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Litak J, Grochowski C, Rysak A, Mazurek M, Blicharski T, Kamieniak P, Wolszczak P, Rahnama-Hezavah M, Litak G. New Horizons for Hydroxyapatite Supported by DXA Assessment-A Preliminary Study. MATERIALS (BASEL, SWITZERLAND) 2022; 15:942. [PMID: 35160888 PMCID: PMC8839981 DOI: 10.3390/ma15030942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 12/10/2022]
Abstract
Dual Energy X-ray Absorptiometry (DXA) is a tool that allows the assessment of bone density. It was first presented by Cameron and Sorenson in 1963 and was approved by the Food and Drug Administration. Misplacing the femoral neck box, placing a trochanteric line below the midland and improper placement of boundary lines are the most common errors made during a DXA diagnostic test made by auto analysis. Hydroxyapatite is the most important inorganic component of teeth and bone tissue. It is estimated to constitute up to 70% of human bone weight and up to 50% of its volume. Calcium phosphate comes in many forms; however, studies have shown that only tricalcium phosphate and hydroxyapatite have the characteristics that allow their use as bone-substituted materials. The purpose of this study is aimed at analyzing the results of hip densitometry and hydorxyapatite distribution in order to better assess the structure and mineral density of the femoral neck. However, a detailed analysis of the individual density curves shows some qualitative differences that may be important in assessing bone strength in the area under study. To draw more specific conclusions on the therapy applied for individual patients, we need to determine the correct orientation of the bone from the resulting density and document the trends in the density distribution change. The average results presented with the DXA method are insufficient.
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Affiliation(s)
- Jakub Litak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (C.G.); (M.M.); (P.K.)
- Department of Automation, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland; (A.R.); (P.W.); (G.L.)
| | - Cezary Grochowski
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (C.G.); (M.M.); (P.K.)
- Department of Automation, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland; (A.R.); (P.W.); (G.L.)
| | - Andrzej Rysak
- Department of Automation, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland; (A.R.); (P.W.); (G.L.)
| | - Marek Mazurek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (C.G.); (M.M.); (P.K.)
| | - Tomasz Blicharski
- Department of Rehabilitation and Orthopedics, Medical University of Lublin, ul. Jaczewskiego 8, 20-090 Lublin, Poland;
| | - Piotr Kamieniak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (C.G.); (M.M.); (P.K.)
| | - Piotr Wolszczak
- Department of Automation, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland; (A.R.); (P.W.); (G.L.)
| | - Mansur Rahnama-Hezavah
- Chair and Department of Oral Surgery, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Grzegorz Litak
- Department of Automation, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland; (A.R.); (P.W.); (G.L.)
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Vaishya R, Vaish A, Ansari AH. Acute painful calcific tendonitis of the shoulder. Postgrad Med J 2021; 98:e2. [PMID: 33688070 DOI: 10.1136/postgradmedj-2021-139719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Raju Vaishya
- Orthopaedics, Institutes of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| | - Abhishek Vaish
- Orthopaedics, Institutes of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| | - Aabid Husain Ansari
- Orthopaedics, Institutes of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
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Cho N, Lee SG, Kim JO, Kim YA, Kim EM, Park C, Ji JH, Kim KK. Identification of Differentially Expressed Genes Associated with Extracellular Matrix Degradation and Inflammatory Regulation in Calcific Tendinopathy Using RNA Sequencing. Calcif Tissue Int 2020; 107:489-498. [PMID: 32776213 DOI: 10.1007/s00223-020-00743-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/31/2020] [Indexed: 12/19/2022]
Abstract
Calcific tendinopathy (CT), developed due to calcium hydroxyapatite deposition in the rotator cuff tendon, mostly affects women in their 40 s and 50 s and causes severe shoulder pain. However, the molecular basis of its pathogenesis and appropriate treatment methods are largely unknown. In this study, we identified 202 differentially expressed genes (DEGs) between calcific and adjacent normal tendon tissues of rotator cuff using RNA sequencing-based transcriptome analysis. The DEGs were highly enriched in extracellular matrix (ECM) degradation and inflammation-related processes. Further, matrix metalloproteinase 9 (MMP9) and matrix metalloproteinase 13 (MMP13), two of the enzymes associated with ECM degradation, were found to be highly upregulated 25.85- and 19.40-fold, respectively, in the calcific tendon tissues compared to the adjacent normal tendon tissues. Histopathological analyses indicated collagen degradation and macrophage infiltration at the sites of calcific deposit in the rotator cuff tendon. Our study acts as a foundation that may help in better understanding of the pathogenesis associated with CT, and thus in better management of the disease.
