Calcific Tendinitis Of Rotator Cuff Research Articles

Infraspinatus and Teres Minor Tendon Calcification with Severe Pain

Calcific tendinitis is an extremely common shoulder disorder which affects 2.7 to 10.3% of the adult population. However, clear details regarding the formation of calcific tendinitis have only been found recently, and its pathology still under debate. In this report, we present a case of calcific tendinitis affect both the infraspinatus and the teres minor tendon with both X-ray and ultrasound findings. Calcific tendinitis at the infraspinatus is rare (around 8.4% in all rotator cuff calcific tendinitis), and no separate case report on calcific tendinitis has been reported in the teres minor region in the preceding several years, therefore, the rarity of reporting this case was considered.4 We assume that additional case reports can help to further improve our understanding regarding infraspinatus and teres minor tendon calcification.

Arthroscopic surgery for refractory rotator cuff calcific tendinitis of the shoulder

Arthroscopic surgery for refractory rotator cuff calcific tendinitis of the shoulder

Arthroscopic Removal and Tendon Repair for Refractory Rotator Cuff Calcific Tendinitis of the Shoulder.

The purpose of this study was to evaluate clinical and radiological outcomes of arthroscopic treatment for refractory rotator cuff calcific tendinitis of the shoulder. Subjects were 37 patients (35 women and 2 men; mean age, 47.8 years; age range 34-61 years) who had undergone arthroscopic treatment for calcific tendinitis of the shoulder. Despite sufficient nonsurgical treatments, all patients had residual calcific deposit with persistent or recurrent pain. Before surgery, all patients underwent 3-directional radiographs of the shoulder and three-dimensional computed tomography to determine the location and size of calcific deposit. Arthroscopic surgery was performed with the patient under general anesthesia in the lateral decubitus position. A 2-cm single longitudinal incision was made with a radiofrequency hook blade on the tendon surface above calcific deposit. Calcific deposit was removed as much as possible with a curette and a motorized shaver. The incised tendon was repaired with a side-to-side suture with strong sutures. The Japanese Orthopaedic Association shoulder score was used to evaluate clinical outcomes. The extent of calcific deposit removal was evaluated with radiographs obtained before surgery, 1 week after the surgery and at the final follow-up examination. The mean follow-up duration was 30.4 (range, 13-72) months. The mean shoulder score significantly improved from 69.7 (range, 58-80) points before surgery to 97.8 (range, 89-100) points at the final follow-up examination. Postoperative radiographs in all patients, showed that the calcific deposit was resolved or reduced and those from 1 week after surgery to the final examination showed no evidence of recurrence or enlargement of calcific deposit. The calcific deposit had completely resolved in 34 patients but remained in 3 patients. When treating calcific tendinitis of the shoulder, it is important to accurately determine the size and location of calcific deposit by radiographs and 3-dimensional computed tomography. Satisfactory clinical and radiological outcomes can be expected after reliable removal of calcific deposit through a single longitudinal incision and side-to-side repair with strong sutures, in association with an appropriate rehabilitation program.

Radiological and clinical predictors of long-term outcome in rotator cuff calcific tendinitis.

ObjectivesKnowledge on the epidemiology and long-term course of rotator cuff calcific tendinitis (RCCT) is scarce. We assessed demographics, radiological characteristics, and their association with long-term outcomes in a large patient group.MethodsBaseline demographics, radiological characteristics and treatment were recorded in 342 patients. Interobserver agreement of radiological measures was analyzed. Long-term outcome was evaluated with questionnaires (WORC, DASH). The association of baseline characteristics with outcome was assessed.ResultsMean age was 49.0 (SD = 10.0), and 59.5 % were female. The dominant arm was affected in 66.0 %, and 21.3 % had bilateral disease. Calcifications were on average 18.7 mm (SD = 10.1, ICC = 0.84 (p < 0.001)) and located 10.1 mm (SD = 11.8) medially to the acromion (ICC = 0.77 (p < 0.001)). Gärtner type I calcifications were found in 32.1 % (Kappa = 0.47 (p < 0.001)). After 14 years (SD = 7.1) of follow-up, median WORC was 72.5 (range, 3.0-100.0; WORC < 60 in 42 %) and median DASH 17.0 (range, 0.0-82.0). Female gender, dominant arm involvement, bilateral disease, longer duration of symptoms, and multiple calcifications were associated with inferior WORC. DASH results were similar.ConclusionsMany subjects have persisting shoulder complaints years after diagnosis, regardless of treatment. Female gender, dominant arm involvement, bilateral disease, longer duration of symptoms, and multiple calcifications were associated with inferior outcome. Radiological measures had moderate-to-good reliability and no prognostic value.Key Points• Most RCCT studies report on short-term outcome and/or small patients groups.• In this large, long-term observational study, RCCT appeared to not be self-limiting in many subjects.• Negative prognostic factors included female gender, more calcifications, dominant arm affected, and longer duration of symptoms.• Interobserver agreement of general radiological RCCT measures is moderate to good.• More rigorous diagnostics and treatment might be needed in specific RCCT cases.Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-016-4224-7) contains supplementary material, which is available to authorized users.

