted using a human-computer interactive electronic medical system (EMS) to clarify the clinical diagnosis of symptomatic RCCT. Based on the exclusion of asymptomatic subjects, risk factors in the baseline characteristics significantly associated with the onset of symptomatic RCCT were assessed via stepwise logistic regression analysis. Results Of the 1,967 consecutive subjects referred to our academic institution for shoulder discomfort, 237 were diagnosed with symptomatic RCCT (12.05%). The proportion of women and the prevalence of clinical comorbidities were significantly higher in the RCCT cohort than those in the non-RCCT cohort. Stepwise logistic regression analysis confirmed that female gender, hyperlipidemia, diabetes mellitus, and hypothyroidism were independent risk factors for the entire cohort. Stratified by gender, the study found a partial overlap of risk factors contributing to morbidity in men and women. Diagnosis of hyperlipidemia, diabetes mellitus, and hypothyroidism in male cases and diabetes mellitus in female cases were significantly associated with symptomatic RCCT. Conclusion Independent predictors of symptomatic RCCT are female, hyperlipidemia, diabetes mellitus, and hypothyroidism. Men diagnosed with hyperlipidemia, diabetes mellitus, and hypothyroidism are at high risk for symptomatic RCCT, while more medical attention is required for women with diabetes mellitus. Artificial intelligence offers pioneering innovations in the diagnosis and treatment of musculoskeletal disorders, and careful assessment through individualized risk stratification can help predict onset and targeted early stage treatment.
Collapse
Affiliation(s)
- Shengtao Dong
- Department of Spine Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Jie Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Haozong Zhao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Yuanyuan Zheng
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Yaoning Chen
- Department of Spine Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Junxi Shen
- Department of Spine Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Hua Yang
- Department of Otolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian 116000, China
| | - Jieyang Zhu
- Department of Spine Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| |
Collapse
|
9
|
Martinel V, Fermandois-Maltes P. Arthroscopic Ultrasound-Guided Needling: An Effective Technique for the Treatment of Calcific Rotator Cuff Tendinopathy. Arthrosc Tech 2021; 10:e2021-e2026. [PMID: 34401249 PMCID: PMC8355534 DOI: 10.1016/j.eats.2021.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/25/2021] [Indexed: 02/03/2023] Open
Abstract
Calcifying tendinopathies of the rotator cuff that do not respond to conservative treatment may require arthroscopic removal. Intraoperative localization of calcifications can be difficult and is usually performed by bursal needle probing. We present a surgical technique combining arthroscopy and intraoperative ultrasonography based on the ultrasound-guided needle technique to precisely and rapidly locate even small calcium deposits. The modalities may differ depending on tendon topography. This nonirradiating technique with this compact device should be more widely used.
Collapse
Affiliation(s)
- Vincent Martinel
- Address correspondence to Vincent Martinel, M.D., Groupe Orthopédie Ormeau Pyrénées, ELSAN - Polyclinique de l’Ormeau, 28 Bvd du 8 Mai 1945, 65000 TARBES – France.
| | | |
Collapse
|
10
|
Tortora S, Messina C, Gitto S, Chianca V, Serpi F, Gambino A, Pedone L, Carrafiello G, Sconfienza LM, Albano D. Ultrasound-guided musculoskeletal interventional procedures around the shoulder. J Ultrason 2021; 21:e162-e168. [PMID: 34258042 PMCID: PMC8264815 DOI: 10.15557/jou.2021.0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/15/2021] [Indexed: 11/22/2022] Open
Abstract
Ultrasound is a fast, accessible, reliable, and radiation-free imaging modality routinely used to assess the soft tissues around the shoulder. It enables to identify a wide range of pathological conditions. Furthermore, most ultrasound-guided musculoskeletal interventional procedures around the shoulder produce better results in terms of accuracy and clinical efficacy than those performed in a blinded fashion. Indeed, intra-articular and peri-articular interventional procedures can be easily performed under continuous ultrasound monitoring to ensure the correct position of the needle and to deliver the medication to a specific target. Several technical approaches and medications can be used to treat different causes of painful shoulder. Intra-articular injections are applied to treat acromioclavicular osteoarthritis as well as glenohumeral joint osteoarthritis and adhesive capsulitis. Subacromial-subdeltoid bursitis, either presenting as a primary inflammatory condition or secondary to rotator cuff disorders, can be easily approached using ultrasound guidance to aspirate synovial effusion and to inject medications. Ultrasound-guided percutaneous irrigation is a well-established technique increasingly applied to treat patients with rotator cuff calcific tendinopathy. Also, degenerative rotator cuff tendinopathy can be conservatively treated by image-guided interventions, specifically with needling under ultrasound guidance that can be associated with injections of platelet-rich plasma. Lastly, periarticular peripheral nerve block can be quickly and safely performed under ultrasound guidance, particularly in conditions involving the suprascapular nerve in the setting of pre-operative analgesia or pain treatment in glenohumeral osteoarthritis and adhesive capsulitis. In this article, the most common ultrasound-guided procedures around the shoulder have been reviewed to discuss indications and techniques.
Collapse
Affiliation(s)
- Silvia Tortora
- Department of Radiology, Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Italy
| | | | - Salvatore Gitto
- Department of Biomedical Science for Health, University of Milan, Italy
| | - Vito Chianca
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonese (EOC), Lugano, Switzerland.,Diagnostica per Immagini, Ospedale Evangelico Betania, Italy
| | - Francesca Serpi
- Department of Radiology, Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Italy
| | | | - Luigi Pedone
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Gianpaolo Carrafiello
- Unità Operativa di Radiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy.,Department of Health Sciences, University of Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Department of Biomedical Science for Health, University of Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Italy
| |
Collapse
|