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Affiliation(s)
- Namjoon Cho
- Department of Biochemistry, College of Natural Sciences, Chungnam National University, Daejeon, Republic of Korea
| | - Sung-Gwon Lee
- School of Biological Science and Technology, Chonnam National University, Gwangju, Republic of Korea
| | - Jong Ok Kim
- Department of Pathology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Yong-An Kim
- Department of Biochemistry, College of Natural Sciences, Chungnam National University, Daejeon, Republic of Korea
| | - Eun-Mi Kim
- Department of Predictive Toxicology, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Chungoo Park
- School of Biological Science and Technology, Chonnam National University, Gwangju, Republic of Korea.
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.
| | - Kee K Kim
- Department of Biochemistry, College of Natural Sciences, Chungnam National University, Daejeon, Republic of Korea.
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Tomori Y, Nanno M, Takai S. Acute calcific periarthritis of the proximal phalangeal joint on the fifth finger: A case report and literature review. Medicine (Baltimore) 2020; 99:e21477. [PMID: 32756172 PMCID: PMC7402791 DOI: 10.1097/md.0000000000021477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
RATIONALE Acute calcium deposits, including acute calcific periarthritis or acute calcific peritendinitis, are benign calcifying soft tissue lesions that have a self-resolving course. These calcifying lesions usually develop in the shoulder, while acute calcific periarthritis in the digits is uncommon. When acute calcific periarthritis involves the digits, the lesion occasionally mimics other benign calcifying or ossifying lesions and can easily be misdiagnosed, resulting in unnecessary diagnostic studies and treatment. We present a rare case of acute calcific periarthritis around the proximal phalangeal joint of the left fifth finger that took a long time to spontaneously resolve, and review previous reports of similar cases. PATIENT CONCERNS A 69-year-old woman complained of longstanding pain and swelling of the fifth finger of the left hand. She had visited several clinics and hospitals and had been treated with analgesics and splinting for more than 2 months, but the pain in the finger had gradually worsened. DIAGNOSES Blood chemistry analysis showed no signs of inflammation or other abnormalities. Radiographs revealed a well-defined subcutaneous calcifying lesion without bony destruction, suggesting a benign calcification process. Computed tomography and magnetic resonance imaging led to a diagnosis of acute calcific periarthritis of the proximal interphalangeal joint of the fifth finger. INTERVENTIONS An excisional biopsy was recommended to achieve a definitive diagnosis, but this was declined by the patient. Thus, no invasive treatments were administered, and she was treated with analgesics and encouraged to massage the affected finger. OUTCOMES The pain gradually improved, and follow-up radiographs showed complete disappearance of the calcifying mass 6 months after the initial visit to our hospital, without recurrence during a follow-up period of more than 2 years. LESSONS Acute calcific periarthritis is diagnosed based on history, clinical examination, and imaging findings, which provide evidence for the diagnosis of calcium deposition in the digits even if the lesions have been present for a long time. Watchful observation is an appropriate treatment strategy for acute calcific periarthritis of the digits.
