Calcific Tendinopathy Research Articles

Cochrane in CORR®: Kinesio Taping for Rotator Cuff Disease.

Cochrane in CORR®: Kinesio Taping for Rotator Cuff Disease.

Ultrasound-Guided Lavage of a Popliteus Tendon Calcification.

A 73-year-old woman presented with lateral knee pain ongoing for 7 months, which was exacerbated the week before ultrasound examination. Her pain was radiating proximally along the lateral thigh and distally over the lateral leg, and it increased with weight bearing. On examination, full knee extension and flexion past 50° were painful. Pain was also elicited with palpation of the posterolateral corner of the lateral femoral condyle. On ultrasound, a well-circumscribed calcification was identified in the proximal popliteus tendon (Figure 1). A knee radiograph also showed the intratendinous calcific deposition (Figure 2). The patient had no pain relief with a short course of nonsteroidal anti-inflammatory drugs and activity modification. An ultrasound-guided percutaneous lavage of the popliteus tendon calcification was performed (Supplementary Data Video 1). The patient reported 90% relief of her pain as soon as the procedure was completed, and she was pain free at the 1-month follow-up. The popliteus is a triangular-shaped muscle innervated by the tibial nerve forming part of the posterolateral corner of the knee. Its proximal tendinous origin inserts on a characteristic groove well visible on an axial ultrasound scan of the lateral femoral condyle [1]. Its muscular portion courses medially and obliquely to insert on the posterior tibia, just above the soleal line. Popliteus calcific tendinopathy is extremely rare, and only a few cases have been reported in the literature. They were treated either with a conservative approach such as oral analgesia [2] and corticosteroid injection [3, 4], or arthroscopic excision [5]. This is the first reported case of popliteus calcific tendinopathy successfully treated with a lavage.

Primena mehaničkog udarnog talasa u lečenju kalcifikovanih tendinopatija

Tendons are the soft tissue that connects muscles to bones. They are made of collagen and elastin, they are strong and solid, and have no possibility of contraction. Their strength helps us to move. Recovery of tendon injuries is long-lasting and can take more than six months. If a tendon is shed during a time injury, calcification occurs at the site of the injury and the disease is called calcifying tendinopathy. The very existence of calcifications is an indication for treatment with a mechanical shock wave (Shock wave). Mechanical shock waves can act in focus or radially. The difference between focused and radial waves is primarily in their physical basis. Focused shock waves differ from radial shock waves in terms of therapeutic depth of penetration into the tissue. The basic biological effect of a mechanical shock wave is stimulating. The energy of the mechanical shock wave acts at the cellular level by stimulating the reduction of inflammation and pain in the tissue. Using mechanical shock wave in the treatment of calcified tendinopathies, a safe method for breaking calcifications was obtained. Shock wave can be applied to using: different frequency, different number of strokes, as well as different strength of strokes in their studies. The choice of parameters for the application depends on whether it is calcified or non-calcified tendinopathy. Indications for the use are: painful shoulder, heel spur, plantar fasciitis, tennis elbow, Achilles tendon tendinopathy, jumping knee, patellar tendinitis, myalgia, myogelosis and muscular tendon overstrain syndrome. Contraindications for the use are: the existence of prostheses, knees and hips, as well as various orthopedic material, pacemaker, as well as the presence of chronic diseases such as multiple sclerosis, amyotrophic lateral sclerosis or tumors. The application of a mechanical shock wave is new, non-invasive method, easy to apply, always reduces pain and practically without side effects. This method has a special role in the treatment of chronic inflammation of diseased tendons, with or without calcification. The only dilemma in the application of a mechanical shock wave can be in the number of applications as well as the time break between the applications of two consecutive mechanical shock waves therapy.

A multicenter randomized controlled trial comparing gamification with remote monitoring against standard rehabilitation for patients after arthroscopic shoulder surgery.

