Biceps Tenosynovitis Research Articles

Ultrasound and PET-CT Correlation in Shoulder Pathology: A 5-Year Retrospective Analysis.

To correlate shoulder ultrasound and radiography with F-FDG PET-CT to establish FDG uptake and therefore range of metabolic activity, as defined by SUV analysis, in various symptomatic shoulder pathologies. Retrospective database query was performed for shoulder ultrasound and PET-CT scans between January 2012 and January 2017. Patients who had both studies within 1 year were included. Age- and sex-matched control patients with PET-CT scans only were also included. Retrospective image review determined shoulder pathology, and F-FDG SUVmax was measured using regions of interest placed at the glenohumeral joint, rotator cuff/bursa, and bicipital groove. Glenohumeral and acromioclavicular osteoarthrosis was assessed by radiography using the Kellgren-Lawrence classification system. Thirty-three patients had both imaging studies within 1 year. Ten patients (11 cases) were included, ranging in age from 56 to 90 years (mean, 67.9 years). Control subjects were selected among patients receiving PET-CT within 1 week of symptomatic patients. Glenohumeral osteoarthrosis was mild in 3 (27%), moderate in 2 (18%), and severe in 2 (18%). Six full-thickness rotator cuff tears (55%) were identified. SUVmax means were compared between the pathologic and control groups and were significantly higher in the former: glenohumeral joint (1.96 vs 1.32; P = 0.016), rotator cuff/bursa (2.80 vs 2.0; P = 0.005), and bicipital groove (2.19 vs 1.48; P = 0.007). The highest values were seen in full-thickness rotator cuff tear and severe biceps tenosynovitis. Increased metabolic activity about the shoulder is associated with a spectrum of rotator cuff, glenohumeral joint, and other soft tissue pathology that can be correlated with diagnostic ultrasound findings.

Subpectoral Biceps Tenodesis for Tenosynovitis of the Long Head of the Biceps in Active Patients Younger Than 45 Years Old

The objective of this study was to assess the outcomes after subpectoral biceps tenodesis (BT) for long head ofthe biceps (LHB) tenosynovitis in active patients <45years old. This was an Institutional Review Board-approved, retrospective outcomes study with prospectively collected data. Patients treated with subpectoral BT were included if they met the following criteria: age <45years, anterior shoulder pain with arthroscopically confirmed LHB tenosynovitis, no concomitant procedures other than debridement and decompression procedures, and minimum 2years out from surgery. Patients were excluded from analysis if they refused participation. The American Shoulder andElbow Surgeons (ASES), Short Form-12, Quick Disabilities of the Arm, Shoulder and Hand, Single Assessment Numeric Evaluation, and pain scores as well as sports participation preoperatively and at a minimum of 2years postoperatively were obtained. Pre- and postoperative scores were compared using paired samples t-test and Wilcoxon signed-rank test. Thirty patients met the inclusion criteria. Two of these patients refused to participate in follow-up and were excluded from analysis. Of the remaining 28 patients (17 male, 11 female; 37.0 ± 8.0years), minimum 2-year outcomes were available for 24 (13 males, 11 females: 37.7 ± 8.2years; 85.7%). Mean follow-up was 3.1years (range, 2.0 to 7.3years). There were significant improvements in all outcome measures including ASES score (P< .001), with a postoperative mean of 95.8 ± 7.8, visual analog scale "pain today" (P < .001), and pain affecting activities of dailyliving (P < .001). Seventeen of 20 (85%) patients who answered the question about postoperative sportparticipation were able to return to sport. Mean patient satisfaction was 9.2/10 (standard deviation,+1.7). Therewere no postoperative complications such as Popeye deformity or cramping. There were no clinical failures. Subpectoral BT is an excellent treatment option for active patients <45years old with LHB tenosynovitis and chronic anterior shoulder pain, resulting in decreased pain, improved function, high satisfaction, and improved quality of life. Level IV, therapeutic case series.