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Affiliation(s)
- Yuji Tomori
- Departments of Orthopaedic Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa
- Departments of Orthopaedic Surgery, Ukima Central Hospital
| | - Mitsuhiko Nanno
- Departments of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinro Takai
- Departments of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Akhtar MA, Tyas B, Bethapudi S. A rare case of calcific tendinitis of biceps femoris presenting with lateral knee pain. J Clin Orthop Trauma 2020; 11:S660-S662. [PMID: 32774045 PMCID: PMC7394803 DOI: 10.1016/j.jcot.2020.04.015] [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: 03/29/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022] Open
Abstract
Distal biceps femoris tendon is an unusual site of calcific tendinitis and a rare cause of knee pain. We present a case of 72-year-old lady who presented with a six-month history of pain over the lateral aspect of knee. Subsequent imaging demonstrated calcific deposits within the biceps femoris tendon substance. She was then successfully treated with ultrasound-guided barbotage of the calcium deposits and peri-tendinous corticosteroid injection. Clinical awareness of the unusual sites of calcific tendinitis with imaging evidence is important for early diagnosis and appropriate management.
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Affiliation(s)
- Muhammad Adeel Akhtar
- Consultant Trauma and Orthopaedic Surgeon, NHS Fife, Victoria Hospital Kirkcaldy, UK
| | - Ben Tyas
- Trauma and Orthopaedic Clinical Research Fellow, QE Gateshead, Gateshead Health NHS Foundation Trust, UK
| | - Sarath Bethapudi
- Lead Consultant Musculoskeletal Radiologist, University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, UK,Durham University, UK,Corresponding author. County Durham and Darlington NHS Foundation Trust, Durham, UK.
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Leverenz DL, Criscione-Schreiber LG. A Fuzzy Cause of Hip Pain. Am J Med 2020; 133:580-581. [PMID: 31715162 DOI: 10.1016/j.amjmed.2019.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022]
Affiliation(s)
- David L Leverenz
- Department of Internal Medicine, Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, N.C.
| | - Lisa G Criscione-Schreiber
- Department of Internal Medicine, Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, N.C
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Agbeboh NI, Oladele IO, Daramola OO, Adediran AA, Olasukanmi OO, Tanimola MO. Environmentally sustainable processes for the synthesis of hydroxyapatite. Heliyon 2020; 6:e03765. [PMID: 32368642 PMCID: PMC7184159 DOI: 10.1016/j.heliyon.2020.e03765] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/15/2020] [Accepted: 04/06/2020] [Indexed: 11/03/2022] Open
Abstract
Hard tissue regeneration and regrowth have continued to be a challenge in the field of conventional medicine in this 21st century. Over the years, the regrowth of broken bones and diseased hard tissue has remained a major concern in medical research. Since the discovery of hydroxyapatite (HA), a bioceramic compound that possesses the ability to activate bone regrowth and bond directly with regenerated bone, it has subsequently become an indispensable biomaterial. Currently, it is being used across the medical fields due to its exceptional biocompatibility. This became plausible because the main mineral phase of mammalian bones is HA. It has found application in various medical fields like medical instruments, drug delivery, bone and tooth fillers, prosthetics, orthotics, and in-vitro implants. As the importance of HA geometrically increases, it is necessary to critically evaluate and propose the most economic process of synthesizing and manufacturing this important bioceramic material. This review, therefore, highlights the different sources of HA and the synthesis/production methods for each source with a strong emphasis on the environment. Thus, the appraisal was carried out based on the properties of the derived HA. Such properties include but are not limited to geometry, particle size, morphology, thermal stability, and stoichiometry to suggest the most economic and environmentally sustainable sources and processing routes.
