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Zamboulis DE, Marr N, Moustafa A, Meeson R, Orriss IR, Thorpe CT. Pathological calcification in canine tendon-derived cells is modulated by extracellular ATP. Vet Res Commun 2024; 48:1533-1543. [PMID: 38381244 PMCID: PMC11147865 DOI: 10.1007/s11259-024-10331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Abstract
Tendon calcification is a commonly associated with degenerative tendinopathy of the Achilles tendons in dogs. It is characterised by the formation of calcific deposits and is refractory to treatment, often re-forming after surgical removal. Little is known about its pathogenesis and therefore the aims of this study were to develop an in vitro model of canine tendon calcification and use this model to investigate mechanisms driving calcification. Cells from the canine Achilles tendon were cultured with different calcifying media to establish which conditions were best able to induce specific, cell-mediated calcification. Once optimum calcification conditions had been established, the effect of ATP treatment on calcification was assessed. Results revealed that 2 mM di-sodium phosphate combined with 2 mM calcium chloride provided the optimum calcifying conditions, increasing calcium deposition and expression of osteogenic-related genes similar to those observed in tendon calcification in vivo. ATP treatment inhibited calcification in a dose-dependent manner, reducing calcium deposition and increasing cell viability, while osteogenic-related genes were no longer upregulated. In conclusion, the in vitro model of canine tendon calcification developed in this study provides the ability to study mechanisms driving tendon calcification, demonstrating that ATP plays a role in modulating tendon calcification that should be explored further in future studies.
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Affiliation(s)
- Danae E Zamboulis
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Camden, London, UK
- Department of Clinical Sciences, School of Veterinary Medicine, Aristotle University of Thessaloniki, 54124, Thessaolinki, Greece
| | - Neil Marr
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Camden, London, UK
- Department of Clinical Science and Services, Royal Veterinary College, London, UK
| | - Alaa Moustafa
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Camden, London, UK
- Department of Surgery, Anaesthesiology, and Radiology, Faculty of Veterinary Medicine, Kafr Elshiekh University, Kafr Elshiekh, Egypt
| | - Richard Meeson
- Department of Clinical Science and Services, Royal Veterinary College, London, UK
| | - Isabel R Orriss
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Camden, London, UK
| | - Chavaunne T Thorpe
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Camden, London, UK.
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Caballero I, Dueñas L, Balasch-Bernat M, Fernández-Matías R, Bresó-Parra L, Gallego-Terres C, Aroca Navarro JE, Navarro-Bosch M, Lewis J, Lluch Girbés E. Effectiveness of non-surgical management in rotator cuff calcific tendinopathy (the effect trial): protocol for a randomised clinical trial. BMJ Open 2024; 14:e074949. [PMID: 38176875 PMCID: PMC10773347 DOI: 10.1136/bmjopen-2023-074949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Rotator cuff calcific tendinopathy (RCCT) involves calcific deposits in the rotator cuff. Non-surgical interventions such as extracorporeal shockwave therapy (ESWT) and ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) are recommended for its early management. Exercise therapy (ET) has shown to be an effective intervention for people with rotator cuff tendinopathy, but it has not been formally tested in RCCT. The main objective of this study is to compare the effectiveness of an ET programme with ESWT and US-PICT in people with RCCT. As a secondary aim, this study aims to describe the natural history of RCCT. METHODS AND ANALYSIS A randomised, single-blinded four-group clinical trial will be conducted. Adults from 30 to 75 years diagnosed with RCCT who accomplish eligibility criteria will be recruited. Participants (n=116) will be randomised into four groups: ET group will receive a 12-week rehabilitation programme; ESWT group will receive four sessions with 1 week rest between sessions during 1 month; US-PICT group will receive two sessions with 3 months of rest between sessions; and (actual) wait-and-see group will not receive any intervention during the 12-month follow-up. The primary outcome will be shoulder pain assessed with the Shoulder Pain and Disability Index at baseline, 2 weeks, 4 months, 6 months and 12 months from baseline. The primary analysis will be performed at 12 months from baseline. Secondary outcomes will include pain, range of motion, patient satisfaction and imaging-related variables. Moreover, the following psychosocial questionnaires with their corresponding outcome measure will be assessed: Central Sensitization Inventory (symptoms related to central sensitization); Pain Catastrophizing Scale (pain catastrophizing); Tampa Scale for Kinesiophobia 11 items (fear of movement); Fear Avoidance Belief Questionnaire (fear avoidance behaviour); Hospital Anxiety and Depression Scale (anxiety and depression); Pittsburgh Sleep Quality Index (sleep quality); and the EuroQol-5D (quality of life). An intention-to-treat analysis will be performed to reduce the risk of bias using a worst-case and best-case scenario analysis. ETHICS AND DISSEMINATION Ethics committee approval for this study has been obtained (reference number: 1718862). The results of the main trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05478902.
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Affiliation(s)
- Iván Caballero
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Lirios Dueñas
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Mercè Balasch-Bernat
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Luis Bresó-Parra
- Department of Radiology, Lluis Alcanyis Hospital of Xativa, Xativa, Spain
| | | | | | - Marta Navarro-Bosch
- Shoulder and Elbow Unit, University and Polytechnic Hospital, Valencia, Spain
| | - Jeremy Lewis
- Consultant Physiotherapist, Therapy Department, Central London Community Healthcare National Health Service Trust, Finchley Memorial Hospital, London N12 0JE, UK
- Professor of Musculoskeletal Research, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Enrique Lluch Girbés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
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Avendano JP, Pereira D. Treatment of Calcific Tendonitis of the Rotator Cuff: An Updated Review. Orthopedics 2023; 46:e326-e332. [PMID: 37672776 DOI: 10.3928/01477447-20230901-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Rotator cuff calcific tendonitis (RCCT) is a disorder that can greatly impair patients' quality of life. A literature review was conducted to find the most effective and newest treatments for RCCT. PubMed and Cochrane Review databases were searched, without strict inclusion/exclusion criteria, for peer-reviewed articles between 1941 and 2021 that discussed RCCT etiology and treatments. If nonoperative measures (non-steroidal anti-inflammatory drugs, physical therapy, and corticosteroids) are unsuccessful, other options include extracorporeal shockwave therapy, ultrasound-guided injection techniques, and minimally invasive surgery. Because RCCT can resolve spontaneously, patients should progress to invasive options only if conservative first-line treatments have failed. [Orthopedics. 2023;46(6):e326-e332.].