Baseline Shoulder Ultrasonography Is Not a Predictive Marker of Response to Glucocorticoids in Patients with Polymyalgia Rheumatica: A 12-month Followup Study

In this study, we evaluated whether ultrasound (US) subdeltoid bursitis (SB) and/or biceps tenosynovitis (BT) presence at baseline could represent a predictive marker of response to standard therapy after 12 months of followup, and whether a positive US examination could highlight the need of higher maintenance dosage of glucocorticoids (GC) at 6 and 12 months in patients with polymyalgia rheumatica (PMR). Sixty-six consecutive patients with PMR underwent bilateral shoulder US evaluations before starting therapy and after 12 months of followup. Absence of girdle pain and morning stiffness (clinical remission) and laboratory variables were evaluated. After diagnosis, all patients were treated with prednisone. At baseline, SB and/or BT were present in 46 patients (70%), of whom 33 (72%) became negative while 13 (28%) remained positive at the 12-month US evaluation. All patients rapidly achieved a clinical remission, and at 6 months 26 (39%) also achieved a laboratory variable normalization. According to US positivity at baseline, no difference was found in remission or relapse rate after 12 months. Thirty patients (46%) at 6 months and 7 (11%) at 12 months were still taking more than 5 mg/day of prednisone. According to the US pattern at baseline, no difference was found in the mean GC dose at 6 and 12 months. In patients with PMR, the presence of SB and/or BT on US at diagnosis is not a predictive marker of GC response or of a higher GC dosage to maintain remission in a 12-month prospective followup study.

Is It Statin Induced Polymyalgia Rheumatica or Just a Coincidence?

©2015 Turkish League Against Rheumatism. All rights reserved. A 53-year-old female presented with pain in her bilateral shoulders, hips and neck, stiffness (lasting one hour), and proximal weakness for three months. She declared that her symptoms had ensued one week after the usage of daily 40 mg atorvastatin for hyperlipidemia. As such, atorvastatin was discontinued; however, her complaints did not decline. Physical examination revealed painful and restricted shoulder and neck movements, weakness in shoulder and hip muscles, and a swollen, warm right knee. Laboratory investigations including creatine kinase (CK), rheumatoid factor and anti-nuclear antibody levels were within normal values, except for the increased C-reactive protein (0.744 mg/dL, N: 0-0.5) and erythrocyte sedimentation rate (75 mm/h, N: 0-20). X-rays of the hand, knee, hip and shoulder were non-contributory. Ultrasound illustrated biceps tenosynovitis and trochanteric bursitis bilaterally, and increased suprapatellar fluid in right knee (Figure 1). Overall, the patient was diagnosed with polymyalgia rheumatica (PMR) according to the 2012 European League Against Rheumatism/American College of Rheumatology classification criteria.1 Her symptoms and clinical findings (erythrocyte sedimentation rate and C-reactive protein levels) responded to medium dose of prednisolone (20 mg/d) treatment dramatically. Although statins have been reported to be associated with some musculoskeletal side effects such as myalgia, myositis, myopathy, and elevated CK, statin induced PMR is a very rare condition which has been reported only in a few anecdotal reports.2-4 Likewise, statin treatment might trigger the development of PMR in our patient. Since statin induced PMR and myalgia have similar clinical features, the exact diagnosis can be challenging. Statin induced myalgia presents with/without increased CK levels with normal erythrocyte sedimentation rate and C-reactive protein levels. Therefore, patients with statin induced myalgia may have normal serum CK levels, which sometimes make it difficult to distinguish PMR from myopathy syndromes. In case of drug discontinuation, symptoms heal in a period of one-week to four-month in statin, myopathy and treatment of steroid is rarely required.5 PMR patients do not recover spontaneously and corticosteroid treatment is usually needed.6

Place de l’échographie ostéo-articulaire dans la prise en charge de la pseudopolyarthrite rhizomélique

Polymyalgia rheumatica (PMR) is a common inflammatory rheumatism in the elderly. It is characterized by inflammatory pain of scapular and pelvic area. In the absence of biological signature, these symptoms may be non-specific and therefore discuss other diagnoses in the elderly. In this context, ultrasound has been developed, in order to assist in the diagnosis and monitoring of treatment. Thus, since 2012, the new classification criteria EULAR 2012 include ultrasonography. In particular, the following abnormalities will be searched: at least one shoulder (subdeltoid bursitis, biceps tenosynovitis or glenohumeral synovitis), and at least one hip (hip joint synovitis or trochanteric bursitis) ; or bilateral involvement of the shoulders. These abnormalities are not specific of PMR, but their presence will have more value if the clinical and biological context is suggestive, especially in case of bilateral abnormalities. This is an easily, non-invasive and accessible examination. Its intra- and inter-observer reproducibility seems excellent. Moreover, its quite good sensitivity to change could make it a useful tool for the monitoring of treatment.

The shoulder.

The shoulder.