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Affiliation(s)
- N I Agbeboh
- Department of Metallurgical and Materials Engineering, Federal University of Technology, Akure, Ondo State, Nigeria.,Department of Mechanical and Mechatronics Engineering, Federal University Otuoke, Ogbia, Bayelsa State, Nigeria
| | - I O Oladele
- Department of Metallurgical and Materials Engineering, Federal University of Technology, Akure, Ondo State, Nigeria
| | - O O Daramola
- Department of Metallurgical and Materials Engineering, Federal University of Technology, Akure, Ondo State, Nigeria.,Institute of Nano-Engineering Research (INER), Department of Chemical, Metallurgical and Materials Engineering (Polymer Division), Tshwane University of Technology, Pretoria, South Africa
| | - A A Adediran
- Department of Mechanical Engineering, Landmark University, Omuaran, Kwara State, Nigeria
| | - O O Olasukanmi
- Department of Industrial Chemistry, Federal University of Technology, Akure, Ondo State, Nigeria
| | - M O Tanimola
- Department of Civil Engineering, Federal University of Technology, Akure, Ondo State, Nigeria
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Awadh B, Al-Allaf AW. Acute calcific epicondylitis associated with primary hypoparathyroidism: a paradox effect or an adverse event. Rheumatol Adv Pract 2020; 4:rkaa007. [PMID: 32296744 PMCID: PMC7151650 DOI: 10.1093/rap/rkaa007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/17/2020] [Accepted: 03/05/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Basem Awadh
- Rheumatology Division, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Abdul Wahab Al-Allaf
- Rheumatology Division, Department of Medicine, Hamad General Hospital, Doha, Qatar
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Zheng F, Wang H, Gong H, Fan H, Zhang K, Du L. Role of Ultrasound in the Detection of Rotator-Cuff Syndrome: An Observational Study. Med Sci Monit 2019; 25:5856-5863. [PMID: 31386649 PMCID: PMC6693366 DOI: 10.12659/msm.915547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Physical tests are usually preferred to assess rotator-cuff syndrome but are insufficient to predict the morphology and size of the rotator-cuff. The objective of the study was to rate the ultrasound findings for patients with sudden shoulder pain and to determine potential predictors of the same. Material/Methods A total of 112 patients with sudden shoulder pain with rotator-cuff syndrome, suspected by orthopedic doctors, were subjected to ultrasonography. Real-time ultrasonography was done for the acromioclavicular joint, biceps, infraspinatus, posterior labrum, subscapularis, supraspinatus, teres minor tendon, and the sub-acromial-subdeltoid bursa. Each tendon was assessed via scanning planes in orientation as per longer and shorter axis, and from their myotendinous junction shoulder to bony insertions. Linear and logistic regression analysis were performed to predict the associations of medical history with rotator-cuff injury. Results Ultrasonography identified that 82% of the enrolled patients had at least one particular cause of the rotator-cuff disorder. Among the rotator-cuff disorders, calcific tendonitis (54%) was observed more frequently followed by tendinopathy (32%), subacromial-subdeltoid bursitis (22%), and partial thickness tear (21%). Also, 46 patients (41%) had multiple findings. Older age (older than 40 years) was a strong predicting factor of rotator-cuff disorder (r2=0.36, P=0.0004). Conclusions Ultrasonography is a vital diagnostic procedure used by orthopedic surgeons for diagnosis of the rotator-cuff disorder(s) in patients with sudden shoulder pain.