Gamification has become increasingly popular in rehabilitation and is viewed as a tool to improve patient activation, motivation, and engagement. The aim of this study was to compare the efficacy of validated exergames played through a system using "depth sensor" and bespoke software against standard physiotherapy in patients treated with arthroscopic shoulder surgery. This included the following common conditions: subacromial impingement syndrome, calcific tendinopathy, and rotator cuff tear. Following arthroscopic shoulder surgery, patients were randomized into 1 of 2 groups: In the standard rehabilitation group, patients were followed up for 12 weeks after surgery with standard postoperative physiotherapy and underwent electronic measurements of their active range of movement (ROM). In the exergame group, patients followed a postoperative regimen of exergames using the principles of gamification with physiotherapy support. Patients were given an exergame schedule prescribed by their therapist on Medical Interactive Recovery Assistant (MIRA) software (MIRA Rehab, London, UK) paired with a Microsoft Kinect sensor (Microsoft, Redmond, WA, USA). The primary outcome was active ROM objectively measured by MIRA and Kinect. Secondary outcome measures included the Oxford Shoulder Score, the Disabilities of the Arm, Shoulder and Hand score, and the EQ-VAS score at 12 weeks after surgery. A total of 71 patients were recruited to the study. We excluded 7 patients based on intraoperative findings. Thirty-three patients were treated with exergames, and 31 patients underwent conventional physiotherapy. There was no significant difference between the 2 groups in baseline ROM. Postoperatively, there was no significant difference in any of the cardinal planes of movement (forward flexion, P = .64; abduction, P = .33; and external rotation, P = .75). The mean Oxford Shoulder Score improved from 29.25 to 38.2 in the control group (P = .001) and from 27.1 to 35.1 in the trial group (P = .01); there was no significant difference between the groups at 12 weeks (P = .246). The mean Disabilities of the Arm, Shoulder and Hand score improved from 38.13 to 16.98 in the control group (P = .001) and from 42.3 to 22.54 in the trial group (P = .007); there was no significant difference between the 2 groups (P = .328). There was no significant difference in the EQ-VAS score in either group at any time point (P = .5866). This randomized controlled trial demonstrates that exergames can be used effectively in the rehabilitation of patients following arthroscopic shoulder surgery. Outcomes, judged by ROM and patient-reported outcome measures, are equivalent to conventional physiotherapy rehabilitation protocols. This health care innovation has the potential to relieve some of the heavy burden placed on physiotherapy departments for "routine" postoperative care in shoulder surgery.

Ultrasound-guided percutaneous irrigation of rotator cuff calcific tendinosis. What radiologist should know.

Rotator cuff calcific tendinopathy is a common condition caused by the presence of calcification into the rotator cuff or in the subacromial-subdeltoid bursa. The pathogenetic mechanism of this pathology is still debated. Calcific tendinitis frequently affects the rotator cuff and may cause shoulder pain and reduction of range of motion. It can be diagnosed with conventional radiography, ultrasound, or magnetic resonance imaging. The first therapeutic option includes conservative management based on rest, physical therapy, and oral non-steroid anti-inflammatory administration. Extracorporeal shock wave therapy is a noninvasive technique that can be useful for the fragmentation of calcific deposits. Imaging-guided percutaneous irrigation is currently considered the gold standard technique for the treatment of calcific tendinitis due to its minimal invasiveness and its success rate of about 80%.

Ultrasound-Guided Musculoskeletal Injections.

Musculoskeletal injections serve a variety of diagnostic and therapeutic purposes, with ultrasonography (US) guidance having many advantages: no ionizing radiation, real-time guidance, high spatial resolution, excellent soft tissue contrast, and the ability to identify and avoid critical structures. Sonography can be cost effective and afford flexibility in resource-constrained settings. This article describes US-guided musculoskeletal injections relevant to many radiology practices and provides experience-based suggestions. Structures covered include multiple joints (shoulder, hip), bursae (iliopsoas, subacromial-subdeltoid, greater trochanteric), peripheral nerves (sciatic, radial), and tendon sheaths (posterior tibial, peroneal, flexor hallucis longus, Achilles, long head of the biceps). Trigger point and similar targeted steroid injections, as well as calcific tendinopathy barbotage, are also described.

The Effects of Comprehensive Occupational Therapy for Hemiplegic Upper-extremity both with Rotator Cuff Calcific Tendinopathy and Shoulder Subluxation：A Case Report

The Effects of Comprehensive Occupational Therapy for Hemiplegic Upper-extremity both with Rotator Cuff Calcific Tendinopathy and Shoulder Subluxation：A Case Report

Tratamiento de la tendinopatía calcificante del manguito de los rotadores mediante punción-aspiración ecoguiada