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Hu C, Ma L, Gao S, Yang MY, Mu MD, Chang L, Huang P, Ye X, Wang W, Tao X, Zhou BH, Chen W, Tang KL. PPP1R3A inhibits osteogenesis and negatively regulates intracellular calcium levels in calcific tendinopathy. iScience 2023; 26:107784. [PMID: 37876608 PMCID: PMC10590817 DOI: 10.1016/j.isci.2023.107784] [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: 03/13/2023] [Revised: 07/25/2023] [Accepted: 08/28/2023] [Indexed: 10/26/2023] Open
Abstract
Calcific tendinopathy (CT) is defined by the progressive accumulation of calcium crystals in tendonic regions that results in severe pain in patients. The etiology of CT is not fully elucidated. In this study, we elucidate the role of PPP1R3A in CT. A significant decrease in PPP1R3A expression was observed in CT patient tissues, which was further confirmed in tissues from a CT-induced rat model. Overexpression of PPP1R3A ex vivo reduced the expression of osteo/chondrogenic markers OCN and Sox9, improved tendon tissue architecture, and reduced intracellular Ca2+ levels. Overexpression of SERCA2 and knockdown of Piezo1 decreased expression of osteo/chondrogenic markers and intracellular calcium in PPP1R3A-knockdown tendon cells. Lastly, PPP1R3A expression was regulated at the posttranscriptional level by binding of HuR. Collectively, the present study indicates that PPP1R3A plays an important role in regulating calcium homeostasis in tendon cells via Piezo1/SERCA2, rendering it a promising target for therapeutic interventions of CT.
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Affiliation(s)
- Chao Hu
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
- Department of Orthopedics, 904 Hospital of PLA, Wuxi 214000 Jiangsu, China
| | - Lin Ma
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Shang Gao
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Ming-Yu Yang
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Mi-Duo Mu
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Le Chang
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Pan Huang
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Xiao Ye
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Wei Wang
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Xu Tao
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Bing-Hua Zhou
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Wan Chen
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Kang-Lai Tang
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400000, China
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Youn SM, Rhee SM, Cho SH, Kim CH, Lee JU, Rhee YG. Arthroscopic decompression of calcific tendinitis without cuff repair. Bone Joint J 2023; 105-B:663-667. [PMID: 37257863 DOI: 10.1302/0301-620x.105b6.bjj-2022-1137.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims The aim of this study was to investigate the outcomes of arthroscopic decompression of calcific tendinitis performed without repairing the rotator cuff defect. Methods A total of 99 patients who underwent treatment between December 2013 and August 2019 were retrospectively reviewed. Visual analogue scale (VAS) and American Shoulder and Elbow Surgeons (ASES) scores were reviewed pre- and postoperatively according to the location, size, physical characteristics, and radiological features of the calcific deposits. Additionally, the influence of any residual calcific deposits shown on postoperative radiographs was explored. The healing rate of the unrepaired cuff defect was determined by reviewing the 29 patients who had follow-up MRIs. Results Statistically significant improvement from pre- to postoperation was seen in all VAS and ASES scores for each group, but no statistical differences were seen between the postoperative scores according to the differences in the features of the calcific deposits. When residual calcification was observed postoperatively, the mean ASES and VAS (rest) scores improved significantly to 95.0 (SD 5.6) and 0.0 (SD 0.0), respectively (p = 0.006 and p < 0.001), and did not differ from those who had the complete removal. Of 29 patients who had follow-up MRIs, six (20.7%) showed signs of an interstitial tear. This group's mean postoperative ASES and VAS (rest) scores improved to excellent levels of 96.0 (SD 3.7) and 0.0 (SD 0.0), respectively, and were similar to those of the 23 patients with normal MRI appearances. Conclusion Arthroscopic removal of calcific deposits without repairing the rotator cuff defect resulted in significant improvement in function and pain level, regardless of the deposit's location, size, type, and whether or not complete excision was achieved. Despite leaving the defects unrepaired, in the limited number of patients with follow-up MRIs, 23 of 29 patients (79.3%) showed good healing, and the rest, who had persistent signs of interstitial defects on the MRIs, still had excellent outcomes. The removal of calcific deposits without repairing the cuff defects provided excellent outcomes.
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Affiliation(s)
- Seung-Min Youn
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Gyeonggi-do, South Korea
| | - Sung M Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Soong-Hwan Cho
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Gyeonggi-do, South Korea
| | - Cheol-Hwan Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Gyeonggi-do, South Korea
| | - Jong-Ung Lee
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Gyeonggi-do, South Korea
| | - Yong G Rhee
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Gyeonggi-do, South Korea
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Hohmann E, Tetsworth K. Arthroscopic treatment and subacromial decompression of calcific tendinitis without removal of the calcific deposit results in rapid resolution of symptoms and excellent clinical outcomes in commercial airline pilots and cabin crew. Arch Orthop Trauma Surg 2023; 143:919-926. [PMID: 35175373 DOI: 10.1007/s00402-022-04339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The purpose of this study was to report the results of subacromial arthroscopic decompression (SAD) without removal of the calcific deposits in patients with calcifying tendinitis. METHODS All patients between 2016 and 2019 were included if they were aged between 18 and 60 years and had an isolated calcific deposit. The Constant-Murley score (CMS), Disabilities of the Arm, Shoulder and Hand (Quick DASH) score, the Shoulder Pain and Disability Index (SPADI), the simple shoulder test (SST), and the single assessment numeric evaluation (SANE) were used for assessment. Time to return to work was recorded. RESULTS 24 patients (13 pilots, 11 cabin crew) with a mean age of 47.1 ± 7.8 years were included. Quick Dash improved from 68.8 preoperative, to 8.4 at 3 months, and 0.1 at 24 months. CMS improved from 37.4 preoperative, to 83 at 3 months, and 94 at 24 months. SPADI improved from 73.8 preoperative, to 5.4 at 3 months, and 1 at 24 months. SST improved from 22.5 preoperative, to 94.2 at 3 months, and 100 at 24 months. SANE improved from 33.5 preoperative, to 78.7 at 3 months, and 95.6 at 24 months. MCID, SCB, and PASS reached values above 83% at 3 months and 100% at 6 months, with the exception of SANE which reached 29% at 3 months and plateaued to 96% at 6 months. The mean time to return to work was 7.1 ± 2.1 weeks. Pilots returned at a mean of 6.9 ± 1.8 weeks; cabin crew returned to work at a mean of 7.8 ± 2.5 weeks. CONCLUSIONS The results of this study suggest excellent short- and mid-term clinical outcomes can be achieved in patients with calcific tendinitis undergoing arthroscopic debridement and subacromial decompression without removal of calcific deposits. In this patient population, early surgical intervention was a potentially viable alternative to nonoperative treatment, and allowed early return to work.