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Affiliation(s)
- Fang Zheng
- Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland).,Department of Ultrasonic, The First Affiliated Hospital of XinXiang Medical University, Weihui, Henan, China (mainland)
| | - Haiyan Wang
- Department of Ultrasonic, The First Affiliated Hospital of XinXiang Medical University, Weihui, Henan, China (mainland)
| | - Hongyan Gong
- Department of Anesthesiology, The First Affiliated Hospital of XinXiang Medical University, Weihui, Henan, China (mainland)
| | - Huijun Fan
- Department of Ultrasonic, The First Affiliated Hospital of XinXiang Medical University, Weihui, Henan, China (mainland)
| | - Kai Zhang
- Department of Ultrasonic, The First Affiliated Hospital of XinXiang Medical University, Weihui, Henan, China (mainland)
| | - Lianfang Du
- Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
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Reifsnyder JW. Acute Calcific Periarthritis of the Hand: A Case Report in an Active Duty Soldier. Mil Med 2019; 184:e587-e589. [DOI: 10.1093/milmed/usz054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/11/2019] [Accepted: 02/28/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Acute calcific periarthritis of the hand is a condition that can easily be misdiagnosed resulting in unnecessary diagnostic studies and treatment. The condition is thought to be benign with a self-resolving course. The author presents a case of an active duty 29-year-old male who presented to a military emergency department with severe atraumatic hand pain developing overnight with initial concern for flexor tenosynovitis. Following orthopedic consultation, he was determined to have acute calcific periarthritis of the small finger (metacarpophalangeal) MCP joint with resolution over approximately 3 weeks without recurrence over a 5-month period. This case report reviews the natural history of acute calcific deposits of the hand and its correct identification through clinical exam and plain radiographs to avoid unnecessary diagnostic testing and invasive surgical interventions.
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Kim J, Bae KJ, Lee DW, Lee YH, Gong HS, Baek GH. Effective period of conservative treatment in patients with acute calcific periarthritis of the hand. J Orthop Surg Res 2018; 13:287. [PMID: 30428905 PMCID: PMC6236998 DOI: 10.1186/s13018-018-0997-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute calcific periarthritis of the hand is a relatively uncommon painful condition involving juxta-articular deposits of amorphous calcium hydroxyapatite. Although conservative treatments have been generally considered effective, there is little evidence regarding how long they could remain effective. METHODS We retrospectively reviewed ten patients who were diagnosed with acute calcific periarthritis of the hand from January 2015 to June 2018. We recommended the use of warm baths, nonsteroidal anti-inflammatory drugs (NSAIDs), and limited activity as initial treatments. If the pain persisted despite at least 3 months of conservative treatment, we explained surgical treatment options. If the pain improved, we recommended gradual range-of-motion exercises with the continuation of daily NSAIDs use. The visual analogue scale (VAS) score for pain at each subsequent visit (3, 6, and 9 months) was compared with that of the previous visit to investigate whether the pain had decreased during each time interval. Simple radiographs taken at each visit were compared with those taken at the previous visit to determine whether any significant changes in the amount of calcification had occurred during each time interval. RESULTS All 10 patients with 17 affected joints continued conservative treatments for an average of 11.1 months. The average VAS score for pain at the initial visit was 7, while that at 3, 6, and 9 months was 4.3, 3.3, and 2.9, respectively. There was a significant reduction in the VAS score at 3 and 6 months, but not at 9 months (P values = 0.004, 0.008, and 0.598, respectively). The simple radiographs also showed a significant reduction in the amount of calcification at 3 and 6 months, but not at 9 months (P values = 0.020, 0.034, and 0.083, respectively). CONCLUSIONS Patients with acute calcific periarthritis of the hand exhibited residual pain and calcification for a relatively prolonged period. Those who continued conservative treatment, including NSAIDs, showed pain relief and reduced calcification for up to 6 months. These results suggest that conservative treatment could be tried for at least 6 months before considering the surgical treatment of calcific periarthritis of the hand.
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Affiliation(s)
- Jihyeung Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kee Jeong Bae
- Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea.
| | - Do Weon Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Yo-Han Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
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Acute calcific tendinopathy of the popliteus tendon: a rare case diagnosed using a multimodality imaging approach and treated conservatively. Skeletal Radiol 2017; 46:1003-1006. [PMID: 28303297 DOI: 10.1007/s00256-017-2623-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/01/2017] [Accepted: 03/05/2017] [Indexed: 02/02/2023]
Abstract
Acute calcific tendinopathy of the popliteus tendon is a rare medical entity associated with significant patient discomfort. We present the case of a previously healthy 48-year-old female who presented to the emergency department with acute onset of left knee pain. Initial radiographs revealed calcifications within the posterolateral compartment of the knee. Ultrasound imaging demonstrated a swollen and hypoechoic popliteus tendon with an increased color Doppler signal at the periphery of the tendon as well as calcification in the tendon and adjacent soft tissues. Subsequently performed MRI revealed a thickened and heterogeneous popliteus tendon near its femoral attachment with marked edematous changes surrounding the tendon. Local ultrasound-guided glucocorticoid injection had successful clinical results with no recurrence at 8-month follow-up. In this case report we review the literature for similar previously reported cases. This case report of popliteus tendon calcific tendinopathy provides comprehensive multimodality imaging findings and a description of its non-surgical management.
