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Góngora-Rodríguez J, Rosety-Rodríguez MÁ, Rodríguez-Almagro D, Martín-Valero R, Góngora-Rodríguez P, Rodríguez-Huguet M. Structural and Functional Changes in Supraspinatus Tendinopathy through Percutaneous Electrolysis, Percutaneous Peripheral Nerve Stimulation and Eccentric Exercise Combined Therapy: A Single-Blinded Randomized Clinical Trial. Biomedicines 2024; 12:771. [PMID: 38672127 PMCID: PMC11048338 DOI: 10.3390/biomedicines12040771] [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: 03/04/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Shoulder tendinopathies produce pain and reduce functionality. The aim of this randomized clinical trial was to analyze the effects of Percutaneous electrolysis (PE), Percutaneous peripheral Nerve Stimulation (PNS) and eccentric exercise (EE) on pain (NPRS), strength, electromyographic activity, ultrasound characteristics of the tendon (echogenicity, thickness and hypervascularization) and functionality (DASH and SPADI) in individuals with supraspinatus tendinopathy. Participants (n = 50) were divided into two groups; they received 4 treatment sessions, 1 per week, of PE and PNS (n = 25) or 10 treatment sessions of TENS and US (n = 25). Both groups performed the EE program consisting of 3 sets of 10 repetitions of each of the 3 exercises, twice a day, during the 4 weeks. Follow-up was carried out at 4, 12 and 24 weeks after the start of the intervention. There are statistically significant differences in the analysis between groups (p < 0.001) in the post-treatment and follow-up measurements favorable to the PE+PNS+EE treatment on pain (NPRS), strength, supraspinatus electromyographic amplitude, ultrasound characteristics of the tendon (echogenicity, thickness and hypervascularization) and DASH and SPADI questionnaires. The combined treatment with PE, PNS and EE is an effective option in the clinical management of tendinopathies, with positive results in the short and long term on the variables studied.
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Affiliation(s)
- Jorge Góngora-Rodríguez
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (J.G.-R.); (M.R.-H.)
| | - Miguel Ángel Rosety-Rodríguez
- Move-It Research Group, Biomedical Research and Innovation Institute of Cadiz, Puerta del Mar University Hospital, University of Cádiz, Plaza Fragela, s/n, 11003 Cadiz, Spain
| | | | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain;
| | | | - Manuel Rodríguez-Huguet
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (J.G.-R.); (M.R.-H.)
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2
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The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:E23-E35. [PMID: 37130137 DOI: 10.1002/jum.16228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
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3
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Yao L, Pang L, Li Y, Tang X. Intraoperative Channeling in Arthroscopic Rotator Cuff Repair: Letter to the Editor. Am J Sports Med 2023; 51:NP26. [PMID: 37454273 DOI: 10.1177/03635465231173856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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4
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Zhou T, Han C, Weng X. Present situation and development prospects of the diagnosis and treatment of rotator cuff tears. Front Surg 2023; 10:857821. [PMID: 37440927 PMCID: PMC10333593 DOI: 10.3389/fsurg.2023.857821] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/24/2023] [Indexed: 07/15/2023] Open
Abstract
Rotator cuff tears are an important cause of shoulder pain and are caused by degeneration or trauma of the shoulder tendon at the anatomical neck of the humeral head. The understanding and research of rotator cuff tears have a history of hundreds of years, and their etiology, diagnosis, and treatment have a complete system, but some detailed rules of diagnosis and treatment still have room for development. This research paper briefly introduces the diagnosis and treatment of rotator cuff tears. The current situation and its valuable research direction are described.
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Affiliation(s)
- Tianjun Zhou
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Chang Han
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xisheng Weng
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
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Janeiro J, Barreira S, Martins P, Sarmento M, Campos J, Fonseca JE. Ultrasound findings and prognosis of shoulder pain: A role for Doppler signal? JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:837-844. [PMID: 36715681 DOI: 10.1002/jcu.23436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 06/02/2023]
Abstract
PURPOSE To find ultrasound prognostic factors for shoulder pain. METHODS This was an observational, prospective study, comparing the evolution of ultrasound findings with clinical outcomes, in patients with shoulder pain. Data were collected in two appointments, from February 2018 to March 2021. Two-tailed non-parametric statistics were used, and p values <0.05 were considered significant. RESULTS A total of 79 participants were included in this study (median age 59 years, range 24-70, 61 women). A positive Doppler signal on tendons (p = 0.002) and absent tendon heterogeneity (p = 0.01) were associated with the patient's self-reported improvement. Tendon calcifications with poorly defined contours (p = 0.03) and sparse distribution (p = 0.001) were associated with VAS improvement. A reduction in the number of calcifications (p = 0.004), in the supraspinatus tendon thickness (p = 0.01), in subacromial effusions (p = 0.03), and in color Doppler grade (p = 0.02), between initial and follow-up exams, was found in patients with an improved DASH outcome. CONCLUSION A positive Doppler signal on shoulder tendons can be a marker for a better prognosis in shoulder pain. Poorly defined and sparsely distributed calcifications can also indicate a better course of the disease.
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Affiliation(s)
- João Janeiro
- Serviço de Imagiologia Geral, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Sofia Barreira
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Patrícia Martins
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Marco Sarmento
- Serviço de Ortopedia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Jorge Campos
- Serviço de Imagiologia Neurológica, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
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Čota S, Delimar V, Žagar I, Kovač Durmiš K, Kristić Cvitanović N, Žura N, Perić P, Laktašić Žerjavić N. Efficacy of therapeutic ultrasound in the treatment of chronic calcific shoulder tendinitis: a randomized trial. Eur J Phys Rehabil Med 2023; 59:75-84. [PMID: 36723056 PMCID: PMC10035437 DOI: 10.23736/s1973-9087.22.07715-2] [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: 02/02/2023]
Abstract
BACKGROUND Calcific shoulder tendinitis (CST) is characterized by hydroxyapatite crystals deposition in the rotator cuff tendons. Therapeutic exercises have been the mainstay of CST treatment, and evidence for therapeutic ultrasound (T-US) utilization and efficacy is lacking. AIM This study aimed to determine whether 4500 J T-US combined with therapeutic exercises is superior to therapeutic exercises alone regarding calcification size reduction and symptom improvement in chronic symptomatic CST. DESIGN This is a double-blind, placebo-controlled study. SETTING This study was conducted at a University Department for Rheumatic Diseases and Rehabilitation of a University Hospital. POPULATION Patients with chronic CST were analyzed. METHODS After eligibility allocation, 46 patients with sonographically confirmed CST were divided into two groups (56 shoulders, 26 per group). Both groups performed the same therapeutic exercises for half an hour under physiotherapist supervision. In the treatment group T-US (4500 J, 10 minutes per session at a frequency of 1 MHz and an intensity of 1.5 W/cm2), and in the placebo group, sham T-US was applied for 4 weeks. Patients were assessed for: calcification size, shoulder pain, global health (GH), shoulder mobility (ROM), handgrip strength, Health Assessment Questionnaire Disability Index (HAQ-DI), Shoulder Pain and Disability Index (SPADI), and overall rehabilitation satisfaction. RESULTS All assessed variables improved in both groups. A significantly greater reduction in calcification size was recorded in the treatment group compared to placebo: -10.92% (IQR 4.61% to 19.38%) versus -5.04% (2.30% to 7.22%), P=0.008. There was a significantly greater decrease in HAQ-DI, reduction of VAS GH, and an increase in hand grip strength in the treatment group, while no significant differences were observed for other parameters between the groups. CONCLUSIONS Our results showed that adding the 4500 J T-US to therapeutic exercises in chronic symptomatic CST therapy resulted in greater calcification size reduction immediately following the treatment, as well as hand grip strength, HAQ-DI, and VAS GH improvement. CLINICAL REHABILITATION IMPACT 4500 J T-US combined with therapeutic exercises is more effective in reducing calcification size than therapeutic exercises alone in the treatment of chronic symptomatic CST.