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Affiliation(s)
- Erik Hohmann
- Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates. .,School of Medicine, Faculty of Health Sciences, University of Pretoria, Cnr Bophelo and Dr Savage Road, Gezina, Pretoria, 0001, South Africa.
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia.,Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia.,Limb Reconstruction Center, Macquarie University Hospital, Macquarie Park, Australia.,Orthopaedic Research Centre of Australia, Brisbane, Australia
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7
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Zhao F, Wu J, Wang D, Li P, Tian W, Li W, Chai B, Zhang Y. The effect of subacromial decompression on the curative effect of arthroscopic treatment of shoulder calcific tendinitis. Front Surg 2023; 9:1043794. [PMID: 36684344 PMCID: PMC9852624 DOI: 10.3389/fsurg.2022.1043794] [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: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023] Open
Abstract
Objective To observe and analyze the surgical efficacy of arthroscopic debridement of calcified deposits and arthroscopic debridement combined with subacromial decompression in patients with supraspinatus tendon calcific myositis. To observe the effect of Subacromial decompression on the efficacy of arthroscopic treatment of shoulder calcific tendinitis. Patients and methods From 2016 to 2021, 48 cases of shoulder arthroscopic debridement due to supraspinatus calcific tendinitis met the inclusion criteria and were included, with 24 cases assigned to the arthroscopic debridement group and 24 cases to the arthroscopic debridement combined with subacromial decompression group. Changes between preoperative and postoperative shoulder pain and shoulder function were statistically analyzed. Results The 24 patients in the arthroscopic debridement group were better than the arthroscopic debridement combined with subacromial decompression group in terms of short-term postoperative shoulder pain and shoulder joint function recovery (P < 0.05). There was no significant difference in the postoperative long-term shoulder pain and shoulder function recovery between the two groups (P > 0.05). Conclusions Compared with arthroscopic debridement combined with subacromial decompression, arthroscopic debridement alone is a better surgical option for the treatment of calcific tendinitis.
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Pang L, Li T, Li Y, Cao Y, Li J, Zhu J, Tang X. Combined arthroscopic rotator cuff repair leads to better clinical outcomes than isolated removal of calcific deposits for shoulder calcific tendinitis: A 2- to 5-year follow-up study. Front Surg 2022; 9:912779. [PMID: 36061068 PMCID: PMC9428341 DOI: 10.3389/fsurg.2022.912779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The optimal treatment procedure for shoulder calcific tendinitis (CT) remains controversial. This study aimed to assess the efficacy of arthroscopic treatment for CT, and to compare the clinical outcomes following combined rotator cuff repair and isolated removal of calcific deposits. Methods This retrospective cohort study included 46 patients (47 shoulders) with confirmed shoulder CT, and the diameter of the calcific deposit was over 1 cm. All patients suffered from CT for a mean period of 17.82 months and had a poor response to conservative treatment. With 12 males and 34 females included, the mean age was 53.94 years. After failed conservative treatment, 23 shoulders underwent combined rotator cuff repair (repair group), and 24 shoulders underwent isolated removal of calcific deposits (debridement group). The clinical outcomes were evaluated at baseline, 3, 6, and 12 months after the surgery and annually thereafter. The efficacy measures included the visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score and radiographic outcomes. Results Remarkable improvement in clinical outcomes at the final follow-up (2- to 5-year) compared with those at baseline were observed (p < 0.0001 for all outcomes). Compared with isolated removal of calcific deposits, combined rotator cuff repair led to worse postoperative 3- and 6-month VAS (p = 0.004 and p = 0.026, respectively), and 3-month ASES scores (p = 0.012). However, better VAS (p = 0.035 and p = 0.007, respectively) and ASES (p = 0.034 and p = 0.020, respectively) scores at 24-month and final follow-up were found in the repair group. All these differences reached the minimal clinical important difference (MCID). MRI scans at the final follow-up showed significantly better outcomes in patients with rotator cuff repair (p = 0.021). Conclusions Arthroscopic removal of calcific deposits is safe and effective for treating CT. Compared with isolated debridement, combined rotator cuff repair led to worse short-term (<12 months) but better medium- (12–48 months) to long-term (≥48 months) improvements in pain, function and integrity of tendons.
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Affiliation(s)
- Long Pang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yinghao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- West China Medical School, Sichuan University, Chengdu, China
| | - Yuanyinuo Cao
- West China Medical School, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Jing Zhu Xin Tang
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Jing Zhu Xin Tang
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Nakhaie Amroodi M, Abdolahi Kordkandi S, Moghtadaei M, Farahini H, Amiri S, Hajializade M. A Study of Characteristic Features and Diagnostic Roles of X-ray and MRI in Calcifying Tendinitis of the Shoulder. Med J Islam Repub Iran 2022; 36:79. [PMID: 36128299 PMCID: PMC9448462 DOI: 10.47176/mjiri.36.79] [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: 12/11/2021] [Accepted: 07/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Calcifying tendinitis (CT) is an enigmatic lesion with several obscure aspects and it is a common disorder of the upper extremity characterized by the presence of calcifications in rotator cuff tendons and synovial tissues. In this study, we aimed to review the demographic and clinical characteristics, as well as radiologic and treatment history in CT patients who were referred with shoulder pain.