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Schaffer TC, Schaffer MC. Disorders of the Upper Extremity. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Park JW, Hwang JH, Choi YS, Kim SJ. Comparison of Therapeutic Effect of Extracorporeal Shock Wave in Calcific Versus Noncalcific Lateral Epicondylopathy. Ann Rehabil Med 2016; 40:294-300. [PMID: 27152280 PMCID: PMC4855124 DOI: 10.5535/arm.2016.40.2.294] [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] [Received: 02/02/2015] [Accepted: 08/28/2015] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the therapeutic effect of extracorporeal shock wave therapy (ESWT) in lateral epicondylopathy with calcification, and compare it to the effect of ESWT in lateral epicondylopathy without calcification. Methods A retrospective study was conducted. Forty-three patients (19 with calcific and 24 with noncalcific lateral epicondylopathy in ultrasound imaging) were included. Clinical evaluations included the 100-point score, Nirschl Pain Phase scale before and after ESWT, and Roles and Maudsley (R&M) scores after ESWT. ESWT (2,000 impulses and 0.06–0.12 mJ/mm2) was performed once a week for 4 weeks. Results The 100-point score and Nirschl Pain Phase scale changed significantly over time (p<0.001), but there was no significant difference between groups (p=0.555). The R&M scores at 3 and 6 months after ESWT were not significantly different between groups. In the presence of a tendon tear, those in the calcific lateral epicondylopathy group showed poor improvement of 100-point scores compared to the noncalcific group (p=0.004). Conclusion This study demonstrated that the therapeutic effect of ESWT in calcific lateral epicondylopathy was not significantly different from that in noncalcific lateral epicondylopathy. When a tendon tear is present, patients with calcific lateral epicondylopathy might show poor prognosis after ESWT relative to patients with noncalcific lateral epicondylopathy.
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Affiliation(s)
- Jong Wook Park
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo Seong Choi
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jun Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rees J, Gaida JE, Silbernagel KG, Zwerver J, Anthony JS, Scott A. Rehabilitation of Tendon Problems in Patients with Diabetes Mellitus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 920:199-208. [PMID: 27535262 DOI: 10.1007/978-3-319-33943-6_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Exercise is crucial in the management of diabetes mellitus and its associated complications. However, individuals with diabetes have a heightened risk of musculoskeletal problems, including tendon pathologies. Diabetes has a significant impact on the function of tendons due to the accumulation of advanced glycation end-products in the load-bearing collagen. In addition, tendon vascularity and healing may be reduced due to diabetes-induced changes in the peripheral vascular system, and impaired synthesis of collagen and glycosaminoglycan. The current chapter presents an evidence-based discussion of considerations for the rehabilitation of tendon problems in people with diabetes. The following conditions are discussed in detail - calcific tendinopathy, tenosynovitis, tendon rupture, and non-calcifying tendinopathy. Common diabetes-related findings are presented, along with their potential impact on tendinopathy management and suggested modifications to standard tendinopathy treatment protocols. A holistic approach should be used to optimize musculotendinous function, including a comprehensive exercise prescription addressing strength, flexibility, and aerobic fitness.
