Calcific Tendinitis Research Articles

Extracorporeal Shock Wave in Combination with Arthroscopy for Calcified Supraspinatus Tendonitis

Objective: Exploring the therapeutic effect of extracorporeal shockwave combined with Arthroscopic Surgery on calcified supraspinatus tendinitis. Materials and Methods: Sixty patients with calcific supraspinatus tendinitis who received treatment in our hospital from June 2022 to June 2023 were randomly divided into two groups. All patients had disease lasting more than 6 months. The control group received extracorporeal shockwave therapy (ESWT), while the observation group, after undergoing arthroscopic debridement of calcific deposits in the joint, began receiving the same ESWT as the control group after 2 weeks. The differences in Visual Analog Scale (VAS) score, University of California at Los Angeles (UCLA) score, and Constant–Murley score between the two groups before and after treatment were recorded and compared. Results: Before treatment, there was no significant difference in VAS score, UCLA score, and Constant–Murley Scale (CMS) score between the two groups of patients (P > 0.05); compared with before treatment, both groups of patients showed a significant decrease in VAS scores after 1 and 2 months of treatment (P < 0.05). After 1 and 2 months of treatment, the VAS scores of the observation group were significantly lower than the ones of the control group (P < 0.05). Compared with before treatment, the UCLA score and CMS score of both groups of patients significantly increased after 1 and 2 months of treatment (P < 0.05). After 1 and 2 months of treatment, the UCLA score and CMS score of the observation group were significantly higher than those of the control group (P < 0.05). Conclusion: The combination of extracorporeal shockwave and arthroscopy has a significant therapeutic effect on calcified supraspinatus tendinitis, helping to improve shoulder joint function and effectively alleviate pain in patients. Keywords: Extracorporeal shockwave, Arthroscopy, Calcifying supraspinatus tendinitis, Shoulder joint function, Pain.

Retracted: Risk Factor Analysis for Predicting the Onset of Rotator Cuff Calcific Tendinitis Based on Artificial Intelligence

Retracted: Risk Factor Analysis for Predicting the Onset of Rotator Cuff Calcific Tendinitis Based on Artificial Intelligence

Extracorporeal Shock Wave Treatment for Calcifying Tendinitis of the Shoulder: A Case Report and Literature Review

Background: Calcifying tendinitis of the shoulder (CTS), also known as rotator cuff calcific tendinitis, is a self-limiting shoulder disorder primarily characterized by inflammation surrounding hydroxyapatite crystal deposits in the tendons of the rotator cuff. Given the specific characteristics of the shoulder joint and the uncertainty regarding the efficacy of various treatments for CTS, no standardized treatment protocol has been established. However, numerous studies have demonstrated that extracorporeal shock wave therapy (ESWT) is effective in alleviating pain and improving joint function in patients with calcifying tendinitis of the shoulder. The therapeutic process works using high-energy shock waves to break down deposits of calcification, reduce local inflammation, and promote tissue healing. The purpose of this article is to present a case of symptomatic calcifying tendinopathy involving the rotator cuff and further demonstrate that ESWT has good efficacy in the treatment of musculoskeletal diseases. Results: In this case, a 39-year-old woman with a 6-month history of shoulder pain and limited range of motion (ROM) was diagnosed with calcifying tendinitis of the shoulder. A single session of shock wave therapy resulted in the complete resolution of calcific deposits and the patient’s symptoms, leading to a return to her normal ROM and improved quality of life. Conclusion: ESWT has been shown to be a good alternative to surgery for the treatment of calcifying tendinitis of the shoulder (CTS). It can significantly alleviate pain, improve shoulder function, and reduce the average size of calcium deposits. It might be the first choice for treating shoulder tendinopathy due to its effectiveness and safety. Keywords: Calcifying tendinitis, Shoulder pain, Extracorporeal shock wave treatment, Case report

A Case of Prevertebral Abscess with Lemierre’s Syndrome Which was Difficult to Differentiate from Retropharyngeal Abscess and Calcific Tendinitis of the Longus Colli Muscle

This is a report of a case of prevertebral abscess with Lemierre’s syndrome, which was difficult to differentiate from a retropharyngeal abscess and calcific tendinitis of the longus colli muscle.