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

Rotator cuff calcific tendinitis (RCCT) is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. Between non-surgical and surgical treatment options, today a few minimal invasive techniques are available to remove the calcific deposit, and they represent a cornerstone in the management of this painful clinical condition. The aim of the work was a retrospective evaluation of double-needle ultrasound-guided percutaneous fragmentation and lavage (DNL), focused on understanding the factors which are of major importance in determining a quick and good response at 1 month. A series of 147 patients affected by RCCT and suitable for DNL were evaluated. A systematic review of anamnestic, clinical and imaging data was performed in 144 shoulders treated in a single-centre setting. Clinical reports and imaging examinations were revisited. The inclusion criteria were submission to DNL, therefore fitness for the percutaneous procedure, and following 1-month follow-up. There was no exclusion owing to risk of bias. The treatment was defined as successful for constant shoulder modified score (CSS) improvement of >50% at 1 month. In 70% of shoulders, the treatment resulted in a quick and significant reduction of symptoms (successful). On the whole, CSS increase at 1 month was estimated at 91.5 ± 69.1%. CSS variations were significantly related to age of patients (better results between 30 and 40 years old), calcification size (more relevant improvement for middle-sized calcifications, 12-17 mm), sonographic and radiographic features of calcific deposits (softer calcifications) and thickening of subacromial/subdeltoid bursa walls. In the final model of stepwise regression for CSS variation, ultrasound score pre-treatment and post-treatment, the distance between bursa and calcification before treatment and the size of post-treatment calcification area were shown to be independently correlated to success. Numeric rating scale score for pain showed similar results. Pain at admission was also related to age, calcification size, ultrasound and Gärtner score, power Doppler positivity, bursal wall thickening and biceps tenosynovitis. The success of the procedure with quick improvement in function and symptoms is warranted in soft and middle-sized calcifications, in young adults. Ultrasound-guided percutaneous procedures for RCCT must be safe, effective and with prompt pain relief and function restoration. This study shows which clinical picture is more favourable to this purpose and actual prognostic factors for DNL (soft and middle-sized calcifications, in young adults, are more favourable).

Poster 376 Ultrasound-Guided Aspiration and Lavage Treatment for Rotator Cuff Calcific Tendinitis: A Literature Review

Poster 376 Ultrasound-Guided Aspiration and Lavage Treatment for Rotator Cuff Calcific Tendinitis: A Literature Review

Ultrasound guided interventions in rotator cuff calcific tendonitis

Purpose: To present our experience with treating rotator cuff calcific tendinitis and mild forms of shoulder impingement syndrome with ultrasound guided interventions.

Calcific tendinitis of rotator cuff with osseous lesion of greater tuberosity

Calcific tendinitis of rotator cuff with osseous lesion of greater tuberosity

The diagnostic value of the shoulder rotator cuff muscles’ isometric force testing

The most prevalent group of disorders of human shoulder is related to the muscles of the rotator cuff. In order to develop a mechanical method for rotator cuff muscles’ evaluation, we hypothesized that measurement of the isometric force generated by the individual muscle of the rotator cuff might detect the variations, which are characteristic to the different disorders of rotator cuff muscles in adults. The isometric force of supraspinatus, infraspinatus and subscapularis muscles were measured in patients with rotator cuff tears, calcific tendinitis and subacromial impingement syndrome, 30 patients with each disorder, and compared to the normal values from our previous study. Torque of the force was calculated and normalized to lean body mass. The profiles of the mean torque-time curves of each group were compared statistically. We found the expected significantly lower profiles of the torque-time curves of all the tested rotator cuff muscles in comparison to the normal values. The best resolution between the curves of different study groups was found in the testing of the infraspinatus muscles. Therefore the previously unrecognized variations of rotator cuff muscles’ isometric strength build up patterns in the common disorders involving the rotator cuff muscles were revealed. The presented data might be a basis for the future development of a simple mechanical diagnostic method for identification of the abnormal patterns of muscle isometric strength in patients with rotator cuff muscles’ pathology.