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Affiliation(s)
- Jonathan Rees
- Department of Rheumatology, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
- Academic Department of Sport and Exercise Medicine, Queen Mary College, London, UK
- Department of Sport and Exercise Medicine, Fortius Clinic, London, UK
| | - Jamie E Gaida
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Discipline of Physiotherapy, University of Canberra, Canberra, ACT, Australia
| | | | - Johannes Zwerver
- Center for Sports Medicine, UMC Groningen, 30.001, 9700, RB Groningen, The Netherlands
| | - Joseph S Anthony
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Alex Scott
- Department of Physical Therapy, Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.
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Vinanti GB, Pavan D, Rossato A, Biz C. Atypical localizations of calcific deposits in the shoulder. Int J Surg Case Rep 2015; 10:206-10. [PMID: 25884610 PMCID: PMC4430114 DOI: 10.1016/j.ijscr.2015.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/20/2015] [Accepted: 04/03/2015] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Calcific tendinopathies of the shoulder are due to inflammation around deposits of calcium within periarticular tendineal structures. PRESENTATION OF CASES We present three cases of atypical localization of calcium deposits in the shoulder. All of the cases have been treated with arthroscopic excision, followed by post-operative rehabilitation, regaining excellent results. Patients were evaluated 6 months after surgery using the Visual Analogue Scale (VAS), the Simple Shoulder Test (SST) and the UCLA modified shoulder rating. DISCUSSION Calcific tendinopathy is a self-limiting condition or is successfully treated with conservative therapy especially during the early phases of the pathology. If conservative measures fail, removal of calcium deposits is recommended. Arthroscopic management showed good results in our three cases. CONCLUSION We suggest that arthroscopic treatment of calcific tendonitis guarantees good results even when calcium deposits are in atypical locations.
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Affiliation(s)
- G B Vinanti
- Saint Rocco Clinic, via dei Sabbioni 24, 25050 Ome, Brescia, Italy.
| | - D Pavan
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128 Padova, Italy.
| | - A Rossato
- Saint Rocco Clinic, via dei Sabbioni 24, 25050 Ome, Brescia, Italy.
| | - Carlo Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128 Padova, Italy.
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Abstract
Calcium, or calcific, deposition disease in the form of acute calcific periarthritis of the hand and wrist is an uncommon entity that may be confused with more common crystalline or inflammatory arthropathies as well as infection. It is important for the clinician to be aware of this disease process and to include it in the differential diagnosis of patients presenting with acutely painful, focal inflammation of the hand or wrist. Nonsurgical management is often sufficient; however, considering the self-limited nature of the disease, accurate diagnosis is essential to avoid unnecessary antibiotic or surgical treatment.
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Ottenheijm RPG, Cals JWL, Weijers R, Vanderdood K, de Bie RA, Dinant GJ. Ultrasound imaging for tailored treatment of patients with acute shoulder pain. Ann Fam Med 2015; 13:53-5. [PMID: 25583893 PMCID: PMC4291266 DOI: 10.1370/afm.1734] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The objective of this study was to assess the frequencies of ultrasound findings in patients with acute rotator cuff disorders in family medicine. METHODS In a prospective observational study, 129 patients aged 18 to 65 years with acute shoulder pain in whom the family physician suspected rotator cuff disease underwent ultrasound imaging. RESULTS Rotator cuff disease was present in 81% of the patients, and 50% of them had multiple disorders. Calcific tendonitis was the most frequently diagnosed specific disorder. An age of 40 years or older was most strongly related to rotator cuff disease. CONCLUSIONS Ultrasound imaging enables family physicians to rationalize treatment in nearly all patients who are aged 40 years and older with acute shoulder pain.