Methods: In this cross-sectional study, a total of 146 patients who were referred with a shoulder CT were included. The definitive diagnosis was based on a combination of plain radiograph and magnetic resonance imaging (MRI). A predesigned independent t test was used to capture demographic and clinical data, as well as radiologic and treatment histories, and a chi-square test was utilized to assess the statistical correlation between qualitative variables. Results: The median age of the patients was 42.5 years. The female to male ratio was 2.3 to 1. The complaint of restricted shoulder movement was recorded in 107 (73.3%) patients and more frequently in women (p = 0.042). Night pain was present in 109 (74.7%) patients. The current and previous diagnoses matched in 36.1% (13 out of 36) of patients who only had MRI and in 63.6% (35 out of 55) patients who had both MRI and plain radiograph with them. Supraspinatus tendon was the main site of calcified deposition 65% (95 out of 146).
Conclusion: CT is frequent at the age of around 40 and in the female gender. The diagnosis should be based on a combination of radiography and MRI and not based on MRI alone. The efficacy of different conservative treatments remains to be unwrapped.
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Affiliation(s)
- Morteza Nakhaie Amroodi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shadi Abdolahi Kordkandi
- Department of Orthopedics, Rasul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moghtadaei
- Department of Orthopedics, Rasul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Farahini
- Department of Orthopedics, Rasul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shayan Amiri
- Department of Orthopedics, Rasul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mikaiel Hajializade
- Department of Orthopedics, Rasul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran,Corresponding author: Dr Mikael Hajializade,
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Fontani V, Rinaldi A, Castagna A, Rinaldi S. Calcific Tendinitis of the Shoulder: A Neuro-Psychomotor Behavioral Diagnostic and Therapeutic Approach With Radioelectric Asymmetric Conveyer Neurobiological Stimulation Treatments. Cureus 2022; 14:e26770. [PMID: 35836712 PMCID: PMC9275448 DOI: 10.7759/cureus.26770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 01/12/2023] Open
Abstract
Calcific tendinitis of the shoulder (CTS) is one of the pathological conditions that most often affects the shoulder and consists of a calcium deposit that settles within the tendon tissue of the rotator cuff. The scientific literature has long highlighted the impact of anxiety, stress, and depression on CTS. The goal of this case report is to highlight how the emotional state of patients and their neuro-psychomotor behavior induce a state of constant muscular tension which, through the physical phenomenon of piezoelectricity, causes calcium salts to precipitate and form calcifications. Therefore, stress, anxiety, and depression are likely factors underlying the etiopathogenesis of CTS. Consistent with this interpretation, this report presents five cases of CTS treated with three specific neurobiological stimulation treatments using the radioelectric asymmetric conveyer (REAC) technology, which has demonstrated its effectiveness on alterations in postural attitude intended as neuro-psychomotor behavior, anxiety, stress, and depression, as well as on autonomic and metabolic alterations of the tissues at a local level. The results presented suggest that this approach may be useful in the treatment and prevention of CTS.
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Efficacy of Ultrasound-Guided Percutaneous Lavage and Biocompatible Electrical Neurostimulation, in Calcific Rotator Cuff Tendinopathy and Shoulder Pain, A Prospective Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105837. [PMID: 35627374 PMCID: PMC9141353 DOI: 10.3390/ijerph19105837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/08/2022] [Accepted: 05/08/2022] [Indexed: 02/01/2023]
Abstract
Calcific tendinopathy of the shoulder (CTS) is the most common cause of shoulder pain. Conservative treatment is considered as the first therapeutic choice for CTS. The main objective of this study was to assess the effect of US-guided needling (UGN) compared to UGN plus Biocompatible Electrical Neurostimulation (BEN) in the treatment of the CTS. Pilot, prospective, non-interventional, monocentric, and observational study of patients treated for calcific rotator cuff tendinopathy and shoulder pain. Patients’ selection, enrollment and interventions were conducted at the Chiparo Physical Medicine and Rehabilitation outpatient facility. Forty adult patients (aged 40−60 years) with a diagnosis of CTS in the acute and colliquative phase were recruited and enrolled into the study. Participants were assessed for self-perceived pain through the Numerical Rating Scale (NRS), and for functional limitation through the Shoulder Pain and Disability Index score (SPADI) at baseline (T0), after 15 days (T1), and after 40 days (T2). As a possible confounding factor between the two treatments’ response, the dimension of the tendon calcification was also assessed by US-examination. Through the study, both groups improved their perceived functional performance of the arm (p-value < 0.001). AT T1, the SPADI score decreased by half in both groups, and the improvement remained stable at T2. A multiplicative effect (Time × Treatment) was demonstrated (p-value < 0.001). An improvement in the NRS score was measured at T1, and it remained stable at T2, a multiplicative effect was also reported (p-value < 0.001). The main results of this pilot study provide evidence that UGN plus BEN increases functional performance and reduces shoulder pain in individuals with CTS. Moreover, the tendon calcification dimension at the baseline and the percentage of drainage of the lesion were associated with a functional performance recovery and pain reduction detected after intervention.