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Affiliation(s)
- Stjepan Čota
- Department of Pediatric Orthopedics, Children's Hospital of Zagreb, Zagreb, Croatia
| | - Valentina Delimar
- Special Hospital for Medical Rehabilitation of Krapinske Toplice, Krapinske Toplice, Croatia
| | - Iva Žagar
- University Department for Rheumatic Diseases and Rehabilitation, University Hospital Centre of Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Kristina Kovač Durmiš
- University Department for Rheumatic Diseases and Rehabilitation, University Hospital Centre of Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Nikolino Žura
- University Department for Rheumatic Diseases and Rehabilitation, University Hospital Centre of Zagreb, Zagreb, Croatia
| | - Porin Perić
- University Department for Rheumatic Diseases and Rehabilitation, University Hospital Centre of Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nadica Laktašić Žerjavić
- University Department for Rheumatic Diseases and Rehabilitation, University Hospital Centre of Zagreb, Zagreb, Croatia -
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Nowotny J, Kasten P. Kalkschulter – konservative und operative
Therapie. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2023. [DOI: 10.1055/a-1990-6407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Erkrankungen der Rotatorenmanschette beinhalten ein breites Spektrum, unter denen
die Kalkschulter oder Tendinosis calcarea (TC) eine häufige Pathologie
der Schulter darstellt und eine herausragende Rolle einnimmt. Das
Erscheinungsbild kann dabei enorm variieren. Die Kalkschulter kann als
Zufallsbefund bei der radiologischen Diagnostik auffallen, jedoch auch bis hin
zu einem der stärksten Schulterschmerzen avancieren. Nachfolgend wird
ein Überblick für das diagnostische und therapeutische Vorgehen
gegeben.
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Pre-procedural Imaging. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Effect of the Critical Shoulder Angle on the Efficacy of Ultrasound-Guided Steroid Injection for Subacromial Bursitis. J Pers Med 2022; 12:jpm12111879. [PMID: 36579587 PMCID: PMC9692981 DOI: 10.3390/jpm12111879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/29/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
The critical shoulder angle (CSA) is associated with impingement and rotator cuff lesions, and ultrasound-guided corticosteroid injection is effective for subacromial bursitis. However, because the efficacy of this treatment varies, this study investigated the effect of the CSA on the efficacy of corticosteroid injection in the subacromial space. Patients who received a diagnosis of subacromial bursitis after a clinical physical examination and ultrasound were enrolled prospectively from May 2019 to December 2021. Patients’ baseline variables and CSAs were assessed before intervention. Patients’ shoulder pain and disability index (SPADI), visual analog scale (VAS), and shoulder joint range of motion (ROM) scores were assessed at 2, 6, and 12 weeks after ultrasound-guided corticosteroid injection. All participants were divided into CSA > 38° and CSA ≤ 38° groups. We conducted the intragroup and intergroup comparisons of the variables and performed Pearson analysis to identify potential correlations between the CSA and outcome parameters. A total of 55 patients were enrolled in this study. Of these, 28 were included in the CSA > 38° group and 27 in the CSA ≤ 38° group. The baseline variables of the two groups did not differ. In the intragroup and intergroup comparisons, although VAS, SPADI, and ROM scores improved up to 12 weeks after intervention, no difference was identified between groups. The Pearson analysis revealed a positive correlation (r = 0.30, p = 0.024) between the CSA and VAS scores before the intervention. However, no correlation was found between the CSA and follow-up parameters. The CSA was not associated with the clinical efficacy of ultrasound-guided corticosteroid injection for subacromial bursitis.
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Effects of High-Energy Extracorporeal Shockwave Therapy on Pain, Functional Disability, Quality of Life, and Ultrasonographic Changes in Patients with Calcified Rotator Cuff Tendinopathy. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1230857. [PMID: 35281612 PMCID: PMC8916860 DOI: 10.1155/2022/1230857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/07/2021] [Accepted: 01/12/2022] [Indexed: 01/05/2023]
Abstract
Objective The current trial was designed to evaluate the effects of high-energy shockwave therapy on objective and subjective outcomes among participants with calcified rotator cuff tendinopathy. Methods This parallel-group, randomized trial consists of 42 patients affected by calcific tendinopathies divided into two groups of 21 participants. Patients having calcified tendinopathy aged between 30 and 65 years with type A or B calcification were selected in the trial after signing the written consent form. Participants in the ESWT+RPT group received eight sessions of shockwaves, while the RPT group was treated by routine physical therapy. About 2000 shockwaves of 0.32 mJ/mm2, 120 Hz per treatment, were given as 12 sessions for the first six weeks (2 sessions/week). Pain intensity and shoulder functional ability, ultrasonographic changes, and quality of life were assessed with the numeric pain rating scale (NPRS), Constant-Murley score (CMS), ultrasonography, and Western Ontario rotator cuff index (WORC). Results There were significant differences regarding NPRS and CMS between the two groups, at baseline and 6th and 12th weeks after intervention (p < 0.05). Within-group differences also showed statistically significant results after treatment (all p < 0.05). Significant results were seen in the WORC and ultrasonographic results pre- and posttreatment; more significant findings were found in the experimental group as compared to others. Conclusion High-energy shockwave therapy has been proved to be effective and thus strongly recommended for the management of calcified rotator cuff tendinopathy, improving the pain, functionality, and quality of life of these participants and decreasing the size of calcified deposits. Shockwave therapy is proved to be superior to routine physiotherapy.
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Kao JT, Chiu CH, Hsu KY, Chang SS, Chan YS, Chen ACY. Arthroscopic diagnosis of long head of biceps tendon instability in refractory anterior shoulder pain: A comparison study between pulley tear and non-tear lesions. Biomed J 2022; 46:163-169. [PMID: 35065282 PMCID: PMC10104962 DOI: 10.1016/j.bj.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Long head of the biceps tendon (LHBT) instability and biceps reflection pulley (BRP) lesions are common cause of refractory anterior shoulder pain. We described a technique using dynamic arthroscopy to determine associated intraarticular pathologies. METHODS Patients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability were enrolled. LHBT instability and the integrity of BRP and concomitant intra-articular lesions were investigated by ramp test. Demographics and arthroscopic findings were compared between patients with and without BRP tear. RESULTS Forty patients were enrolled. BRP tear was noted in 25 patients (group A) and superior glenohumeral ligament (SGHL) insufficiency through ramp test in 15 patients (group B). Concomitant intraarticular pathologies were noted in 27 patients, including 19 in group A (76%) and eight in group B (53%), without significant group-wise difference (p = 0.138). The incidence of articular-side subscapularis tear was significantly higher in group A (p = 0.021), and those of the other intraarticular pathologies were similar between groups A and B. Fraying at the articular side of the subscapularis and supraspinatus tendons was frequent in group B, without difference of incidence as compared to group A (p = 0.5 and p = 0.084, respectively). CONCLUSIONS LHBT instability was a common disorder in patients with refractory shoulder pain. In those patients, dynamic assessment of BRP lesions and SGHL insufficiency and meticulous survey of associated intra-articular pathologies, including subscapularis tear are necessary for making accurate diagnosis and treatment decision.