COMPARISON OF IMMEDIATE EFFECTS OF EXTRACORPOREAL SHOCKWAVE THERAPY AND CONVENTIONAL PHYSICAL THERAPY IN PATIENTS WITH CALCIFIC TENDINITIS OF THE SHOULDER ROTATOR CUFF

Calcific tendinitis of the shoulder is a frequent disorder with an unknown etiology. It is usually treated with different physical therapy modalities where extracorporeal shockwave therapy comes as a new effective method. The aim of the study was to compare extracorporeal shockwave therapy and conventional physical therapy in the treatment of calcific tendinitis of the rotator cuff of the shoulder. The study is a prospective, monocentric clinical trial involving 40 patients with calcific tendinitis of the rotator cuff of the shoulder who were divided into two groups: group 1 (study group), 20 patients receiving extracorporeal shockwave therapy and performing shoulder exercises, and group 2 (control group), 20 patients who received conventional physical therapy with therapeutic ultrasound and diadynamic currents and performed shoulder exercises. Patients were evaluated with a Numerical Pain Scale and the range of motion in the shoulder joint was assessed. Clinical findings were evaluated before starting treatment and at the end of the treatment. All patients after the treatment showed statistically significantly better results in the Numerical Pain Scale and the shoulder range of motion. Extracorporeal shockwave therapy is a safe and non-invasive treatment that reduces pain and improves range of motion in the treatment of calcific tendinitis of the rotator cuff.

The Treatment of Calcific Tendinitis of the Gluteus Medius Muscle Using Ultrasound-Guided Barbotage Technique

The Treatment of Calcific Tendinitis of the Gluteus Medius Muscle Using Ultrasound-Guided Barbotage Technique

A Benign Mimic of Dangerous Neck Pathology: A Case Report of Longus Colli Calcific Tendonitis.

Longus colli calcific tendonitis (LCCT) is a calcium deposition disease that causes acute or subacute atraumatic neck pain. It is important for the emergency physician to consider LCCT in the differential diagnosis because the clinical presentation of this benign condition may mimic life-threatening disease processes that require invasive diagnostic measures. We present a case of a 63-year-old female with atraumatic right-sided neck pain. On exam she had tenderness to palpation in the neck, as well as difficulty ranging her neck and opening her mouth. She underwent computed tomography of her neck with intravenous contrast, which showed calcific tendonitis of the longus colli muscle with retropharyngeal edema. She was seen by otolaryngology, underwent nasopharyngolaryngoscopy, and ultimately was discharged with antibiotics and corticosteroids. The presentation of LCCT can mimic symptoms of dangerous causes of neck pain including retropharyngeal abscess and meningitis. Early diagnosis in the ED can potentially avoid more invasive diagnostic and therapeutic measures. While LCCT is thought to be self-limiting, it can be treated with non-steroidal anti-inflammatory medications and corticosteroids. If pain is controlled, patients can be discharged from the ED with no specialist follow-up required.

Biological effects of extracorporeal shockwave therapy in tendons: A systematic review.

Extracorporeal shockwave therapy was initially used for kidney stone disintegration and its application was then extended to calcific tendinitis. The therapeutic field expanded and included numerous types of tendinopathies, from shoulder to plantar fascia. The clinical benefits were documented in trials and the effects and mechanisms were studied on models including animal and human tendons. The present systematic review outlines a large spectrum of biological effects. First, an optimal dose is adapted for each species and each tendon; exceeding the optimal dose may lead to structural injury. Furthermore, the biological effects may be grouped into neovascularization induction, cellularity and extracellular matrix changes, metalloprotease and cytokine modulation, as well as lubricin production. As a result, the remodeled tendon displays improved biomechanical properties to resist stress.

Treatment Protocol for Rotator Cuff Calcific Tendinitis Using a Single-Crystal Piezoelectric Focused Shock Wave Source

Focused shock waves have emerged as a highly effective noninvasive therapeutic option for the treatment of calcific tendinitis of the shoulder. There are three types of focused shock wave generators: electrohydraulic, electromagnetic, and piezoelectric. According to our literature search, there are no reports of results with the use of single-crystal piezoelectric generators in calcific tendinitis of the shoulder. In a consecutive retrospective series of 23 patients with Gärtner type I and II calcifications of the rotator cuff, we performed three applications of high-energy piezoelectric focused waves (4,000 pulses per session with a frequency of 6 Hz). At the final follow-up (average of 14 months), 82.6% of the cases showed complete resorption of the calcification in radiographic controls. In 8.7% of the cases, partial disappearance of the calcification was achieved, and in the remaining 8.7% there were no significant changes. Single-crystal piezoelectric generators have a success rate comparable to those already reported with electrohydraulic and electromagnetic devices.