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Joshi V, Osborne T, Tzias D. A case of non-traumatic shoulder pain. BMJ 2022; 376:e052278. [PMID: 34987027 DOI: 10.1136/bmj-2019-052278] [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: 11/04/2022]
Affiliation(s)
- Vanya Joshi
- Department of Radiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey, UK
| | - Thomas Osborne
- Department of Radiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey, UK
| | - Demitrios Tzias
- Department of Radiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey, UK
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13
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Ju X, Xu Y, Zhang X, Huang H, Dai L, Wang J. Clinical outcomes after arthroscopic treatment of calcification with surrounding inflammation in the hip labrum. Knee Surg Sports Traumatol Arthrosc 2021; 29:2819-2824. [PMID: 34213587 DOI: 10.1007/s00167-021-06638-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to investigate the surgical methods and clinical outcomes of arthroscopic treatment of a special type of calcification with surrounding inflammation in the acetabular labrum of the hip, which was temporarily named "calcifying labrumitis". METHODS From April 2015 to November 2019, a total of seven patients with calcifying labrumitis of the hip who underwent arthroscopic excision of calcified lesions and suture or partial resection of the labrum were included in this study. Radiographs were retrospectively evaluated for morphologic characteristics of calcifying labrumitis. Each patient was assessed by the visual analogue scale (VAS), modified Harris hip score (mHHS), nonarthritic hip score (NAHS) and satisfaction rate before surgery and at the final follow-up evaluation. RESULTS Seven patients, one male and six females aged 29-48 years, were included in the study; of these patients, three had calcifying labrumitis on the left side and four had calcifying labrumitis on the right side. All patients had hip pain and limited range of motion for a mean of 7.5 ± 3.1 months (range, 3-12 months). The mean follow-up period was 34.9 ± 19.5 months (range, 12-66 months). The lateral central-edge angle (LCEA) was 31.7 ± 3.9° (range, 28.8-36.4°), and the α angle was 41.4 ± 5.3° (range, 33.6-48.2°). None of the patients had cam or pincer lesions. After complete removal of calcified lesions, five patients underwent repair of the labrum with a suture anchor, and two patients underwent partial resection of the labrum. The symptoms of all patients improved significantly at the last follow-up. Mean scores improved from 5.8 ± 1.5 to 1.1 ± 0.3 (p < 0.01) for the VAS, from 57.3 ± 10.6 to 90.8 ± 13.4 for the mHHS and from 62.5 ± 10.7 to 84.3 ± 9.6 for the NAHS. The satisfaction rate was 100%. CONCLUSION Calcifying labrumitis of the hip is a special kind of rare disease that is different from calcifications accompanying FAI and os acetabuli. Arthroscopic treatment of calcification with suture or partial resection of the labrum is an effective, safe and minimally invasive method, significantly relieving pain and improving hip joint function. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Xiaodong Ju
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Yan Xu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Xin Zhang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Hongjie Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Linghui Dai
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Jianquan Wang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China.
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Martinel V, Fermandois-Maltes P. Arthroscopic Ultrasound-Guided Needling: An Effective Technique for the Treatment of Calcific Rotator Cuff Tendinopathy. Arthrosc Tech 2021; 10:e2021-e2026. [PMID: 34401249 PMCID: PMC8355534 DOI: 10.1016/j.eats.2021.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/25/2021] [Indexed: 02/03/2023] Open
Abstract
Calcifying tendinopathies of the rotator cuff that do not respond to conservative treatment may require arthroscopic removal. Intraoperative localization of calcifications can be difficult and is usually performed by bursal needle probing. We present a surgical technique combining arthroscopy and intraoperative ultrasonography based on the ultrasound-guided needle technique to precisely and rapidly locate even small calcium deposits. The modalities may differ depending on tendon topography. This nonirradiating technique with this compact device should be more widely used.
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Affiliation(s)
- Vincent Martinel
- Address correspondence to Vincent Martinel, M.D., Groupe Orthopédie Ormeau Pyrénées, ELSAN - Polyclinique de l’Ormeau, 28 Bvd du 8 Mai 1945, 65000 TARBES – France.
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15
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Robinson DM, Schowalter S, McInnis KC. Update on Evaluation and Management of Calcific Tendinopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00317-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Xin Ooi MW, Fenning L, Dhir V, Basu S. Rotator cuff assessment on imaging. J Clin Orthop Trauma 2021; 18:121-135. [PMID: 33996457 PMCID: PMC8102769 DOI: 10.1016/j.jcot.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/28/2021] [Accepted: 04/03/2021] [Indexed: 11/29/2022] Open
Abstract
The rotator cuff is a group of four muscles and tendons surrounding the shoulder joint providing it strength and stability. The rotator cuff consists of the subscapularis, supraspinatus, infraspinatus and teres minor. Many shoulder complaints are caused by rotator cuff pathology such as impingement syndrome, tendon tears and other diseases e.g. calcific tendonitis. Diagnosis starts with clinical history and physical examination, after which imaging is often used to help confirm clinical findings depending on the differential diagnosis. The aim of the article is to review the frequently used imaging modalities to assess the rotator cuff and cuff-related disease, specifically focusing on radiography, ultrasonography and magnetic resonance imaging. This article will outline the advantages and disadvantages for each modality and illustrate typical radiological findings of common rotator cuff pathologies.
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Affiliation(s)
| | | | | | - Subhasis Basu
- Corresponding author. Radiology Department, Wrightington, Wigan and Leigh NHS Trust, Hall Ln, Appley Bridge, Wigan, WN6 9EP, United Kingdom.
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17
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Martinel V, Bonnevialle N, Maltes Fermandois P. Does intraoperative ultrasound help the surgeon in arthroscopic excision of rotator cuff tendon calcifications ? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:939-944. [PMID: 34185159 DOI: 10.1007/s00590-021-03045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Arthroscopic excision of rotator cuff tendon calcifications is a common procedure in cases where medical treatment has failed. The objective of this study was to evaluate how intraoperative ultrasound contributes to improving the interventional procedure. Our hypothesis was that through the use of ultrasonography the frequency of postoperative residual calcium deposits could be reduced without increasing operating time. METHODS In a non-randomized single-operator comparative study, 56 patients who underwent arthroscopic excision of calcification were retrospectively included: group 1 (n = 20) without ultrasound guidance and group 2 (n = 36) with guidance. Operating time was measured and localization failures noted. Radiological follow-up was carried out with x-ray images at conventional angles and ultrasound at 1.5, 3 and 6 months postoperatively. Clinical follow-up was based on the Constant score (CS) at 6 months. RESULTS The mean operating time was 18 min in group 1 (9-33 ± 8.1) and 22 min in group 2 (10-48 ± 7.7) (p = 0.03). The rate of failure to identify calcifications was 8% and 2% in groups 1 and 2, respectively (p = 0.22). At 6 months, four calcifications were still visible on radiography in group 1 vs 1 in group 2 (20% vs 2.7%, p = 0.03). The mean CS increased from 35 to 81 points in group 1 (p < 0.001) and from 34 to 82 points in group 2 (p < 0.001). CONCLUSION Despite an increase in operating time, intraoperative ultrasound improves the process of excising rotator cuff intratendinous calcifications, prevents localization failures and enables a more complete extraction.
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Affiliation(s)
- Vincent Martinel
- Groupe Orthopedie Ormeau Pyrenees-Polyclinique de l'Ormeau, 28 Bvd du 8 Mai 1945, 65000, Tarbes, France
| | - Nicolas Bonnevialle
- Hopital Pierre Paul Riquet-CHU de Toulouse-Place Baylac, 31059, Toulouse, France. .,Institut de Recherche Riquet (I2R), Balma, France.