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12
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Wu CH, Chiu PH, Boudier-Revret M, Chang SW, Chen WS, zakar L. Deep learning for detecting supraspinatus calcific tendinopathy on ultrasound images. J Med Ultrasound 2022; 30:196-202. [DOI: 10.4103/jmu.jmu_182_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/04/2022] Open
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Janeiro J, Barreira SC, Martins P, Ninitas P, Campos J, Fonseca JE. Ultrasound Features Associated With Shoulder Complaints: Calcifications Larger Than 6 mm in Young Patients and Positive Doppler Are Associated With Pain. Front Med (Lausanne) 2021; 8:715423. [PMID: 34869414 PMCID: PMC8639518 DOI: 10.3389/fmed.2021.715423] [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: 05/26/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To identify ultrasound (US) features associated with the presence of shoulder complaints. Methods: This observational, case-control study, compared US findings between participants with and without shoulder complaints, matched for age, sex, and dominancy. Data was collected from February 2018 to June 2020. Two-tailed Fisher's and Mann-Whitney U-tests were used, with p-values < 0.05 considered significant. Results: A total of 202 participants were enrolled (median age 56 years, range 18–70, 155 women), comprising 140 cases and 62 controls. A calcification size ≥6 mm, when age < 56 (p = 0.02), and a distance to tendon insertion ≥6 mm, when age ≥56 (p = 0.009), were only found in symptomatic shoulders. Color Doppler in rotator cuff (RC) tendons predominated in the presence of symptoms (26/140 vs. 2/62, p = 0.003). An algorithm also combining the number of calcifications, tendon echotexture and insertional thickening, osseous irregularity, cuff tears, and subacromial effusion showed a 92% (57/62) specificity for shoulder pain on this study sample. Conclusion: Calcification diameter of 6 mm or more is associated with shoulder pain in patients younger than 56 years. A distance from calcification to tendon insertion of 6 mm or more is related to pain in older patients. Doppler signal also is associated with shoulder pain. An algorithm based on a set of specific ultrasonographic criteria have a strong association with the presence of symptoms.
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Affiliation(s)
- João Janeiro
- Serviço de Imagiologia Geral, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Sofia C Barreira
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Patrícia Martins
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Pedro Ninitas
- Serviço de Imagiologia Geral, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Jorge Campos
- Serviço de Imagiologia Neurológica, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - João E Fonseca
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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Farooqi AS, Lee A, Novikov D, Kelly AM, Li X, Kelly JD, Parisien RL. Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211035106. [PMID: 34660823 PMCID: PMC8511934 DOI: 10.1177/23259671211035106] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears. Purpose To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds. Study Design Systematic review; Level of evidence, 3. Methods The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with <10 patients, studies including massive tears without reporting diagnostic data for specific tendons, and studies lacking diagnostic outcome data. Extracted outcomes included diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value. The mean difference and 95% confidence interval were calculated for both US and MRI diagnostic values, and meta-analysis was conducted using the Mantel-Haenszel random-effects model. Results In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears (P = .13-.81). Conclusion For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.
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Affiliation(s)
- Ali S Farooqi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander Lee
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Novikov
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ann Marie Kelly
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - John D Kelly
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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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.
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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
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16
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Perez J, Sorensen S, Rosselli M. Utilisation of musculoskeletal ultrasonography for the evaluation of septic arthritis in a patient presenting to the emergency department with fever during the era of COVID-19. BMJ Case Rep 2021; 14:14/4/e242370. [PMID: 33849885 PMCID: PMC8051413 DOI: 10.1136/bcr-2021-242370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Prompt recognition and treatment of septic arthritis are crucial to prevent significant morbidity and mortality in affected patients. During the current COVID-19 pandemic, anchoring bias may make an already challenging diagnosis like septic arthritis more difficult to diagnose quickly and efficiently. Musculoskeletal (MSK) point of care ultrasonography (POCUS) is an imaging modality that can be used to quickly and efficiently obtain objective findings that may help a clinician establish the diagnosis of septic arthritis. We report a case where MSK POCUS was a key element in establishing the diagnosis of glenohumeral joint septic arthritis and subdeltoid septic bursitis for a patient that presented to the emergency department with a fever during the era of the COVID-19 pandemic.
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Affiliation(s)
- Jiodany Perez
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Stefani Sorensen
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Michael Rosselli
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
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17
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Perone MV, Yablon CM. Musculoskeletal Ultrasound in the Emergency Department: Is There a Role? Semin Roentgenol 2020; 56:115-123. [PMID: 33422179 DOI: 10.1053/j.ro.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Corrie M Yablon
- Department of Radiology, University of Michigan, Ann Arbor, MI.
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18
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Ayekoloye CI, Nwangwu O. Ultrasound-Guided Versus Anatomic Landmark-Guided Steroid Injection of the Subacromial Bursa in the Management of Subacromial Impingement: A Systematic Review of Randomised Control Studies. Indian J Orthop 2020; 54:10-19. [PMID: 32952904 PMCID: PMC7474019 DOI: 10.1007/s43465-020-00148-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/21/2020] [Indexed: 02/04/2023]
Abstract
This study is a systematic review of prospective randomised control studies comparing ultrasound-guided steroid injection of the subacromial space with anatomic landmark-guided injection in the treatment of subacromial impingement to determine if there is any difference in pain relief and functional outcome. Mesh terms and free-text words search of electronic databases, reference list of identified studies and grey literature was performed using the PICO format. All identified papers were sifted sequentially by title, abstract and review of full text articles. Four papers qualified and were included in the review and analysis. The total number of patients in the studies was 234 patients with 117 patients randomised to each of landmark-guided and ultrasound-guided injection groups. There was no statistically significant difference in VAS pain scores (P = 0.67), SDQ scores (P = 0.43), SPADI disability score (P = 0.17) and functional outcomes scores (P = 0.09) at 4 to 6 weeks when USS-guided subacromial steroid injection was compared with landmark-guided injection. SPADI pain scores (P = 0.02) demonstrates significant reduction in favour of landmark-guided injection. There was low to moderate risk of bias. In conclusion, ultrasound-guided subacromial steroid injection does not offer any statistically significant clinical improvement over landmark-guided injection in adults with subacromial impingement.