Surgical treatment of shoulder pain: a focused study on rotator cuff injury

Background: Shoulder pain is a common problem nowadays. With the increase in sports activities and an ageing population, the number of patients with shoulder pain is also increasing. The cause of shoulder pain is very complicated. Most shoulder pain is caused by rotator cuff disease, adhesive capsulitis, joint instability, calcific tendinitis, biceps problem, degenerative osteoarthritis, or rheumatoid arthritis. This article aims to identify and describe various surgical treatment methods and prognosis associated with rotator cuff disease.Current Concepts: The initial treatment for rotator cuff disease is conservative with rehabilitative exercise therapy. Patients who do not respond to conservative treatment require appropriate surgical treatment. The surgical treatment methods differ depending on the lesions. The surgical treatment can be classified as: open rotator cuff repair, arthroscopic rotator cuff repair, and reverse total shoulder arthroplasty. If patients do not receive the appropriate surgical treatment, there will be irreversible changes in the patient’s shoulder joint. Besides, the prognosis of the disease would also not be good for any other treatment.Discussion and Conclusion: For the best prognosis of patients, it is important to choose an appropriate treatment method after an accurate diagnosis as per the patient’s conditions.

Nonoperative treatment of shoulder pain

Background: The shoulder joint has a wide range of motion and is extensively used. Damage in its components may cause functional deficits and pain. In particular, shoulder joint pain is associated with discomfort due to the involvement of the joint’s movement in basic tasks of daily life, such as washing one’s hair, dressing, and eating.Current Concepts: Diseases that cause shoulder joint pain include shoulder impingement syndrome, rotator cuff tear and tendinopathy, lesion of superior labrum anterior to posterior, biceps tendinitis, adhesive capsulitis, calcific tendinitis, and shoulder instability. Nonoperative treatment of shoulder joint pain includes: (1) reducing pain and preventing structural damage through rest, lifestyle modification, and physical therapy; (2) reducing pain through drug and injection treatment; (3) strengthening the rotator cuff muscles, around the scapula; and (4) performing scapular stabilization treatment through muscle strengthening. These treatments maintain the biomechanics of the shoulder joint, prevent disease progression, and enable pain-free daily life and exercise through symptom relief.Discussion and Conclusion: It is necessary to have an accurate understanding of the structures that cause shoulder joint pain. Understanding the cause of the pain can prevent the disease from progressing. Nonoperative management for shoulder pain consists of preventing a decrease in the range of motion of the shoulder joint with reduction of pain relief, preventing inflammation through drug treatment, injection treatment, lifestyle modifications, and improving muscle strength of the muscles around the rotator cuff and periscapular muscle joint through rehabilitation exercise. Nonoperative treatment modalities are valuable and cost-effective management options for shoulder pain.

Postoperative rehabilitation of shoulder pain

Background: Shoulder joint diseases such as rotator cuff tear, adhesive capsulitis, calcific tendinitis, shoulder instability, and glenohumeral osteoarthritis often require surgical treatment. Surgical outcomes can change significantly depending on whether the postoperative rehabilitation was appropriately performed.Current Concepts: The focus of postoperative rehabilitation should be to remove pain and restore functional movement through improving the dynamic stability of the rotator cuff and shoulder muscles. However, rehabilitation should not include activities that aggravate the injury. Therefore, rehabilitation treatment should be carried out with gradual increments in exercise intensity. Postoperative rehabilitation is not only related to exercise but may also include drug administration, such as steroid injection. In particular, many investigations have been performed to identify the clinical risks and benefits of steroid injection after rotator cuff repair. Notably, telemedicine can be used as a solution for the problematic situations that have been caused by coronavirus disease 2019 pandemic.Discussion and Conclusion: A thorough understanding and appropriate application of postoperative rehabilitation protocols are essential to improve surgical outcomes.

Chronic intramuscular calcific tendinitis of the deltoid muscle.

