Usefulness of rehabilitation in patients with rotator cuff calcific tendinopathy after ultrasound-guided percutaneous treatment

Physiotherapy after ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy

BACKGROUND

Rotator cuff calcific tendinopathy (RCCT) is a very frequent and debilitating disease often treated with Ultrasound-guided percutaneous irrigation (UGPI) followed by physiotherapy.

OBJECTIVE

A multicenter observational clinical study was designed to assess the effects of physiotherapy after UGPI on the functional recovery of the shoulders of patients suffering from RCCT.

METHOD

One hundred sixty-six patients (mean age 50.7± 7.6 years), 121 women, with painful RCCT were treated with UGPI and assessed at the day of UGPI (T0), and at one (T1), 3 (T2) and 6 (T3) months after treatment by the Constant- Murley Score (CMS), Oxford Shoulder Scale (OSS) and Numerical Rating Scale (NRS). Patients were divided into 2 groups, Physiotherapy (PT+) and not Physiotherapy (PT-) according to the performance of the rehabilitation program based on personal decision.

RESULTS

A significant improvement at T1 in all outcomes in both groups and between T1 and T3 for NRS during movement and OSS was found, but not for NRS at rest and CMS. There was no difference between groups for all outcome measures. In 27,1% of patients symptoms recurred in an average of 13 ± 8 weeks.

CONCLUSIONS

Results suggest that post-UGPI not-standardized physiotherapy might not provide additional clinical benefits in short and medium term. Further studies could assess the effectiveness of physiotherapy performed after three months in patients with recurrence of pain.

Ultrasound-guided Percutaneous Lavage in the Treatment of Calcific Tendinopathy of Elbow Extensor Tendons: A Case Report

We report the efficacy of the ultrasound-guided percutaneous treatment in the management of elbow extensor tendons calcific tendinopathy. The ultrasound-guided percutaneous treatment is broadly used with positive results in patients suffering from rotator cuff calcific tendinopathy. However, this interventional method has been reported only in one patient in the medical literature. A 34 years-old female who complained pain, swelling and severe functional limitation of the right elbow was referred to our unit. Elbow radiographs and ultrasound examination showed a soft-fluid calcification above the origin of the extensor tendons. Ultrasound-guided percutaneous treatment was therefore performed. After one year, the patient reported no pain and regained complete range of elbow motion. This method, in well trained hands, is an alternative treatment in the management of the uncommon elbow calcific deposit.

The effects of therapeutic exercise using PNF on the size of calcium deposits, pain self-awareness, and shoulder joint function in a calcific tendinitis patient: a case study

[Purpose] The purpose of this case study was to identify the effects of independent and intensive therapeutic exercise using Proprioceptive neuromuscular facilitation on the size of calcium deposits, pain self-awareness, and shoulder joint function in a patient with calcific tendonitis. [Subject and Methods] The subject was a 42-year-old female patient with calcific tendonitis and acute pain who had difficulty with active movement and problems with general function. The independent and intensive Proprioceptive neuromuscular facilitation exercise was applied for 40 min twice a day five times a week for two weeks for a total of 20 times. An X-ray, the visual analog scale, a simple shoulder test, the Constant-Murley Scale, and passive range of motion was used to evaluate the patient’s change. [Results] The size of the calcium deposit, the visual analog scale score, and the simple shoulder test score decreased. The Constant-Murley Scale score and the passive range of motion were increased. [Conclusion] The results of this study suggested that intensive and independent therapeutic short-term exercise without any other exercise reduced pain and produced positive effects in shoulder function in a patient with the calcific tendonitis, which could confirm the importance of therapeutic exercise in the treatment of calcific tendonitis.

Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome

OBJECTIVE

Rotator cuff calcific tendinitis (RCCT) is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. Between non-surgical and surgical treatment options, today a few minimal invasive techniques are available to remove the calcific deposit, and they represent a cornerstone in the management of this painful clinical condition. The aim of the work was a retrospective evaluation of double-needle ultrasound-guided percutaneous fragmentation and lavage (DNL), focused on understanding the factors which are of major importance in determining a quick and good response at 1 month.

METHODS

A series of 147 patients affected by RCCT and suitable for DNL were evaluated. A systematic review of anamnestic, clinical and imaging data was performed in 144 shoulders treated in a single-centre setting. Clinical reports and imaging examinations were revisited. The inclusion criteria were submission to DNL, therefore fitness for the percutaneous procedure, and following 1-month follow-up. There was no exclusion owing to risk of bias. The treatment was defined as successful for constant shoulder modified score (CSS) improvement of >50% at 1 month.

RESULTS

In 70% of shoulders, the treatment resulted in a quick and significant reduction of symptoms (successful). On the whole, CSS increase at 1 month was estimated at 91.5 ± 69.1%. CSS variations were significantly related to age of patients (better results between 30 and 40 years old), calcification size (more relevant improvement for middle-sized calcifications, 12-17 mm), sonographic and radiographic features of calcific deposits (softer calcifications) and thickening of subacromial/subdeltoid bursa walls. In the final model of stepwise regression for CSS variation, ultrasound score pre-treatment and post-treatment, the distance between bursa and calcification before treatment and the size of post-treatment calcification area were shown to be independently correlated to success. Numeric rating scale score for pain showed similar results. Pain at admission was also related to age, calcification size, ultrasound and Gärtner score, power Doppler positivity, bursal wall thickening and biceps tenosynovitis.

CONCLUSION

The success of the procedure with quick improvement in function and symptoms is warranted in soft and middle-sized calcifications, in young adults.

ADVANCES IN KNOWLEDGE

Ultrasound-guided percutaneous procedures for RCCT must be safe, effective and with prompt pain relief and function restoration. This study shows which clinical picture is more favourable to this purpose and actual prognostic factors for DNL (soft and middle-sized calcifications, in young adults, are more favourable).