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Affiliation(s)
- Charles I. Ayekoloye
- Department of Orthopaedics, Oaklands Hospital, 19 Lancaster Road, Salford, M6 8AQ UK
| | - Osondu Nwangwu
- Department of Orthopaedics, Luton & Dunstable Hospital, Bedfordshire, UK
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19
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Wada T, Itoigawa Y, Yoshida K, Kawasaki T, Maruyama Y, Kaneko K. Increased Stiffness of Rotator Cuff Tendons in Frozen Shoulder on Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:89-97. [PMID: 31218712 DOI: 10.1002/jum.15078] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/28/2019] [Accepted: 06/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the stiffness and morphologic characteristics of the capsule, rotator cuff tendons and muscles, coracohumeral ligament (CHL), and long head of the biceps in patients with frozen shoulder using shear wave elastography (SWE) with B-mode ultrasound. METHODS Thirty-two patients with frozen shoulder were divided into freezing and frozen phases. All patients had limitations of their range of motion without rotator cuff tears. Stiffness was measured by SWE in the supraspinatus (SSp) tendon, infraspinatus (ISp) tendon, SSp muscle, ISp muscle, teres minor muscle, upper and lower trapezius muscles, posterior capsule, CHL, and long head of the biceps. The posterior capsule and CHL thicknesses were also investigated with B-mode ultrasound. All values were compared in the affected and unaffected shoulders in each phase. RESULTS The SWE values for the SSp and ISp tendons in the freezing phase and the CHL in the frozen phase were significantly greater on the affected side than the unaffected side (mean ± SD, 280.4 ± 125.3 versus 178.1 ± 73.3, 318.4 ± 110.7 versus 240.8 ± 91.5, and 287.2 ± 135.3 versus 214.1 ± 91.1 kPa, respectively; P < .05). The posterior capsule in both the freezing and frozen phases and the CHL in the frozen phase were significantly thicker on the affected side than the unaffected side (1.3 ± 0.2 versus 0.9 ± 0.3, 1.2 ± 0.4 versus 0.9 ± 0.3, and 4.4 ± 1.4 versus 3.3 ± 1.1 mm; P < .01). CONCLUSIONS The SWE values of the both SSp and ISp tendons increased in the freezing phase, and that of the CHL also increased in the frozen phase. Not only the change in thickness of the capsule but also the change in stiffness of the rotator cuff may correlate with frozen shoulder.
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Affiliation(s)
- Tomoki Wada
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Keiichi Yoshida
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | | | - Yuichiro Maruyama
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
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20
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Strakowski JA, Visco CJ. Diagnostic and therapeutic musculoskeletal ultrasound applications of the shoulder. Muscle Nerve 2019; 60:1-6. [PMID: 31054148 DOI: 10.1002/mus.26505] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/28/2019] [Indexed: 11/10/2022]
Abstract
High frequency ultrasound is a valuable tool for assessing soft tissue injuries about the shoulder. It has advantages over other imaging modalities including relatively low cost, portability, and dynamic real-time visualization. It has a high sensitivity for identifying tendon degeneration, bursitis, and rotator cuff tears. Ultrasound is also an excellent modality for diagnostic and therapeutic needle-guided procedures. A detailed knowledge of shoulder anatomy and transducer positioning is required for obtaining adequate diagnostic value from ultrasound. This Monograph is designed to help develop scanning protocols for optimizing image acquisition for musculoskeletal assessment of the shoulder. Muscle Nerve, 2019.
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Affiliation(s)
- Jeffrey A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA.,OhioHealth Riverside Methodist Hospital, 3555 Olentangy River Road, Columbus, 43214, Ohio, USA.,The McConnell Spine, Sport, and Joint Center, Columbus, Ohio, USA
| | - Christopher J Visco
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
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21
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Ultrasound Visualization of Torsional Anatomic Changes From External Rotation of the Anterior Shoulder. J Comput Assist Tomogr 2019; 43:519-523. [DOI: 10.1097/rct.0000000000000861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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22
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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: 28] [Impact Index Per Article: 4.7] [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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23
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Zhao Y, Rascoff NE, Iyer RS, Thapa M, Reichley L, Oron AP, Wallace CA. Flares of Disease in Children with Clinically Inactive Juvenile Idiopathic Arthritis Were Not Correlated with Ultrasound Findings. J Rheumatol 2018; 45:851-857. [PMID: 29606669 DOI: 10.3899/jrheum.170681] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The validity of our current definitions for clinically inactive disease (CID) in juvenile idiopathic arthritis (JIA) based on physical examination is challenged by the development of advanced musculoskeletal imaging tools. We aimed to prospectively determine the prevalence of abnormal ultrasound (US) findings in children with CID in JIA and their clinical significance. METHODS Children aged ≥ 4 years with CID and a history of arthritis from a single tertiary center were approached over 1 year. Standard US of knees, tibiotalar joints, subtalar joints, and wrists were performed at baseline and at a followup visit. US images were scored by 2 pediatric musculoskeletal radiologists. RESULTS Forty children with CID were enrolled and followed clinically. The median duration of inactive disease was 1 year. The most common International League of Associations for Rheumatology JIA categories were extended oligoarticular JIA (30%) and rheumatoid factor-negative polyarthritis (38%). At baseline, among a total of 289 joints scanned, 24 joints (8%) had at least 1 abnormal finding in 18 (45%) of 40 subjects. When evaluated at the individual joint level against flares identified during followup exams, these baseline US findings had a sensitivity of 15% and a positive predictive value of 12%. The predictive performance of the second US was even less. CONCLUSION Our study demonstrates that nearly half of children with CID had abnormal US findings in 1 of 8 commonly affected joints. These findings did not correlate with subsequent clinical flares in up to 2 years of followup.
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Affiliation(s)
- Yongdong Zhao
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA. .,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project.
| | - Nanci E Rascoff
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
| | - Ramesh S Iyer
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
| | - Mahesh Thapa
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
| | - Lucas Reichley
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
| | - Assaf P Oron
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
| | - Carol A Wallace
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
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24
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Abate M, Di Carlo L, Salini V, Schiavone C. Risk factors associated to bilateral rotator cuff tears. Orthop Traumatol Surg Res 2017; 103:841-845. [PMID: 28578100 DOI: 10.1016/j.otsr.2017.03.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/21/2017] [Accepted: 03/31/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Overuse, micro-traumas, and impingement, isolated or combined, are the more common etiological factors for rotator cuff tears. Metabolic disorders (diabetes, adiposity, hypercholesterolemia), hypertension, cigarette smoking and a genetic predisposition are considered risk factors. However, no study has compared the prevalence of these risk factors in subjects with bilateral and monolateral tears. HYPOTHESIS Controlateral tears can be observed in patients with symptomatic monolateral rotator cuff lesions, especially in those with comorbidities. MATERIAL AND METHODS In patients with symptomatic rotator cuff tear, the controlateral shoulders were evaluated by means of ultrasound imaging. Age, BMI, diabetes, hypercholesterolemia, hypertension, cigarette smoking, work habits were registered. Risk factors in subjects with bilateral tears were compared with those with monolateral lesions. RESULTS Of the 180 subjects recruited, 69 had a tear in the controlateral shoulder. Higher age and BMI values, heavy repetitive work and diabetes were significantly prevalent in these patients. At multivariate analysis, these factors were independently related to a higher probability to detect bilateral tears. DISCUSSION Metabolic risk factors are more heavily involved in presence of bilateral rotator cuff tears, in comparison to monolateral. TYPE OF STUDY Original study. LEVEL OF PROOF IV.