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18
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Arthroscopic Excision of Infraspinatus Calcific Tendinitis With Double-Row Margin Convergence Repair. Arthrosc Tech 2021; 10:e1455-e1467. [PMID: 34258190 PMCID: PMC8252855 DOI: 10.1016/j.eats.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/08/2021] [Indexed: 02/03/2023] Open
Abstract
Calcific rotator cuff tendinitis is a common cause of shoulder pain. It is thought to be an active cell-mediated process although the exact pathophysiology remains unclear. It commonly affects the supraspinatus tendon. The condition is generally self-limiting and can be managed with appropriate nonoperative treatment; however, some cases may need surgical excision. Complete removal of the calcific deposits may result in large significant defects. Infraspinatus calcific deposits were seldomly described. This report illustrates a double-row suture bridge technique with margin convergence of a large cuff defect after excision of calcific deposits within the infraspinatus tendon.
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Akkus G, Karagun B, Çetinalp NE, Açıkalın A, Evran M, Sengöz S, Sert M, Zorludemir S, Tetiker T. Clinical Relevance and Immunohistochemical Patterns of Silent Pituitary Adenomas: 10 Years of Single-centre Experience. Curr Med Imaging 2021; 17:310-317. [PMID: 33357196 DOI: 10.2174/1573405616666201223125642] [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: 07/07/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Silent pituitary adenomas are clinically non-functional (i.e., without clinically evident pituitary hormone production). INTRODUCTION The aim of this study was to investigate subjects with silent pituitary adenomas for possible variations in their clinical status. METHODS A total of 102 patients who had undergone surgery for pituitary adenoma and had been diagnosed with silent pituitary adenoma was included in the study. The patients' preoperative and postoperative hormonal parameters and magnetic resonance imaging (MRI) features were collected, and pathological specimens were re-evaluated. RESULTS Immunohistochemistry results of the 102 patients were as follows: hormone-negative adenomas (n=35) 35.5%; FSH+LH-positivity (n=32) 31.3%; ACTH-positivity (n=11) 10.7%; α-subunit- positivity (n= 9) 8.8%; prolactin-positivity (n=8) 7.8%; GH-positivity (n=6) 5.4%; and plurihormonal adenoma (n=1). The mean sizes of SGA, SGHA, and SCA were 28.0±12.7, 30.0±16.0, and 27.7±8.9mm (p>0.05), respectively. With the exception of silent gonadotroph adenomas (SGAs), female gender dominance was shown in patients with silent growth hormone adenoma (SGHA) and silent corticotroph adenoma (SCA). Although no clinical relevance was observed in relation to hormonal excess, preoperative GH (4.21±4.6, vs. 0.27±0.36 p=0.00) was slightly more elevated in SGHA than in GH-negative adenomas. Additionally, preoperative basal ACTH values (47.3±28.7 vs. 23.9±14.4, p=0.003) were also higher in SCA compared to the other types. Our findings revealed SCAs to be of more aggressive behaviour than SGHAs and SGAs due to invasiveness in radiological imaging, their elevated re-operation, and postoperative ACTH values. CONCLUSION Silent pituitary adenomas represent a challenging diagnostic tumour group. Careful initial evaluation of patients with pituitary adenomas should consider any mild signs and symptoms of functionality, particularly in cases of GH- and ACTH-secreting adenomas.
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Affiliation(s)
- Gamze Akkus
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Barış Karagun
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Nuri E Çetinalp
- Cukurova University, Faculty of Medicine, Division of Neurosurgery, Adana, Turkey
| | - Arbil Açıkalın
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Mehtap Evran
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Sinem Sengöz
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Murat Sert
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Suzan Zorludemir
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Tamer Tetiker
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
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20
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Yoo YS, Park JY, Kim MS, Cho NS, Lee YB, Cho SH, Park KJ, Cho CH, Lee BG, Shin DJ, Kim HH, Lim TK. Calcific tendinitis of the shoulder in the Korean population: demographics and its relation with coexisting rotator cuff tear. Clin Shoulder Elb 2021; 24:21-26. [PMID: 33652508 PMCID: PMC7943381 DOI: 10.5397/cise.2020.00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 12/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background To evaluate the demographics, clinical and radiographic features of calcific tendinitis of the shoulder in the Korean population, specifically focusing on the incidence of coexisting rotator cuff tear. Methods Between October 2014 and January 2015, we performed a prospective multicenter study with 506 patients from 11 training hospitals in Korea. We collected data of demographics and radiographic analysis based on simple radiographs, clinical assessments based on visual analog scale (VAS) and the American Shoulder Elbow Surgeons (ASES) score, and treatment modalities that are used currently. We also evaluated coexisting rotator cuff tear by ultrasonography (US) or magnetic resonance imaging (MRI) images. Results There were 402 female patients (79%) with mean age of 55 years (range, 31–87 years). Mean duration of symptoms was 16 months. Mean size of calcific materials was 11.4 mm (range, 0–35 mm). Mean value of VAS and ASES scores were 6.5 (range, 1–10) and 47 (range, 8–95), respectively. Of 383 patients (76%), 59 (15%) had rotator cuff tear including 15 full-thickness tears on US or MRI. Patients with rotator cuff tears were significantly associated with older age, recurrent symptoms, menstrual disorders in females, and having undergone calcification removal surgery and rotator cuff repair (all p<0.05). Conclusions This study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in Korean population, which were not different from those of Western population. Coexisting rotator cuff tear was found with 15% incidence in this large series, suggesting that further radiographic study to evaluate rotator cuff tear might be needed in some calcific tendinitis patients of older age and presenting with recurrent symptoms.