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関節切開による二頭筋腱切断術で治療した犬の二頭筋腱滑膜炎の1例

Value of dynamic sonography in the management of shoulder pain in patients with rheumatoid arthritis

PurposeThe purpose of this study is to evaluate the role of dynamic high resolution ultrasonography in the detection of abnormalities of rheumatoid arthritis and to find out the value added to the management plan of the disease. Patients and methods21 shoulders of rheumatoid arthritis patients complaining of shoulder pain were scanned with ultrasound (static and dynamic) and compared to clinical examination. ResultThe most predictive sign of rheumatoid arthritis was sub-acromial impingement which was screened and graded by ultrasound in (100%). Other US signs included sub-acromial bursitis in 14.2%, biceps teno-synovitis in 52.4%, supraspinatous tendinopathy in 57.1%, supraspinatous partial thickness bursal surface tear in 14.2% and joint effusion in 9.5% of our patients. The combination of more than one finding was of higher sensitivity than isolated sign alone. ConclusionDynamic ultrasound examination for the diagnosis of shoulder impingement in Rheumatoid arthritis should be done in addition to the clinical and static ultrasound examination to improve the management plan.

SAT0277 Has Shoulder Ultrasonography Got A Predictive Value in Polymialgia Rheumatica?

BackgroundPolymyalgia rheumatica (PMR) is an inflammatory condition characterized by aching and morning stiffness in the shoulders, hip girdle, and neck. The initial goal of therapy is to rapidly achieve symptomatic...

Joint Involvement in Patients with Early Polymyalgia Rheumatica Using High-resolution Ultrasound and Its Contribution to the EULAR/ACR 2012 Classification Criteria for Polymyalgia Rheumatica

To assess joint involvement and the contribution of musculoskeletal ultrasound (MSUS) to the novel European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) 2012 classification criteria in patients with polymyalgia rheumatic (PMR). MSUS was performed in 54 consecutive patients with recent-onset PMR. Biceps tenosynovitis of at least 1 shoulder has been observed in 70.4% of patients, and 64.8% had a bilateral biceps tenosynovitis. Subdeltoid bursitis (27.8% unilateral, 5.6% bilateral), glenohumeral synovitis (22.2% unilateral, 9.3% bilateral), and hip involvement (22.2% unilateral, 16.7% bilateral) were observed less frequently. The sensitivities of the classification criteria were 85.2% for EULAR/ACR without MSUS and 81.5% for EULAR/ACR with MSUS. The most common MSUS pathology was a biceps tenosynovitis. However, US findings had no effect on the sensitivity of the novel EULAR/ACR criteria for PMR.

Outcomes of Primary Biceps Sub-pectoral Tenodesis in an Active Population: A prospective Evaluation of 101 Patients

Objectives:SLAP tears and tendonitis disorders of the long head of the biceps tendon (LHBT) remain a challenge to treat in an active population. The purpose of this study is to prospectively compare the surgical outcomes of a primary biceps tenodesis for SLAP tears and biceps tenosynovitis in a young active population.Methods:Over a 6-year period, 125 patients with mean age of 42.6 (range, 26.3 to 56.5) with a diagnosis of LHBT were prospectively evaluated. Inclusion criteria included patients with a clinical diagnosis of a type II SLAP or anterior shoulder pain who failed conservative management and underwent a diagnostic shoulder arthroscopy. Patients were excluded for full-thickness rotator cuff tears, AC joint pathology, and labral pathology outside of the SLAP lesion. Patients with an arthroscopically confirmed labral tear or biceps tendonopathy underwent a mini-open subpectoral tenodesis with interference screw and were independently evaluated with patient reported outcome measurements (SANE, WORC), and a biceps position examination. Statistical analysis was via Student’s t-test and significance set at p <.05.Results:101 of 125 patients (81%) completed the study requirements at a mean of 2.75 years (range 1.5 to 5.7 years). 50 Patients were diagnosed with SLAP II tears (40%) and 75 patients with biceps tendonitis (60%), 28 (22%) underwent a rotator cuff debridement for a concomitant low-grade partial rotator cuff tear and LHBT instability. There was a clinically and statistical improvement in patient outcomes scores: (WORC=54%, SANE=58) improved to (WORC=89%, SANE=89.5, p<0.01). 82% of patients returned to work and full activity at a mean of 4.1 months. The biceps muscle measured relative to the antecubital fossa of operative (mean 3.20 cm) versus non-operative (3.11 cm) was not clinically different (p=0.57), except in the 3 that failed tenodesis fixation. There was an 8% complication rate: 3 patients sustained failure of the LHBT tenodesis requiring revision; 2 superficial infections treated with antibiotics; and 3 transient musculoskeletal neruopraxias.Conclusion:A primary biceps tenodesis for pathology of the LHBT provides a clinical and statistically significant improvement in shoulder outcomes with a reliable and efficient return to previous activity level and low risk for surgical complications. However, additional work is necessary to define optimal primary treatment of LHB disorders.