ObjectiveCalcific tendinopathy of the rotator cuff is a common condition caused by the deposition of calcium crystals in the tendons of the rotator cuff. This study aimed to analyze the effectiveness of ultrasound-guided puncture and aspiration in calcific tendinopathy of the should in 86 patients treated at our center and to determine the factors associated with poor prognosis after this treatment. Material and methodsThis retrospective descriptive study included 86 patients with calcific tendinopathy of the rotator cuff treated with ultrasound-guided puncture and aspiration between 2015 and 2019 for whom clinical and radiological variables were collected 1, 3, 6, and 12 months after the procedure. ResultsOne year after treatment, 81.4% patients showed clinical improvement and 96.5% showed radiological improvement. Complications were observed in 34.9%; all complications were mild. ConclusionsUltrasound-guided puncture and aspiration is an effective treatment for calcific tendinopathy of the shoulder, resulting in a high rate of clinical and radiological improvement and a low rate of minor complications. This technique has additional advantages, such as interaction with the patient and the lack of ionizing radiation.

Predicting long-term outcomes of ultrasound-guided percutaneous irrigation of calcific tendinopathy with the use of machine learning.

To evaluate the performance of two machine learning models in predicting the long-term complete pain resolution in patients undergoing ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT). Within a 3-year period, 100 consecutive patients who underwent US-PICT for rotator cuff disease were prospectively enrolled. The location, maximum diameter, and type of each calcification were recorded. The degree of calcium retrieval was graded as complete or incomplete. Shoulder pain was assessed with the visual analogue scale (VAS) at baseline, 1-week, 1-month, and 1-year post-treatment. Measurements related to procedural details, patient, and calcification characteristics were used to construct a machine learning model for the prediction of pain at 1-year post-US-PICT. Two distinct models were built, one including VAS data at 1 week and another additionally including pain data at 1-month post-treatment. Variable importance analysis was performed for the 1-week model. Model performance was evaluated by using receiver operating characteristics (ROC) curves and the respective areas under the curve (AUC). The model exhibited an AUC of 69.2% for the prediction of complete pain resolution at 1 year. The addition of VAS scores at 1 month did not significantly alter the performance of the algorithm. Age and baseline VAS scores were the most important variables for classification performance. The presented machine learning model exhibited an AUC of almost 70% in predicting complete pain resolution at 1 year. Pain data at 1 month do not appear to improve the performance of the algorithm.

Impact of ultrasonography detected quadriceps calcific tendinopathy on pain and function in patients with primary knee osteoarthritis.

Calcific tendinopathy is most commonly seen around the shoulder joint. Only a few cases of quadriceps calcific tendinopathy (QCT) were reported. This study compares pain, function, clinical examination results, and ultrasonographic findings among primary knee osteoarthritis (KOA) patients with or without ultrasonography-detected QCT. A cross-sectional study was conducted on 214 patients with knee OA. Ultrasonography (US) of knee joints was performed according to the EULAR guidelines. Kellgren-Lawrence radiographic grading was used to score OA. Pain and functional status were assessed using the visual analog scale (VAS), the Health Assessment Questionnaire-II (HAQ-II), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). QCT was detected in 50 out of 428 knees (11.6%), i.e. in 46 out of 214 patients (21.49%). Most cases of QCT were detected in the following sites: 36 in the vastus lateralis (72%), 10 in the vastus intermedius (20%), and only 4 in the vastus medialis (8%). QCT was found mainly in advanced KOA stages: 44 cases of QCT were found in patients with grade 4 KOA and 6 cases in grade 3 KOA. The presence of QCT showed a statistically significant association (p<0.05) with VAS, HAQ-II, WOMAC subscales, synovitis, and effusion detected by US. In knees with ultrasound-detected QCT, ultrasonographic features of CPPD were found in 31 knees (62%). QCT was found in cases with advanced KOA and mainly with ultrasonographic findings of CPPD disease. QCT could be considered an independent poor prognostic finding regarding pain, functional activity, and response to NSAIDs.

Arthroscopic Ultrasound-Guided Needling: An Effective Technique for the Treatment of Calcific Rotator Cuff Tendinopathy

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.

Update on Evaluation and Management of Calcific Tendinopathy

Update on Evaluation and Management of Calcific Tendinopathy

Increased risk of shoulder calcific tendinopathy in diabetes mellitus: A nationwide, population-based, matched cohort study.