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Affiliation(s)
- M Abate
- Department of medical science and aging, 31, via dei vestini, 66013 Chieti, Italy.
| | - L Di Carlo
- Department of medical science and aging, 31, via dei vestini, 66013 Chieti, Italy
| | - V Salini
- Department of medical science and aging, 31, via dei vestini, 66013 Chieti, Italy
| | - C Schiavone
- Department of medical science and aging, 31, via dei vestini, 66013 Chieti, Italy
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25
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Friedman MV, Hillen TJ, Holland DV, Essenberg JM, Demertzis JL. Impact of Shoulder Sonography on Clinical Decision Making. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1365-1371. [PMID: 28304099 DOI: 10.7863/ultra.16.07013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To assess the impact of musculoskeletal shoulder sonography (US) on clinical decision making. METHODS This Health Insurance Portability and Accountability Act-compliant retrospective study received Institutional Review Board approval with a waiver of informed consent. Consecutive musculoskeletal shoulder US examinations ordered over a 12-month period were retrospectively reviewed. The medical records of each patient were analyzed, recording immediate pre- and post-US treatment plans. Treatment plans were categorized as follows: 1, no further treatment; 2, conservative management/physical therapy; 3, therapeutic injection; 4, surgical intervention; 5, change in diagnosis; and 6, need additional imaging. Data were analyzed by nonparametric statistical methods. RESULTS A total of 935 patient examinations met inclusion criteria. Of 935 patients, 591 (63.2%) had a post-US treatment plan that differed from pre-US treatment, showing a statistically significant impact on patient treatment (P < .001). In 744 of the 935 examinations (79.6%), the treating physician initially prescribed conservative therapy as a treatment plan; 423 of those 744 patients (56.9%) were subsequently prescribed a more invasive form of treatment. Of the remaining 191 of 935 patients (20.4%) initially treated with invasive treatment, 101 (52.9%) received a change in the treatment plan after the US examinations, with 46 patients (24.1%) relegated to noninvasive treatment. Sonography also played a role in surgical planning, with 25 studies (2.7%) specifically performed to evaluate rotator cuff integrity when deciding between conventional and reverse shoulder arthroplasty. CONCLUSIONS Musculoskeletal shoulder US has a substantial impact on clinical decision making and patient treatment.
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Affiliation(s)
- Michael V Friedman
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri USA
| | - Travis J Hillen
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri USA
| | - David V Holland
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri USA
| | - James M Essenberg
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri USA
| | - Jennifer L Demertzis
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri USA
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26
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Amoo-Achampong K, Nwachukwu BU, McCormick F. An orthopedist's guide to shoulder ultrasound: a systematic review of examination protocols. PHYSICIAN SPORTSMED 2016; 44:407-416. [PMID: 27548649 DOI: 10.1080/00913847.2016.1222224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The utilization of musculoskeletal ultrasound has expanded within the setting of the orthopedic clinic as a cost-effective, point-of-care diagnostic tool for shoulder pathology. In experienced hands, ultrasound exhibits capabilities equivalent to that of magnetic resonance imaging in the diagnosis of many shoulder diseases including full-thickness and partial-thickness rotator cuff tears. Although similarly effective in identifying additional shoulder disease processes, major obstacles to its widespread use include user dependence and intrinsic limitation to extra-articular diagnosis. OBJECTIVES The purpose of this review is to present a step-by-step guide of how to perform a comprehensive shoulder examination and to discuss the appropriate use, economic benefit and implementation of ultrasound within the clinic. METHODS A systematic search (June 2016) of PubMed, Scopus, and EMBASE databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for literature presenting shoulder ultrasound examination protocols. Included studies were peer-reviewed articles or academic society endorsed protocols presenting comprehensive sonographic examinations of the adult shoulder. Papers with limited or single structure examination descriptions, non-English language, and publication dates before 1980 were excluded. Final papers meeting criteria were secondarily screened for publication after 2005 to reflect the current state of ultrasound imaging. RESULTS AND CONCLUSIONS The search yielded 1,725 unique articles with 17 studies meeting final selection criteria. Information from identified studies was summarized to formulate a 4-part shoulder examination protocol, including steps most pertinent to orthopedic in-office diagnoses. In agreement with previous studies, the inexperienced orthopedic surgeon can be quickly trained to expert level proficiency in shoulder ultrasound diagnosis. Using an established protocol, a comprehensive, yet effective shoulder ultrasound examination can be performed within ten minutes. Further, ultrasound provides opportunity to off-set costs through the engagement of revenue generating activity for the orthopedic practice.
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Affiliation(s)
- Kelms Amoo-Achampong
- a Sports Medicine and Shoulder Division , SOAR Institute , Pompano Beach , FL , USA
| | - Benedict U Nwachukwu
- b Department of Orthopaedic Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Frank McCormick
- a Sports Medicine and Shoulder Division , SOAR Institute , Pompano Beach , FL , USA
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Lee GE, Son C, Lee J, Lee SH, Lee HJ, Lee KJ, Lim SM, Choi H, Kim DA, Kim WH. Acupuncture for shoulder pain after stroke: A randomized controlled clinical trial. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Park M, Park JS, Ahn SE, Ryu KN, Park SY, Jin W. Sonographic Findings of Common Musculoskeletal Diseases in Patients with Diabetes Mellitus. Korean J Radiol 2016; 17:245-54. [PMID: 26957910 PMCID: PMC4781764 DOI: 10.3348/kjr.2016.17.2.245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/28/2015] [Indexed: 12/18/2022] Open
Abstract
Diabetes mellitus (DM) can accompany many musculoskeletal (MSK) diseases. It is difficult to distinguish the DM-related MSK diseases based on clinical symptoms alone. Sonography is frequently used as a first imaging study for these MSK symptoms and is helpful to differentiate the various DM-related MSK diseases. This pictorial essay focuses on sonographic findings of various MSK diseases that can occur in diabetic patients.
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Affiliation(s)
- Minho Park
- Department of Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Sung Eun Ahn
- Department of Radiology, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, Seoul 02447, Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
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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: 47] [Impact Index Per Article: 5.9] [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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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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Sansone V, Consonni O, Maiorano E, Meroni R, Goddi A. Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders. Skeletal Radiol 2016; 45:49-55. [PMID: 26306389 DOI: 10.1007/s00256-015-2240-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 07/12/2015] [Accepted: 08/16/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide new epidemiological data regarding the prevalence, distribution and macroscopic features of shoulder rotator cuff calcific tendinopathy (calcific tendinopathy), and to identify the characteristics of calcific deposits associated with shoulder pain. MATERIALS AND METHODS Three hundred and two female volunteers (604 shoulders) who had been referred to a gynaecological clinic participated in the study. The subjects underwent a high-resolution ultrasonography of both shoulders, and those with a diagnosis of calcific tendinopathy compiled a standardized questionnaire relating to shoulder symptoms. We determined the prevalence of symptomatic and asymptomatic rotator cuff calcific tendinopathy, and compared differences in distribution and macroscopic features of the symptomatic and asymptomatic calcifications. RESULTS The prevalence of calcific tendinopathy was 17.8% (103 shoulders). Ninety-five shoulders (15.7%) were symptomatic; of these, calcific tendinopathy was found in 34 shoulders (33%) on imaging. Of the 509 asymptomatic (84.3%) shoulders, calcific tendinopathy was observed in 69 cases (67%). Among tendons, supraspinatus (53.4%) and infraspinatus (54.6%) were the most frequently involved. The majority of calcific deposits were of maximum diameter between 2 and 5 mm (77.9%), and were linear in form (69.9%). The involvement of multiple tendons and a location in the supraspinatus tendon were found to be significantly correlated with pain (p = 0.023, p = 0.043 respectively), as were age (p = 0.041) and an excessive body mass index (p = 0.024). CONCLUSION In this sample from the general population of working age females, both intrinsic factors (location in supraspinatus, multiple tendon involvement) and extrinsic variables (age, abnormally high BMI) were correlated with pain in calcific tendinopathy. LEVEL OF EVIDENCE Level III, cross-sectional study, prevalence study.