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Affiliation(s)
- Yon-Sik Yoo
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jin-Young Park
- Global Center for Shoulder, Elbow and Sports at Neon Orthopaedic Clinic, Seoul, Korea
| | - Myung-Sun Kim
- Department of Orthopaedics, Chonnam National University College of Medicine, Gwangju, Korea
| | - Nam-Su Cho
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Yong-Beom Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | | | | | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Bong Gun Lee
- Department of Orthopaedics, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Joo Shin
- Department of Orthopaedics, Daegu Fatima Hospital, Daegu, Korea
| | - Han-Hoon Kim
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Tae Kang Lim
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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21
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Ji JH, Kim JH. Is common the rotator cuff tear in the calcific tendinitis? Clin Shoulder Elb 2021; 24:1-3. [PMID: 33652504 PMCID: PMC7943384 DOI: 10.5397/cise.2021.00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jae-Hoon Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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22
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Cesarec G, Martinec S, Čičak N. CALCIFIC TENDINOPATHY: CALCIUM DEPOSIT MORPHOLOGY DIRECTLY AFFECTS PAIN AND FUNCTION OF THE SHOULDER. Acta Clin Croat 2021; 59:270-276. [PMID: 33456114 PMCID: PMC7808232 DOI: 10.20471/acc.2020.59.02.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to determine conventional ultrasonography characteristics of calcium deposits in patients diagnosed with calcific tendinopathy, to determine vascularization around deposits by power Doppler, and to compare morphological and power Doppler findings with clinical findings by use of two questionnaires. Pain and function were evaluated using the visual analog scale and two questionnaires, Constant Shoulder Score and Oxford Shoulder Score. All subjects underwent ultrasonography examination and evaluation of vascularization (flow) along calcium deposit using power Doppler. Fifty-one subjects were included in the study. The χ2-test, a non-parametric statistics method was used because of the categorical type of variables. The level of statistical significance was set at p<0.05. In the inactive phase, calcium deposit was shown as a hyperechoic focal point with dorsal acoustic shadow and negative power Doppler finding, whereas in the resorptive phase it appeared as fragmented irregular hyperechoic focal points with positive power Doppler findings. This study showed the patients with fragmented, cloudy calcification to have statistically significantly worse results on functional questionnaires and more positive power Doppler findings (grades II and III) and to experience stronger pain (visual analog scale 8-10). Upon defining the stage of calcific tendinopathy, the method of treatment can be determined and further course of the disease predicted. Defining the stage of calcification precisely helps avoid unnecessary and long-lasting physical therapy while introducing an effective treatment option, depending on the stage of the disease.
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Affiliation(s)
| | - Sunčica Martinec
- 1Krapinske Toplice Special Hospital for Medical rehabilitation, Krapinske Toplice, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Akromion Special Hospital for Orthopedic Surgery, Krapinske Toplice, Croatia; 4School of Medicine, University of Split, Split, Croatia
| | - Nikola Čičak
- 1Krapinske Toplice Special Hospital for Medical rehabilitation, Krapinske Toplice, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Akromion Special Hospital for Orthopedic Surgery, Krapinske Toplice, Croatia; 4School of Medicine, University of Split, Split, Croatia
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Abstract
Inorganic phosphate is a vital constituent of cells and cell membranes, body fluids, and hard tissues. It is a major intracellular divalent anion, participates in many genetic, energy and intermediary metabolic pathways, and is important for bone health. Although we usually think of phosphate mostly in terms of its level in the serum, it is needed for many biological and structural functions of the body. Availability of adequate calcium and inorganic phosphate in the right proportions at the right place is essential for proper acquisition, biomineralization, and maintenance of mass and strength of the skeleton. The three specialized mineralized tissues, bones, teeth, and ossicles, differ from all other tissues in the human body because of their unique ability to mineralize, and the degree and process of mineralization in these tissues also differ to suit the specific functions: locomotion, chewing, and hearing, respectively. Biomineralization is a dynamic, complex, and lifelong process by which precipitations of inorganic calcium and inorganic phosphate divalent ions form biological hard tissues. Understanding the biomineralization process is important for the management of diseases caused by both defective and abnormal mineralization. Hypophosphatemia results in mineralization defects and osteomalacia, and hyperphosphatemia is implicated in abnormal excess calcification and/or ossification, but the exact mechanisms underlying these processes are not fully understood. In this review, we summarize available evidence on the role of phosphate in biomineralization. Other manuscripts in this issue of the journal deal with other relevant aspects of phosphate homeostasis, phosphate signaling and sensing, and disorders resulting from hypo- and hyperphosphatemic states.
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Affiliation(s)
| | - Sudhaker D Rao
- Division of Endocrinology, Diabetes, and Bone & Mineral Disorders, Henry Ford Hospital, New Center One; Suite # 800, Detroit, MI, 48202, USA.
- Bone & Mineral Research Laboratory, Henry Ford Hospital, Detroit, MI, USA.
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CONFORTI M. Combination of laser needling and hyaluronic acid infiltration treatments for rotator cuff calcific tendinopathies. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.20.04535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Albano D, Coppola A, Gitto S, Rapisarda S, Messina C, Sconfienza LM. Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls. Radiol Med 2020; 126:608-619. [PMID: 33151457 PMCID: PMC8007494 DOI: 10.1007/s11547-020-01300-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022]
Abstract
Rotator cuff calcific tendinopathy (RCCT) is a very common condition, characterized by calcium deposition over fibrocartilaginous metaplasia of tenocytes, mainly occurring in the supraspinatus tendon. RCCT has a typical imaging presentation: in most cases, calcific deposits appear as a dense opacity around the humeral head on conventional radiography, as hyperechoic foci with or without acoustic shadow at ultrasound and as a signal void at magnetic resonance imaging. However, radiologists have to keep in mind the possible unusual presentations of RCCT and the key imaging features to correctly differentiate RCCT from other RC conditions, such as calcific enthesopathy or RC tears. Other presentations of RCCT to be considered are intrabursal, intraosseous, and intramuscular migration of calcific deposits that may mimic infectious processes or malignancies. While intrabursal and intraosseous migration are quite common, intramuscular migration is an unusual evolution of RCCT. It is important also to know atypical regions affected by calcific tendinopathy as biceps brachii, pectoralis major, and deltoid tendons. Unusual presentations of RCCT may lead to diagnostic challenge and mistakes. The aim of this review is to illustrate the usual and unusual imaging findings of RCCT that radiologists should know to reach the correct diagnosis and to exclude other entities with the purpose of preventing further unnecessary imaging examinations or interventional procedures.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy.