Calcific tendinopathy of the rotator cuff is a common cause of painful disability in the shoulder with unclear aetiology. Diabetes mellitus (DM) is associated with calcific tendinopathy; however, large epidemiological data are lacking. Thus, we conducted a nationwide population-based matched cohort study to investigate the risk for calcific tendinopathy of the shoulder in diabetic patients. The National Health Insurance Research Database of Taiwan was used to include 42915 patients newly diagnosed with DM between 1 January 2000 and 31 December 2015 and randomly extract the data of 171660 individuals, as a matched control group. All individuals were followed-up until the development of calcific tendinopathy or the end of 2015. Overall, 122 patients from the DM group (0.284%) developed calcific tendinopathy compared with 340 individuals from the non-DM group (0.198%). The Kaplan-Meier analysis indicated that patients with DM had a higher risk of calcific tendinopathy since the eighth year of follow-up (log-rank test, P=.006). Cox proportional hazard regression revealed that the adjusted hazard ratio of calcific tendinopathy in diabetic patients to that in non-diabetic patients was 1.276 (95% confidence interval 1.037-1.571, P=.002). Moreover, the stratified analysis disclosed that DM was a strong independent risk factor for calcific tendinopathy irrespective of the existing comorbidities. This study demonstrated that patients with DM had a 27% increased risk of developing calcific tendinopathy of the shoulder, 8years after initially being diagnosed with DM.

Progressively Increasing Teres Minor Calcific Tendinopathy in an Elderly Male

Calcific tendinopathy is a common pathology involving a variety of tendons across many joints. It is most commonly seen involving tendons of the rotator cuff with supraspinatus being the favorite. It can mimic aggressive pathologies such as neoplasms resulting in unnecessary interventions. Rarely, it involves teres minor tendon. We report a case of teres minor calcific tendinopathy detected over serial radiographs and diagnosed using magnetic resonance imaging.

Management of Calcific Supraspinatus TendinitisA Systematic Review

Background: The objectives of this comprehensive quantitative review of the treatment of calcific supraspinatus tendinitis were to investigate if there is a sustainable positive effect on outcomes after treatment with extracorporeal shockwave therapy (ESWT) or ultrasound (US)-guided needling and to compare these results with those of treatment with arthroscopic surgery. Method: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this review. A systematic literature search was conducted in December 2019 to identify relevant clinical articles in peer-reviewed journals with at least 3 months’ follow-up. Each article was scored using the Coleman Methodology Score. The primary endpoints were functional outcome and radiologic change in the size of the calcific deposit. Results: Twenty-four studies were included (1,509 shoulders). The mean Coleman Methodology Score for the included studies was 77.1± 9.1. Overall, good to excellent clinical outcomes were achieved after treatment with either ESWT, US-guided needling, or arthroscopic surgery, with an improvement in the Constant-Murley score ranging between 26.3 and 41.5 points after 1 year. No severe side effects or long-term complications were encountered. Conclusions: Patients can achieve good to excellent clinical outcomes after ESWT, US-guided needling, and arthroscopy for calcific tendinopathy of the shoulder. Side effects and posttreatment complications should be taken into account when a decision is being made for each individual patient. Physicians should consider ESWT and US-guided needling as minimally invasive treatment options when primary conservative treatment fails. Arthroscopy can safely be used as a very effective but more invasive secondary option, although the extent of deposit removal and the additional benefit of subacromial decompression remain unclear. Keywords: Calcific Tendinitis, Treatment, ESWT, US-PICT, Arthroscopy, supraspinatus Management UGN.

Pro-inflammatory effects of human apatite crystals extracted from patients suffering from calcific tendinopathy

BackgroundCalcific tendonitis of the rotator cuff is due to carbonated apatite deposits in the shoulder tendons. During the evolution of the disease, an acute inflammatory episode may occur leading to the disappearance of the calcification. Although hydroxyapatite crystal-induced inflammation has been previously studied with synthetic crystals, no data are available with calcifications extracted from patients suffering from calcific tendinopathy. The objective of the study was to explore the inflammatory properties of human calcifications and the pathways involved.MethodsHuman calcifications and synthetic hydroxyapatite were used in vitro to stimulate human monocytes and macrophages, the human myeloid cell line THP-1, and human tenocytes. The release of IL-1β, IL-6, and IL-8 by cells was quantified by ELISA. The gene expression of pro- and anti-inflammatory cytokines was evaluated by quantitative PCR. NF-kB activation and NLRP3 involvement were assessed in THP-1 cells using a NF-kB inhibitor and a caspase-1 inhibitor. The inflammatory properties were then assessed in vivo using a mouse air pouch model.ResultsHuman calcifications were able to induce a significant release of IL-1β when incubated with monocytes, macrophages, and THP-1 only if they were first primed with LPS (monocytes and macrophages) or PMA (THP-1). Stimulation of THP-1 by human calcifications led to similar levels of IL-1β when compared to synthetic hydroxyapatite although these levels were significantly inferior in monocytes and macrophages. The patient’s crystals enhanced mRNA expression of pro-IL-1β, as well as IL-18, NF-kB, and TGFβ when IL-6 and TNFα expression were not. IL-1β production was reduced by the inhibition of caspase-1 indicating the role of NLRP3 inflammasome. In vivo, injection of human calcifications or synthetic hydroxyapatite in the air pouch led to a significant increase in membrane thickness although significant overexpression of IL-1β was only observed for synthetic hydroxyapatite.ConclusionsAs synthetic hydroxyapatite, human calcifications were able to induce an inflammatory response resulting in the production of IL-1β after NF-kB activation and through NLRP3 inflammasome. In some experiments, IL-1β induction was lower with human calcifications compared to synthetic apatite. Differences in size, shape, and protein content may explain this observation.