Calcific tendinitis is a potentially symptomatic disorder characterized by calcium deposits in the substance of the tendon. Although this condition can occur in any tendinous tissue throughout the human body, calcium deposition commonly occurs at tendon insertions near the bone-tendon junction. The musculotendinous junction of the deltoid muscle has peculiarly dense intramuscular tendons to which muscle fibers attach obliquely to create muscular strength. Given that the intramuscular tendons themselves, which form the consecutive part from the insertion, are subjected to unpredictable stress load or microtrauma similar to tendon insertions, it is reasonable to assume that calcific tendinitis could also occur at the intramuscular tendons. Here we report a case of chronic symptomatic calcium deposition in the lateral part of the deltoid muscle between the origin and the insertion, which was eventually surgically removed and confirmed as intramuscular calcific tendinitis.

Calcific Tendinitis of the Longus Colli Muscle in a Pediatric Patient With Acquired Torticollis

Case: We report a case of an 11-year-old girl with acute calcific tendinitis of the longus colli (ACTLC) muscle causing torticollis. To the best of our knowledge, this is the first documented case of calcific tendinitis of the longus colli muscle in a pediatric patient. Conclusion: ACTLC is an unusual cause of painful torticollis in the pediatric population. Our report will help guide clinicians who may encounter this pathology in their practice.

Complete Closed Rupture of the Medial Bundle of the Flexor Hallucis Brevis Tendon Off the Medial Sesamoid Insertion

Category: Midfoot/Forefoot; Basic Sciences/Biologics; Sports; Trauma Introduction/Purpose: Flexor tendon injuries of the hallux are uncommon overall but when they happen, the flexor hallucis longus (FHL) tendon is the most frequent one affected. The rupture of FHL usually results from open injuries and deep cuts in the sole at the base of the toe;4 complete subcutaneous ruptures are extremely rare.5 There are around 36 cases reported of complete or partial closed ruptures of the FHL tendon along its entire course6 and the majority of the partial ruptures correspond to dancers and athletes.7 As far as FHB, we found a few reports of calcific tendinitis of the medial bundle and cases of calcifying tendinitis.8 To the best of our knowledge, this is the only case report of isolated closed rupture of the FHB tendon. Methods: A 33-year-old man, amateur soccer player, presented with mild swelling, ecchymosis, and increasing pain in the left hallux triggered by movement and palpation, relieved by rest. He sustained a direct axial blow and blunt force trauma with a soccer ball plus hyperextension. Standard bilateral weightbearing feet radiographs were normal. Physical exam revealed the left hallux normally aligned but with limited painful motion of 20° each way and no obvious instability. Palpation of the left first metatarsophalangeal joint was tender but not particularly over the sesamoids. MRI revealed an avulsion of the flexor Hallucis Brevis tendon off the proximal aspect of the medial sesamoid accompanied by fluid and edema, effusion in the first MTP joint and bone contusions in the first metatarsal head and dorsal base of the first proximal phalanx. Treatment with a toe spacer and postop sandal with the toe straight with an extension block was decided. Results: Tendon's blood flow around the sesamoids is limited making it susceptible to degenerative rupture. The most common mechanism of complete tendon rupture is direct open injury. Closed rupture is very rare and complete rupture in closed injury is even more. We did not find reports on third degree type of injuries, neither for any kind of isolated rupture of FHB. In our patient's case, dorsiflexion stretched all plantar soft tissue around the first MTP but he was able to do active movement of the great toe probably due to the FHL and lateral FHB insertion integrity. We found few reports of second-degree strain injury of FHL and FHB in a chronic setting, all treated conservatively with partial immobilization and strapping of the hallux to prevent extension. After conservative treatment at 3 months follow-up, our patient presented with no subjective complains, normal motion, stability and alignment of the hallux. Conclusion: Despite an extensive literature search, we did not find a similar injury, and this is probably the first time it is described. As found in our research, the most common injury related to the flexor tendons of the hallux are in soccer players and involve the FHL or both.23 These findings made us conclude that these injuries are either under-diagnosed or exceptional.