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Affiliation(s)
- Valerio Sansone
- Orthopaedic Department of the Università degli Studi di Milano, Milan, Italy. .,Istituto Ortopedico Galeazzi IRCCS, Via Riccardo Galeazzi 4, 20161, Milano, Italy.
| | - Olmo Consonni
- Orthopaedic Department of the Università degli Studi di Milano, Milan, Italy
| | - Emanuele Maiorano
- Orthopaedic Department of the Università degli Studi di Milano, Milan, Italy
| | - Roberto Meroni
- Department of Surgery and Interdisciplinary Medicine, Program in Physical Therapy, University of Milano-Bicocca, Milan, Italy
| | - Alfredo Goddi
- SME - Diagnostic Imaging Medical Centre, Varese, Italy
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Abstract
CLINICAL/METHODICAL ISSUE Shoulder impingement syndrome is a clinically common entity involving trapping of tendons or bursa with typical clinical findings. STANDARD RADIOLOGICAL METHODS Important radiological procedures are ultrasound, magnetic resonance imaging (MRI) and MR arthrography. Projection radiography and computed tomography (CT) are ideal to identify bony changes and CT arthrography also serves as an alternative method in cases of contraindications for MRI. These modalities support the clinically suspected diagnosis of impingement syndrome and may identify its cause in primary diagnosis. In addition, effects of impingement are determined by imaging. Therapy decisions are based on a synopsis of radiological and clinical findings. PERFORMANCE The sensitivity and specificity of these imaging modalities with regard to the diagnostics of a clinically evident impingement syndrome are given in this review article. PRACTICAL RECOMMENDATIONS Orthopedic and trauma surgeons express the suspicion of an impingement syndrome based on patient history and physical examination and radiologists confirm structural changes and damage of intra-articular structures using dedicated imaging techniques.
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Affiliation(s)
- J K Kloth
- Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland,
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Paz DA, Chang GH, Yetto JM, Dwek JR, Chung CB. Upper extremity overuse injuries in pediatric athletes: clinical presentation, imaging findings, and treatment. Clin Imaging 2015; 39:954-64. [DOI: 10.1016/j.clinimag.2015.07.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/25/2015] [Accepted: 07/23/2015] [Indexed: 12/29/2022]
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Messina C, Banfi G, Orlandi D, Lacelli F, Serafini G, Mauri G, Secchi F, Silvestri E, Sconfienza LM. Ultrasound-guided interventional procedures around the shoulder. Br J Radiol 2015; 89:20150372. [PMID: 26313499 DOI: 10.1259/bjr.20150372] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Ultrasound is an established modality for shoulder evaluation, being accurate, low cost and radiation free. Different pathological conditions can be diagnosed using ultrasound and can be treated using ultrasound guidance, such as degenerative, traumatic or inflammatory diseases. Subacromial-subdeltoid bursitis is the most common finding on ultrasound evaluation for painful shoulder. Therapeutic injections of corticosteroids are helpful to reduce inflammation and pain. Calcific tendinopathy of rotator cuff affects up to 20% of painful shoulders. Ultrasound-guided treatment may be performed with both single- and double-needle approach. Calcific enthesopathy, a peculiar form of degenerative tendinopathy, is a common and mostly asymptomatic ultrasound finding; dry needling has been proposed in symptomatic patients. An alternative is represented by autologous platelet-rich plasma injections. Intra-articular injections of the shoulder can be performed in the treatment of a variety of inflammatory and degenerative diseases with corticosteroids or hyaluronic acid respectively. Steroid injections around the long head of the biceps brachii tendon are indicated in patients with biceps tendinopathy, reducing pain and humeral tenderness. The most common indication for acromion-clavicular joint injection is degenerative osteoarthritis, with ultrasound representing a useful tool in localizing the joint space and properly injecting various types of drugs (steroids, lidocaine or hyaluronic acid). Suprascapular nerve block is an approved treatment for chronic shoulder pain non-responsive to conventional treatments as well as candidate patients for shoulder arthroscopy. This review provides an overview of these different ultrasonography-guided procedures that can be performed around the shoulder.
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Affiliation(s)
- Carmelo Messina
- 1 Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy
| | - Giuseppe Banfi
- 2 IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,3 Università Vita-Salute San Raffaele, Milano, Italy
| | - Davide Orlandi
- 4 Scuola di dottorato in Medicina Interna, Università degli Studi di Genova, Genova, Italy
| | - Francesca Lacelli
- 5 Dipartimento di Radiologia, Ospedale Santa Corona, Pietra Ligure, Italy
| | - Giovanni Serafini
- 5 Dipartimento di Radiologia, Ospedale Santa Corona, Pietra Ligure, Italy
| | - Giovanni Mauri
- 6 Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Francesco Secchi
- 6 Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.,7 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Enzo Silvestri
- 8 Servizio di Radiologia, Ospedale Evangelico Internazionale, Genova, Italy
| | - Luca Maria Sconfienza
- 6 Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.,7 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
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MRI and Ultrasound Imaging of the Shoulder Using Positional Maneuvers. AJR Am J Roentgenol 2015; 205:W244-54. [DOI: 10.2214/ajr.15.14512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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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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Merolla G, Paladini P, Di Napoli G, Campi F, Porcellini G. Outcomes of arthroscopic Hill-Sachs remplissage and anterior Bankart repair: a retrospective controlled study including ultrasound evaluation of posterior capsulotenodesis and infraspinatus strength assessment. Am J Sports Med 2015; 43:407-14. [PMID: 25504843 DOI: 10.1177/0363546514559706] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hill-Sachs lesions are compression fractures that result from shoulder dislocation. They involve "engaging" the humeral head on the anterior glenoid rim when the arm is abducted and externally rotated. The defect grows as the number of dislocations increases. HYPOTHESIS Arthroscopic remplissage and anterior Bankart repair do not significantly affect infraspinatus strength while ensuring healing of the capsulotenodesis. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Sixty-one patients with traumatic anterior shoulder instability treated by arthroscopic Bankart repair and Hill-Sachs remplissage at least 24 months previously were compared with a control group of 40 healthy participants. Preoperative imaging included magnetic resonance imaging for Bankart lesion identification and computed tomography to quantify the humeral head defect. Active range of motion and clinical scores (Walch-Duplay, Constant-Murley, and Rowe) were assessed. External rotation (ER) and internal rotation (IR) were measured with arm at the side (ER1 and IR1) and abducted at 90° (ER2 and IR2). Infraspinatus strength was assessed with the scapula free (infraspinatus strength test [IST]) and retracted (infraspinatus scapula retraction test [ISRT]). Infraspinatus tenodesis and posterior capsulodesis healing were evaluated by ultrasound (US). RESULTS The follow-up median was 39.5 months (range, 24-56 months). One patient experienced a recurrence of instability at 34 months. In the remplissage patients, ER1 was significantly lower in the affected compared with the unaffected shoulder (P < .001). Mean IST and ISRT strength values did not show differences between sides. The mean Constant-Murley score rose from 62.9 ± 7.1 to 90 ± 5.2 (P < .0001). The Walch-Duplay and Rowe scores were excellent in 23 (78.6%), good in 6 (17.8%), and poor in 1 patient (both scores). The remplissage group had significantly lower ER1 (P < .001), ER2 (P < .001), and IR2 (P < .01) values compared with the control group. Differences in IST and ISRT between the groups were not significant. Capsulotenodesis healing and filling of the Hill-Sachs defect were confirmed by dynamic US in all subjects. CONCLUSION Arthroscopic remplissage is a reliable approach to Hill-Sachs lesions. The ER and IR restriction does not significantly affect quality of life. Infraspinatus strength recovery is satisfactory even compared with healthy subjects. Ultrasound examination allows accurate evaluation of capsulotenodesis healing.