Double-needle ultrasound-guided percutaneous treatment of rotator cuff calcific tendinitis: tips &amp; tricks

Rotator cuff calcific tendinitis is a very common disease and may result in a very painful shoulder. Aetiology of this disease is still poorly understood. When symptoms are mild, this disease may be treated conservatively. Several treatment options have been proposed. Among them, ultrasound-guided procedures have been recently described. All procedures use one or two needles to inject a fluid, to dissolve calcium and to aspirate it. In the present article, we review some tips and tricks that may be useful to improve performance of an ultrasound-guided double-needle procedure.

Rotator Cuff Calcific Tendinitis: Does Warm Saline Solution Improve the Short-term Outcome of Double-Needle US-guided Treatment?

To determine whether saline temperature influences procedure performance and outcome in patients undergoing ultrasonography (US)-guided lavage for the treatment of rotator cuff calcific tendinitis (RCCT). This study was approved by the institutional review board, and informed consent was obtained from all patients. From December 2009 to May 2011, 462 patients (191 men and 271 women; mean age, 39.7 years) with painful RCCT diagnosed at US were prospectively enrolled and randomized into two groups. Operators subjectively classified calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous treatment of RCCT (local anesthesia, double-needle lavage, intrabursal steroid injection) was performed with warm saline (42°C, 107°F) in 229 patients and with room-temperature saline in 233. Operators and patients were not blinded to saline temperature. The ease of calcium dissolution was subjectively scored (easy=1, intermediate=2, difficult=3). Procedure duration was recorded. Patient discomfort was assessed by using a visual analog scale (VAS). The occurrence of postprocedure bursitis was recorded. Statistical analyses were performed with Mann-Whitney U, χ2, and analysis of variance tests. Procedure duration was significantly shorter (P<.001) in patients treated with warm saline (mean, 576 seconds±121) than in those treated with room-temperature saline (mean, 777 seconds±151). Calcium dissolution was significantly easier in patients treated with warm saline (median score, 1) than in those treated with room-temperature saline (median score, 2). Subgroup analysis according to calcification appearance at US showed a significant difference between groups for both soft (P=.003) and hard (P<.001) calcifications. No overall significant differences were found for VAS score (warm saline group: baseline=8.9±0.6, 1 month=4.7±0.6, 2 months=4.0±0.7, 3 months=3.4±0.4, 1 year=3.0±0.7; room-temperature saline group: baseline=9.2±0.4, 1 month=4.5±0.7, 2 months=4.1±0.9, 3 months=3.1±0.7, 1 year=3.2±0.8; P=.491). Postprocedural bursitis was observed in eight patients in the warm saline group and 20 in the room-temperature saline group (P<.022). In the treatment of RCCT, warm saline appears to reduce procedure duration and improve calcification dissolution while reducing the frequency of postprocedural bursitis.

Calcific tendinitis of the rotator cuff associated with intraosseous loculation: Two case reports

The radiographic appearance of rotator cuff calcific tendinitis has been widely described in the literature.1,4,5,8,10 It is generally a benign, self-limiting condition, with soft tissue calcification noted in the rotator cuff on plain radiographs. Rarely however, the calcification can extend into the epiphyseal region, mimicking infection or tumor.

Shockwave therapy under ultrasonographic guidance in rotator cuff calcific tendinitis

Objectives. This is the first efficacy evaluation in patients with rotator cuff calcific tendinitis treated with shockwave therapy delivered using a dedicated extracorporeal lithotripter and ultrasonographic guidance. Patients and methods. Thirty-two patients with rotator cuff calcific tendinitis received shockwave therapy delivered using a lithotripter specifically designed for the musculoskeletal system (DORNIER EPOS ULTRA), under ultrasonography guidance (which is not part of the conventional procedure). The cumulative dose per patient was 1300 mJ/mm 2 divided in two or three sessions. Three, six, 12, and 24 weeks after treatment, the patients were evaluated using a visual analog scale for pain, the ASES self-questionnaire, Constant’s score, and plain radiographs. Results. Improvements in the pain and self-questionnaire scores were noted in 36.6% of patients after 12 weeks and 55.1% after 24 weeks. Plain radiographs were changed in 26.6% of patients after 12 weeks (with complete clearance of the calcific deposits in 6.6%) and in 24.1% of patients after 24 weeks (complete clearance in 17.2%). Conclusion. These results seem less favorable than those reported with dedicated lithotripters and computed tomography guidance.