| | - Alessandra Coppola
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, 20122, Milan, Italy
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
| | - Santi Rapisarda
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
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Phan M, Birkemeier K, George R, Garza-Gongora R, Crisp M, Trotter B, Haghshenas V. Calcific tendonitis of the flexor pollicis longus tendon at the thumb interphalangeal joint in childhood. Proc (Bayl Univ Med Cent) 2020; 34:309-311. [PMID: 33678974 DOI: 10.1080/08998280.2020.1834805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
In rare instances, calcific tendonitis may manifest in the pediatric population as inflammatory calcium hydroxyapatite deposition. To our knowledge, there have been no previous case reports involving the flexor pollicis longus tendon at the thumb interphalangeal joint. We present a 9-year-old boy with a painful mass at the right thumb interphalangeal joint. Initial radiographs revealed a 7-mm ovoid calcific mass along the volar soft tissues of the thumb interphalangeal joint. Subsequent ultrasound and magnetic resonance findings further confirmed calcification with surrounding edema. Because the pain was limiting the patient's school activities, his family elected for excisional biopsy of the calcific mass. Pathology ultimately revealed prominent dystrophic calcifications with surrounding granulomatous inflammation, consistent with calcific tendonitis.
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Affiliation(s)
- Mimi Phan
- College of Medicine, Texas A&M Health Science Center, Houston, Texas
| | - Krista Birkemeier
- Department of Radiology, Texas A&M Health Science Center and Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Reshma George
- College of Medicine, Texas A&M Health Science Center, Houston, Texas
| | - Ricardo Garza-Gongora
- Department of Radiology, Texas A&M Health Science Center and Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Matthew Crisp
- Department of Radiology, Texas A&M Health Science Center and Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Bradley Trotter
- Department of Radiology, Texas A&M Health Science Center and Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Varan Haghshenas
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, Texas
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Ultrasound-guided percutaneous irrigation of calcific tendinopathy: redefining predictors of treatment outcome. Eur Radiol 2020; 31:2634-2643. [PMID: 33040221 DOI: 10.1007/s00330-020-07334-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/19/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To identify prognostic factors affecting the clinical outcome in patients treated with rotator cuff ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT), by evaluating the degree of calcium removal, the size and consistency of calcific deposits, and baseline level of shoulder pain and functionality. METHODS From January 2017 to December 2019, 79 patients (23 males, 56 females; mean age, 45.7 years) who underwent US-PICT were prospectively enrolled. The calcifications' location, consistency, and size were evaluated. For US-PICT, local anesthesia, lavage of calcific material, and intrabursal steroid injection were performed. The degree of calcium removal was graded as total/partial. Shoulder pain and functionality were assessed with the visual analogue scale (VAS) in all and Constant score (CS) in a subset of patients, respectively, at 4 time-points. Mann-Whitney U test, Fisher's test, and linear and binary logistic regression were utilized for analysis. RESULTS Pain improvement correlated with the presence of larger calcifications and lower baseline VAS score, at 1 week (p = 0.001, p < 0.001, respectively) and 1 year (p < 0.001, p = 0.002, respectively). Improved functionality correlated with total calcification retrieval, higher baseline CS, and fluid/soft calcific consistency at 1 week (p = 0.013, p = 0.003, p = 0.019, respectively). Increased calcification size, cystic appearance, and lower baseline VAS scores independently predicted complete pain resolution at 1 year. CONCLUSION Large calcifications and low-grade pain at baseline correlated with short- and long-term pain improvement. The degree of calcium removal did not impact pain or functional improvement beyond 1 week. Increased calcification size, cystic appearance, and low-grade baseline pain predicted complete pain recovery at 1 year. KEY POINTS • The presence of larger calcifications and lower-grade baseline pain appear to correlate with pain improvement at 1 week and 1 year after ultrasound-guided irrigation of rotator cuff calcific tendinopathy (US-PICT). • Total calcification retrieval, less affected baseline shoulder functionality, and presence of fluid/soft consistency of calcific deposits appear to correlate with improved shoulder functionality at 1 week post-treatment. • Baseline pain intensity and calcifications' morphologic characteristics, but not the degree of calcium retrieval, represent predictors of complete pain recovery at 1 year after US-PICT.
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Malahias MA, Chronopoulos E, Raoulis V, Vergados N, Kaseta MK, Nikolaou VS. Questioning the therapeutic value of corticosteroid bursal injection after ultrasound-guided irrigation and lavage for the treatment of shoulder calcific tendinosis. J Orthop 2019; 18:16-22. [PMID: 32189877 DOI: 10.1016/j.jor.2019.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/27/2019] [Indexed: 12/14/2022] Open
Abstract
Objectives The therapeutic value of corticosteroid bursal injection after ultrasound-guided irrigation and lavage for the treatment of shoulder calcific tendinosis has not been established yet in the long term. Methods 41 patients suffering from chronic symptomatic rotator cuff calcific tendinopathy were recruited for this study. Group A (20 patients) received a double needle ultrasound-guided irrigation and lavage of the calcification with xylocaine injection, while group B (21 patients) underwent a double needle ultrasound-guided irrigation and lavage of the calcification with a xylocaine and betamethazone bursal injection. Results After twelve months, we documented full -or almost full- decline (VAS: 0-20/100) of the symptoms in 70% of the group A patients and in 61.9% of the group B patients. There was no statistical difference (chi square, p < 0.05) in group success ratio. We also did not find any statistical difference as for the mean Q-DASH difference between the two groups (t-test). Conclusions It was proven that the additional use of corticosteroid bursal injection did not provide with any additional short- to mid-term therapeutic benefit those patients with shoulder calcific tendinopathy who were treated with ultrasound-guided aspiration.
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Affiliation(s)
- Michael-Alexander Malahias
- 2nd Orthopaedic Department. National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Chronopoulos
- 2nd Orthopaedic Department. National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vasileios Raoulis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | | - Maria-Kyriaki Kaseta
- 2nd Orthopaedic Department. National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vasileios S Nikolaou
- 2nd Orthopaedic Department. National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Dragičević-Cvjetković D, Erceg-Rukavina T, Manojlović S. Effects of the radial extracorporeal shock wave therapy (rESWT) in patients with calcific tendinopathy of the shoulder. SCRIPTA MEDICA 2019. [DOI: 10.5937/scriptamed50-22618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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