Applying Focused and Radial Shock Wave for Calcific Tendinitis of the Shoulder : Randomized Controlled Study

Applying Focused and Radial Shock Wave for Calcific Tendinitis of the Shoulder : Randomized Controlled Study

Hyperlipidemia in Patients with Calcific Tendinitis

Objective: Calcific tendinitis is a disease of unclear etiology and is associated with metabolic diseases. Hyperlipidemia, one of the metabolic diseases with systemic effects, may be associated with tendinopathy and tendinitis. In this study, we aimed to evaluate the relationship between hyperlipidemia and hypertriglyceridemia, calcific tendinitis, the location of tendinitis, and the frequency of severely symptomatic tendinitis attacks. Methods: This retrospective study included a total of 2055 patients diagnosed with calcific tendinitis between August 1, 2019, and August 1, 2021. The patients were evaluated in terms of their hyperlipidemia and hypertriglyceridemia status, statin and/or fibrate use, and the frequency of tendinitis, and the location of attack. Results: It was observed that 64.4% (n=230) of the patients had hyperlipidemia and 11.8% (n=42) had hypertriglyceridemia. It was determined that the most common tendinitis area among 357 patients was the shoulder. There was no statistically significant difference between the frequency of attacks (P = .712), and the location of attack (P = .069) in patients with hyperlipidemia. There was no statistically significant difference between the frequency of attacks (P =.735) and the location of attack (P =.286) in patients with hypertriglyceridemia. However, a statistically significant difference was found between the attack area (P =.032) in patients with triglyceride values higher than the target recommended values. Conclusion: The frequency of hyperlipidemia is high in patients with calcific tendinitis; it will be useful to evaluate patients with calcific tendinitis in terms of hyperlipidemia.

Comparison of the effects of ultrasound- guided needle puncture, radial shock wave therapy, and combined treatments on calcific tendinitis of the shoulder: A single-blind randomized controlled trial.

Calcific tendinitis of the shoulder is a common disorder resulting in restricted motion and pain. This study compared the effects of ultrasound-guided fine-needle puncture (USNP), radial shock wave therapy (RSWT), and the combination of both treatments (COMB) on calcific tendinitis of the shoulder. We enrolled 62 patients who had unilateral shoulder pain for more than 3 months. The patients were randomly divided into three groups: USNP, RSWT, and COMB. All USNP needle punctures were guided with ultrasound (US), and RSWT was delivered at 2 Hz (2000 shock waves; 0.26 mJ/mm2) once a week for 3 weeks. The COMB group received three weekly rounds of RSWT after a single US-guided needle puncture. The primary outcome was the pain visual analog scale (VAS), and secondary outcomes were the Constant scores, 36-Item Short-Form Health Survey, and range of motion. A within-group comparison at 3 months revealed significant improvements in the pain VAS (p< 0.05, during activity) and Constant (p< 0.05) scores, but between-group comparisons revealed no statistically significant differences in the pain VAS (p> 0.05) or Constant (p= 0.089) scores. Only improvement differences in role-emotional (SF-36; p= 0.01) and active external rotation (p= 0.035) were determined over time, which favored the USNP and COMB groups. Although no significant differences were observed among the groups in the treatment of calcific tendinitis of the shoulder, more satisfactory outcomes were noted in the USNP and COMB groups than in the RSWT group. Larger samples, longer follow-up times, and other treatment protocols are suggested for future studies.

492 Calcific Tendonitis of the Longus Colli: A Rare Cause of Neck Pain

Abstract Cervical tendonitis of the Longus Colli muscle (CTLC) is a rare but clinically significant cause of neck pain. It can mimic other more serious pathologies in the retro-pharygneal area and requires sufficient investigation for diagnosis. This case presented with a fit and well 54-year-old gentleman suffering from progressive left sided neck pain, stiffness, and odynophagia. His imaging demonstrated a prevertebral fluid collection of unclear aetiology and an area of calcification just below the anterior arch of C1. Along with the differential diagnosis of calcific tendonitis of longus colli, the fluid collecting inferior to C1 could have represented a retropharyngeal abscess - a potentially life-threatening infection. This patient required input from multiple specialities to safely reach diagnosis and exclude more significant pathology. Although CTLC represents a benign and perhaps under-recognised condition, this case highlights the importance of considering other differential diagnoses and multidisciplinary management in a patient presenting with limited neck movements.

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.

PurposeThe 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.MethodsThis 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.ResultsRemarkable 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).ConclusionsArthroscopic 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.