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Affiliation(s)
- Ramon P G Ottenheijm
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Jochen W L Cals
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - René Weijers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kurt Vanderdood
- Department of Radiology, Orbis Medical Centre, Sittard-Geleen, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Geert-Jan Dinant
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Ottenheijm RPG, van't Klooster IGM, Starmans LMM, Vanderdood K, de Bie RA, Dinant GJ, Cals JWL. Ultrasound-diagnosed disorders in shoulder patients in daily general practice: a retrospective observational study. BMC FAMILY PRACTICE 2014; 15:115. [PMID: 24916105 PMCID: PMC4057656 DOI: 10.1186/1471-2296-15-115] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 05/28/2014] [Indexed: 01/27/2023]
Abstract
Background Ultrasound imaging (US) is considered an accurate and widely available method to diagnose subacromial disorders. Yet, the frequency of the specific US-diagnosed shoulder disorders of patients with shoulder pain referred from general practice is unknown. We set out to determine the frequency of specific US-diagnosed shoulder disorders in daily practice in these patients and to investigate if the disorders detected differ between specific subgroups based on age and duration of pain. Methods A predefined selection of 240 ultrasound reports of patients with shoulder pain (20 reports for each month in 2011) from a general hospital (Orbis Medical Centre Sittard-Geleen, The Netherlands) were descriptively analysed. Inclusion criteria were: (i) referral from general practice, (ii) age ≥18 years, and (iii) unilateral shoulder examination. Subgroups were created for age (<65 years and ≥65 years) and duration of pain (acute or subacute (<12 weeks) and chronic (≥12 weeks)). The occurrence of each specific disorder is expressed as absolute and relative frequencies. Results With 29%, calcific tendonitis was the most frequently diagnosed disorder, followed by subacromial-subdeltoid bursitis (12%), tendinopathy (11%), partial-thickness tears (11%), full-thickness tears (8%) and AC-osteoarthritis (0.4%). For 40% of patients, no disorders were found on US. Significantly more full thickness-tears were found in the ≥65 years group. ‘No disorders’ was reported significantly more often in the <65 years group. The supraspinatus tendon was the most frequently affected tendon (72%). Conclusions Calcific tendonitis is the most common US-diagnosed disorder affecting patients in general practice, followed by subacromial-subdeltoid bursitis, tendinopathy, partial- and full-thickness tears and AC-osteoarthritis. Full-thickness tears were diagnosed significantly more frequently in patients ≥65 years, while ‘no disorders’ was more frequently reported in patients <65 years. Our findings imply that patients can be stratified into diagnostic subgroups, allowing more tailored treatment than currently applied.
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Affiliation(s)
- Ramon P G Ottenheijm
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands.
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Treatment of nongout joint deposition diseases: an update. ARTHRITIS 2014; 2014:375202. [PMID: 24895535 PMCID: PMC4034491 DOI: 10.1155/2014/375202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/24/2014] [Indexed: 12/16/2022]
Abstract
This update develops the actual therapeutic options in the management of the joint involvement of calcium pyrophosphate deposition disease (CPPD), basic calcium phosphate (BCP) deposition disease, hemochromatosis (HH), ochronosis, oxalosis, and Wilson's disease. Conventional pharmaceutical treatment provides benefits for most diseases. Anti-interleukine-1 (IL-1) treatment could provide similar results in CPPD than in gout flares. There is only limited evidence about the efficacy of preventive long-term colchicine intake, methotrexate, and hydroxychloroquine in chronic CPPD. Needle aspiration and lavage have satisfactory short and midterm results in BCP. Extracorporeal shockwave therapy has also proved its efficacy for high-doses regimes. Phlebotomy does not seem to have shown real efficacy on joint involvement in HH so far. Iron chelators' effects have not been assessed on joint involvement either, while IL-1 blockade may prove useful. NSAIDs have limited efficacy on joint involvement of oxalosis, while colchicine and steroids have not been assessed either. The use of nitisinone for ochronotic arthropathy is still much debated, but it could provide beneficial effects on joint involvement. The effects of copper chelators have not been assessed either in the joint involvement of Wilson's disease. NSAIDs should be avoided because of the liver affection they may worsen.
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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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Disorders of the Upper Extremity. Fam Med 2014. [DOI: 10.1007/978-1-4939-0779-3_117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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