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Affiliation(s)
- Giovanni Merolla
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Rimini, Italy Biomechanics Laboratory "Marco Simoncelli," D. Cervesi Hospital, Cattolica, Rimini, Italy
| | - Paolo Paladini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Rimini, Italy
| | - Giuseppe Di Napoli
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Rimini, Italy
| | - Fabrizio Campi
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Rimini, Italy
| | - Giuseppe Porcellini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Rimini, Italy
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Do subacromial ultrasonography findings predict efficacy of intra-bursal injection? Prospective study in 39 patients. Orthop Traumatol Surg Res 2014; 100:S361-4. [PMID: 25454329 DOI: 10.1016/j.otsr.2014.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ultrasonography has become an investigation of choice in the management of shoulder pain. The objective of this study was to determine whether the efficacy of subacromial-subdeltoid bursa injection correlated with the ultrasound findings. MATERIAL AND METHODS We prospectively recruited patients who were seen between November 2012 and November 2013 for subacromial pain and whose rotator cuff was either intact or showed a full-thickness tear less than 1cm in length. A standardised physical examination of the shoulder was followed immediately by static and dynamic ultrasonography, intra-bursal injection of lidocaine, and a repetition of the same physical examination. Recorded ultrasonography features were the appearance of the bursa, shape of the coraco-acromial ligament, and bursal deformation induced by passage under the coraco-acromial ligament during dynamic imaging. A response to the injection was defined as greater than 75% improvements in at least three of the physical examination parameters. RESULTS We included 39 patients with a mean age of 56.7 years. Ultrasonography showed abnormalities of the bursa in 30 patients, including 1 with an intra-bursal effusion, 10 with thickening, and 19 with both. Deformation of the bursa under the coraco-acromial ligament was noted in 26 patients. The proportions of patients with bursal effusion and with bursal thickening were similar in the 20 responders and 19 non-responders. Neither were any significant differences found for coraco-acromial ligament shape or bursal deformation under the ligament. CONCLUSIONS No correlation was found between ultrasonography findings and the efficacy of a local anaesthetic injection into the subacromial bursa. These findings suggest that ultrasound abnormalities may constitute mere physiological changes, in keeping with earlier studies in asymptomatic individuals. Thus, subacromial impingement may be currently overdiagnosed.
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Chen DY, Haw-Chang Lan H, Lai KL, Chen HH, Chen YM, Chen CP. Diagnostic Utility of US for Detecting Rotator Cuff Tears in Rheumatoid Arthritis Patients: Comparison with Magnetic Resonance Imaging. J Med Ultrasound 2014. [DOI: 10.1016/j.jmu.2014.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Mohamed RE, Amin MA, Aboelsafa AA. Ultrasonographic and clinical study of post-stroke painful hemiplegic shoulder. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.06.011] [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] Open
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Tagliafico A, Cadoni A, Bignotti B, Martinoli C. High-resolution ultrasound of rotator cuff and biceps reflection pulley in non-elite junior tennis players: anatomical study. BMC Musculoskelet Disord 2014; 15:241. [PMID: 25034864 PMCID: PMC4109776 DOI: 10.1186/1471-2474-15-241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/25/2014] [Accepted: 06/20/2014] [Indexed: 11/17/2022] Open
Abstract
Background Tennis is believed to be potentially harmful for the shoulder, therefore the purpose of this study is to evaluate the anatomy of the rotator cuff and the coraco-humeral ligament (CHL) in a-symptomatic non-elite junior tennis players with high-resolution ultrasound (US). Methods From August 2009 to September 2010 n = 90 a-symptomatic non-elite junior tennis players (mean age ± standard deviation: 15 ± 3) and a control group of age- and sex- matched subjects were included. Shoulder assessment with a customized standardized protocol was performed. Body mass index, dominant arm, years of practice, weekly hours of training, racket weight, grip (Eastern, Western and semi-Western), kind of strings were recorded. Results Abnormalities were found at ultrasound in 14/90 (15%) players. Two players had supraspinatus tendinosis, two had subacromial impingement and ten had subacromial bursitis. CHL thickness resulted comparable in the dominant and non-dominant arms (11.3 ± 4.4 mm vs. 13 ± 4.2, p > 0.05). Multivariate analysis demonstrated that no association was present among CHL thickness and the variables evaluated. In the control group, abnormalities were found at ultrasound in 6/60 (10%) subjects (sub-acromial bursitis). No statistically significant differences between players and control group were found (p = 0.71). Conclusion In a-symptomatic non-elite junior tennis players only minor shoulder abnormalities were found.
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Affiliation(s)
| | | | - Bianca Bignotti
- Radiology Department -DISSAL- Università di Genova, Largo Rosanna Benzi 8, 16138 Genova, Italy.
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The Clinical and Sonographic Effects of Kinesiotaping and Exercise in Comparison With Manual Therapy and Exercise for Patients With Subacromial Impingement Syndrome: A Preliminary Trial. J Manipulative Physiol Ther 2014; 37:422-32. [DOI: 10.1016/j.jmpt.2014.03.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 02/04/2014] [Accepted: 03/15/2014] [Indexed: 01/30/2023]
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Lin HY, Wong PK, Ho WP, Chuang TY, Liao YS, Wong CC. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion--dynamic sonographic evaluation. J Orthop Surg Res 2014; 9:6. [PMID: 24502688 PMCID: PMC3922330 DOI: 10.1186/1749-799x-9-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 01/28/2014] [Indexed: 01/28/2023] Open
Abstract
Background Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures. Methods We prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores. Results Clinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%). Conclusions We demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved.
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Affiliation(s)
| | | | | | | | | | - Chin-Chean Wong
- Department of Orthopaedic Surgery, Wan Fang Hospital, Taipei Medical University, No, 111, Sec, 3, Xinglong Road, Taipei 11696, Taiwan.