FRI0481-HPR Assessment of validity of clinical impingement tests in patients with thickened subacromial bursa using dynamic us examination as gold standard

BackgroundSubacromial impingement (SAI) is a common disorder of the shoulder accounting for about half of all complains of pain in the shoulder.A number of clinical tests are recommended to identify...

AB0737 Shoulder ultrasound in women with breast cancer and mastectomy

BackgroundIn Mexico, breast cancer (BC) is the second leading cause of death from tumor processes in women over 25 years. It is estimated that by 2020 this group will reach...

AB0669 The importance of diagnostic ultrasound in the differential diagnosis of painful shoulder

ObjectivesThe aim of this study was to evaluate the diagnostic significance of musculoskeletal ultrasound (MSUS) in determining the type and presence of soft tissue changes in patients with a referral...

Ultrasound assessment of new onset bilateral painful shoulder in patients with polymyalgia rheumatica and rheumatoid arthritis

The aim of our study was to investigate by ultrasound (US) the anatomical structures affected during a new episode of bilateral painful shoulder in patients with polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA) and to compare the findings between these two conditions. PMR and RA patients complaining of new onset bilateral painful shoulder were included. Subjects without any known rheumatic condition with a new onset unilateral painful shoulder were assessed as a control group. US evaluation includes the depiction subacromial-subdeltoid (SAD) bursitis, long head biceps (LHB) tenosynovitis and/or gleno-humeral (GH) synovitis. Thirty patients with PMR, 30 with RA, and 60 controls were included for a total of 60 shoulders per group. Unilateral SAD bursitis and LHB tenosynovitis were significantly more frequent in patients with PMR when compared to those with RA (p < 0.0001 and p < 0.01, respectively) and controls (p < 0.001 and p < 0.01, respectively). Unilateral GH synovitis was more common in RA than in PMR and controls (p < 0.05 and p < 0.01, respectively). Bilateral SAD bursitis was significantly more frequent in patients with PMR than in those with RA (p < 0.01) as was bilateral LHB tenosynovitis (p < 0.01). No significant differences were found in bilateral GH synovitis. US-detected periarticular inflammatory involvement more frequently in PMR both unilaterally and bilaterally and intra-articular inflammatory involvement was commonly in RA but only unilaterally.

Causes of Shoulder Pain in Women with Breast Cancer-Related Lymphedema: A Pilot Study

PurposeTo inform on shoulder pathology and to identify the disabilities and level of quality of life (QOL) associated with shoulder pain in patients with breast cancer-related lymphedema (BCRL).Materials and MethodsUsing patient history, physical examination, and ultrasound (US), we classified patients with BCRL into the following three groups: no pain with normal ultrasound (US), pain with normal US, and pain with abnormal US. We evaluated shoulder pathology using US, pain intensity using a visual analogue scale (VAS), and functional disability using the Korean version of the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire. For assessment of QOL, we used the Korean version of the brief form of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF).Results28.9% of patients had no pain and normal US, 31.6% had pain with normal US, and 39.5% had pain with abnormal US. The US findings for those with pain and abnormal US revealed the following: 53.3% had a supraspinatus tear, 13.3% had biceps tenosynovitis, 13.3% had acromioclavicular arthritis, 13.3% had subdeltoid bursitis, and 53.3% had adhesive capsulitis. Patients with shoulder pain and abnormal US findings had significantly higher mean DASH and pain scores. Pain scores were positively correlated with DASH scores and negatively correlated with QOL.ConclusionWe found that BCRL with shoulder pain and evidence of shoulder pathology on US was associated with reduced QOL and increased disability. Proper diagnosis and treatment of shoulder pain are necessary to improve QOL and decrease disability in patients with BCRL.

Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard

To assess the intra- and interobserver reproducibility of musculoskeletal ultrasonography (US) in detecting inflammatory shoulder changes in patients with rheumatoid arthritis, and to determine the agreement between US and the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, using magnetic resonance imaging (MRI) as a gold standard. Eleven rheumatologists investigated 10 patients in 2 rounds independently and blindly of each other by US. US results were compared with shoulder function tests and MRI. The positive and negative predictive values (NPVs) for axillary recess synovitis (ARS) were 0.88 and 0.43, respectively, for posterior recess synovitis (PRS) were 0.36 and 0.97, respectively, for subacromial/subdeltoid bursitis (SASB) were 0.85 and 0.28, respectively, and the NPV for biceps tenosynovitis (BT) was 1.00. The intraobserver kappa was 0.62 for ARS, 0.59 for PRS, 0.51 for BT, and 0.70 for SASB. The intraobserver kappa for power Doppler US (PDUS) signal was 0.91 for PRS, 0.77 for ARS, 0.94 for SASB, and 0.53 for BT. The interobserver maximum kappa was 0.46 for BT, 0.95 for ARS, 0.52 for PRS, and 0.61 for SASB. The interobserver reliability of PDUS was 1.0 for PRS, 0.1 for ARS, 0.5 for BT, and 1.0 for SASB. P values for the SPADI and DASH versus cuff tear on US were 0.02 and 0.01, respectively; all other relationships were not significant. Overall agreements between gray-scale US and MRI regarding synovitis of the shoulder varied considerably, but excellent results were seen for PDUS. Measures of shoulder function have a poor relationship with US and MRI. Improved standardization of US scanning technique could further reliability of shoulder US.

Longitudinal examination with shoulder ultrasound of patients with polymyalgia rheumatica

To determine if ultrasonography (US) and power Doppler (PD) may be useful in identifying polymyalgia rheumatica (PMR) patients with relapsing disease. For a mean of 41 months, 57 consecutive untreated patients with PMR were prospectively assessed for relapses/recurrences. This cohort represented all the patients diagnosed over a 18-month period in one Italian secondary referral centre. Clinical signs and symptoms as well as ESR and CRP were evaluated. US examination of the shoulders was performed in all 57 patients at diagnosis and after the onset of prednisone treatment (mean 24 +/- 3 weeks). Power Doppler ultrasonography (PDUS) was performed in 24 patients. Shoulder sonograms were obtained according to standardized techniques. Prednisone therapy significantly reduced the frequency and the degree of subacromial/subdeltoid bursitis, long head biceps tenosynovitis and glenohumeral synovitis. At diagnosis, a positive PD signal was observed more frequently in the subacromial/subdeltoid bursae (33%). Prednisone therapy significantly reduced the frequency of patients with positive PD signal. Of the 44 patients in remission or with low disease activity at the time of the second US, 26 (59%) still had evidence of persistent inflammatory lesions. There was no association between the persistence of inflammation at US and relapses/recurrences; in contrast, a positive PD signal at diagnosis was significantly associated with the occurrence of relapses/recurrences at follow-up. Subclinical inflammation detected by US persists in most PMR patients despite glucocorticoid treatment. PDUS may be useful to detect at diagnosis the patients with most active inflammation who have a higher risk of relapses/recurrences.

Reliability Exercise for the Polymyalgia Rheumatica Classification Criteria Study: The Oranjewoud Ultrasound Substudy

Objective. A study supported by the EULAR and the ACR being conducted to establish classification criteria for polymyalgia rheumatica (PMR) will include ultrasound examination of the shoulders and hips. Ultrasound (US) depicts glenohumeral joint effusion, biceps tenosynovitis, subdeltoid bursitis, hip joint synovitis, and trochanteric bursitis in PMR. These findings may aid in distinguishing PMR from other diseases. The purpose of this study was to assess standards and US interreader agreement of participants in the PMR classification criteria study. Methods. Sixteen physicians in four groups examined shoulders and hips of 4 patients and 4 healthy adults with ultrasound. Overall agreement and interobserver agreement were calculated. Results. The overall agreement (OA) between groups was 87%. The OA for healthy shoulders was 88.8%, for healthy hips 100%, for shoulders with pathology 85.2%, and 74.3% for hips with pathology, respectively. Conclusion. There was a high degree of agreement found for the examination of healthy shoulders and pathologic hips. Agreement was moderate for pathologic shoulders and perfect for healthy hips. US of shoulder and hips performed by different examiners is a reliable and feasible tool for assessment of PMR related disease pathology and can be incorporated into a classification criteria study.

Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis

Objective:To assess the intra and interobserver reproducibility of musculoskeletal ultrasonography (US) among rheumatologists in detecting destructive and inflammatory shoulder abnormalities in patients with rheumatoid arthritis (RA) and to determine the...