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

Rotator cuff calcific tendinopathy (RCCT) is a very frequent and debilitating disease often treated with Ultrasound-guided percutaneous irrigation (UGPI) followed by physiotherapy. A multicenter observational clinical study was designed to assess the effects of physiotherapy after UGPI on the functional recovery of the shoulders of patients suffering from RCCT. One hundred sixty-six patients (mean age 50.7± 7.6years), 121 women, with painful RCCT were treated with UGPI and assessed at the day of UGPI (T0), and at one (T1), 3 (T2) and 6 (T3) months after treatment by the Constant- Murley Score (CMS), Oxford Shoulder Scale (OSS) and Numerical Rating Scale (NRS). Patients were divided into 2 groups, Physiotherapy (PT+) and not Physiotherapy (PT-) according to the performance of the rehabilitation program based on personal decision. A significant improvement at T1 in all outcomes in both groups and between T1 and T3 for NRS during movement and OSS was found, but not for NRS at rest and CMS. There was no difference between groups for all outcome measures. In 27,1% of patients symptoms recurred in an average of 13 ± 8weeks. Results suggest that post-UGPI not-standardized physiotherapy might not provide additional clinical benefits in short and medium term. Further studies could assess the effectiveness of physiotherapy performed after three months in patients with recurrence of pain.

Is routine gleno-humeral exploration a risk factor for adhesive capsulitis after arthroscopic removal of rotator cuff calcifications? A comparative retrospective study in 340 cases

BackgroundArthroscopic surgery has earned its place as the reference standard treatment for rotator cuff calcific tendinopathy refractory to conservative medical treatment. Adhesive capsulitis of the shoulder is the most common complication (12%). Standard practice involves routine gleno-humeral exploration before calcification removal. The objective of this study was to identify risk factors for adhesive capsulitis. HypothesisThe development of adhesive capsulitis is associated with gleno-humeral exploration. MethodsWe conducted a multicentre, multi-surgeon, retrospective cohort study of 340 consecutive patients who underwent arthroscopic removal of rotator cuff calcifications between 1 January 2012 and 1 January 2018. We collected epidemiological data (age, sex, work-related physical activity), the history of previous treatments (local injections, needling), the type and location of the calcifications as assessed radiologically, the clinical findings (Constant score before and 6 months after surgery, diagnosis of adhesive capsulitis defined as shoulder pain with motion range limitation in all directions), and the surgical details (type of anaesthesia, gleno-humeral exploration). ResultsOf the 340 patients, 251 underwent routine gleno-humeral exploration and 89 did not. Adhesive capsulitis developed in 40 (12%) patients. By multivariate analysis, gleno-humeral exploration was an independent risk factor for adhesive capsulitis (p=0.022; odds ratio, 5.60). Of the 251 gleno-humeral explorations, 8% identified concomitant lesions and only 4% led to a curative procedure. ConclusionGiven our results and the data in the literature, we believe that routine gleno-humeral exploration during the arthroscopic treatment of rotator cuff calcific tendinopathy is inadvisable. Level of evidenceIII; case-control study.

Delayed Diagnosis and Surgical Management for Gluteus Medius/Minimus Calcific Tendinopathy with Heterotopic Ossification: A Case Report

Delayed Diagnosis and Surgical Management for Gluteus Medius/Minimus Calcific Tendinopathy with Heterotopic Ossification: A Case Report

Acute fracture of extensive Achilles tendon calcific tendinopathy.

Acute fracture of extensive Achilles tendon calcific tendinopathy.