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Harris G, Bou-Haidar P, Harris C. Adhesive capsulitis: review of imaging and treatment. J Med Imaging Radiat Oncol 2013; 57:633-43. [PMID: 24283550 DOI: 10.1111/1754-9485.12111] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/10/2013] [Indexed: 12/23/2022]
Abstract
Adhesive capsulitis is one of the most common conditions affecting the shoulder; however, early clinical diagnosis can be challenging. Treatment is most effective when commenced prior to the onset of capsular thickening and contracture; consequently, the role of imaging is increasing. The aim of this review is to demonstrate the typical imaging appearances of adhesive capsulitis and to examine some of the evidence regarding each of these imaging modalities. An evaluation of the various management options available to the clinician is also presented.
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Affiliation(s)
- Guy Harris
- Central Coast Local Health District, Gorsford, New South Wales, Australia
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Verdano MA, Pellegrini A, Schiavi P, Somenzi L, Concari G, Ceccarelli F. Humeral shaft fractures treated with antegrade intramedullary nailing: what are the consequences for the rotator cuff? INTERNATIONAL ORTHOPAEDICS 2013; 37:2001-7. [PMID: 23881061 DOI: 10.1007/s00264-013-2007-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 06/23/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to investigate the clinical and sonographic impact on the rotator cuff (RC) of the use of the anterolateral approach for nailing. METHODS A retrospective cohort of 48 patients treated for humeral diaphyseal fractures at the University Hospital of Parma between 2007 and 2011 was analysed. Inclusion criteria were (1) acute humeral shaft fractures treated with T2-proximal humeral nail (PHN) and (2) a minimum follow-up of one year. Exclusion criteria were (1) history of proximal and metaphyseal humeral fractures, (2) pathological fractures or open fractures of the humerus, and (3) RC lesions. Clinical assessment using the Constant score, simple shoulder test and through shoulder examination tests was carried out. The sonographic study investigated the integrity of the RC. RESULTS Mean score on Constant's scale was 78.21 points, with most patients achieving a good result (79% obtained more than 65 points). One patient had a limited functional outcome (Constant's score of 49 points). The sonographic findings described for supraspinatus tendon were a partial ruptures of less than 30 mm in three patients and a complete tendon rupture in one case. CONCLUSIONS The results of this study suggest that the use of the anterolateral approach for antegrade humeral nailing ensures a good functional result with no significant clinical-sonographic impact on the rotator cuff and a satisfactory long term clinical outcome.
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Affiliation(s)
- Michele Arcangelo Verdano
- Orthopaedic and Traumatologic Department, University Hospital of Parma, Via Gramsci 14, Parma, Italy
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Abstract
Shoulder ultrasound is consistently used in the assessment of rotator cuff and is as accurate as magnetic resonance imaging in the detection of rotator cuff tear. It can be used as a focused examination providing rapid, real-time diagnosis, and treatment in desired clinical situations. This article presents a simplified approach to scanning and image-guided intervention, and discusses common sonographically apparent shoulder pathologies.
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Cho HK, Kim HS, Joo SH. Sonography of affected and unaffected shoulders in hemiplegic patients: analysis of the relationship between sonographic imaging data and clinical variables. Ann Rehabil Med 2013; 36:828-35. [PMID: 23342316 PMCID: PMC3546186 DOI: 10.5535/arm.2012.36.6.828] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 06/23/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore the relationship between a number of clinically relevant variables and sonographic imaging data in respect to the level of impairment experienced in the affected and unaffected shoulders of hemiplegic stroke patients. METHOD Fifty-one hemiplegic stroke patients (32 males, 19 females; 29 right-sided hemiplegics, 22 left-sided hemiplegics) participated in this study. A musculoskeletal radiologist conducted a sonographic exam on both the affected and unaffected shoulders of all patients and two physicians classified the severity of the injury on a six-point rating scale. Clinical variables including age, sex, duration of injury, spasticity and muscle power of the hemiplegic side, and level of functional activity of the shoulder were assessed. RESULTS The sonographic rating scores of hemiplegic shoulders were positively correlated with age (p<0.01) and negatively correlated with level of muscle spasticity (p<0.05). The sonographic rating scores of unaffected shoulders were positively correlated with duration of injury (p<0.01). Affected shoulders received sonographic rating scores that reflected significantly more impairment than those of unaffected shoulders (p<0.001), and pre-morbid handedness did not affect the relationship between impairment rating and shoulder injury status. CONCLUSION Hemiplegic stroke influences not only affected shoulders, but also unaffected sides. Proper management of spasticity, enhancement of motor recovery, and avoidance of unaffected shoulder overuse should be considered to prevent shoulder problems following strokes which result in hemiplegia.
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Affiliation(s)
- Hyong Keun Cho
- Department of Physical Medicine and Rehabilitation, National Health Insurance Corporation Ilsan Hospital, Goyang 410-719, Korea
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Ditsios K, Agathangelidis F, Boutsiadis A, Karataglis D, Papadopoulos P. Long head of the biceps pathology combined with rotator cuff tears. Adv Orthop 2012; 2012:405472. [PMID: 23209915 PMCID: PMC3507080 DOI: 10.1155/2012/405472] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/15/2012] [Indexed: 01/02/2023] Open
Abstract
The long head of the biceps tendon (LHBT) is an anatomic structure commonly involved in painful shoulder conditions as a result of trauma, degeneration, or overuse. Recent studies have pointed out the close correlation between LHBT lesions and rotator cuff (RCT) tears. Clinicians need to take into account the importance of the LHBT in the presence of other shoulder pathologies. This paper provides an up-to-date overview of recent publications on anatomy, pathophysiology, diagnosis, classification, and current treatment strategies.
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Affiliation(s)
- Konstantinos Ditsios
- 1st Department of Orthopaedics, G. Papanikolaou General Hospital, Aristotle University of Thessaloniki, Exohi, 57010 Thessaloniki, Greece
| | - Filon Agathangelidis
- 1st Department of Orthopaedics, G. Papanikolaou General Hospital, Aristotle University of Thessaloniki, Exohi, 57010 Thessaloniki, Greece
| | - Achilleas Boutsiadis
- 1st Department of Orthopaedics, G. Papanikolaou General Hospital, Aristotle University of Thessaloniki, Exohi, 57010 Thessaloniki, Greece
| | - Dimitrios Karataglis
- 1st Department of Orthopaedics, G. Papanikolaou General Hospital, Aristotle University of Thessaloniki, Exohi, 57010 Thessaloniki, Greece
| | - Pericles Papadopoulos
- 1st Department of Orthopaedics, G. Papanikolaou General Hospital, Aristotle University of Thessaloniki, Exohi, 57010 Thessaloniki, Greece
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Abstract
OBJECTIVE The purpose of this article is to describe the imaging appearances of musculoskeletal injuries related to yoga. We performed an automated search in the database of a large tertiary care center and conducted a retrospective analysis of the imaging findings in 38 patients over a 9-year period. CONCLUSION The most frequently encountered musculoskeletal injuries were tendinous lesions, including tears of the supraspinatus, Achilles, and peroneus brevis tendons and fibrocartilaginous tears involving the medial meniscus, acetabular labrum, glenoid labrum, and lumbar disk with extrusion.
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AIUM practice guideline for the performance of a musculoskeletal ultrasound examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1473-1488. [PMID: 22922632 DOI: 10.7863/jum.2012.31.9.1473] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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