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Delen M, Tayfur A, Gulle H, Birn-Jeffery A, Morrissey D. Which self-reported bio-psychosocial variables predict recovery in rotator cuff tendinopathy? An international prospective cohort study. Physiother Theory Pract 2025:1-14. [PMID: 40378170 DOI: 10.1080/09593985.2025.2502509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 05/01/2025] [Accepted: 05/01/2025] [Indexed: 05/18/2025]
Abstract
INTRODUCTION It is unclear what baseline factors predict recovery from rotator cuff (RC) tendinopathy, making evidence-based prognostic estimates difficult. The study aimed to identify predictors of RC tendinopathy recovery to guide clinical decision-making. METHODS People with RC tendinopathy were recruited to an international prospective cohort study. Participants completed a detailed baseline survey in which 41 plausible bio-psychosocial and demographic factors were measured. Recovery was established via the Global Rating of Change scale at monthly follow-ups for a year. Univariate and multivariate Cox proportional-hazards regression analyses were conducted to identify predictors and to build models. Model performance (internal validity) was evaluated using bootstrapping. RESULTS Seventy-three people with RC tendinopathy (43.9 ± 14.0 years; Shoulder Pain and Disability Index = 37.7 ± 24.4; 45 females) were recruited, providing 15,284 days at risk (208 ± 129 days). The recovery rate was 47%. Participants typically recovered around month seven. Being moderately active (hazard ratio (HR) = 2.23) and having higher health status (HR = 1.03) were associated with recovery. Demographic and shoulder severity variables did not improve the model performance nor individually predict recovery. The final model partially predicted recovery with near acceptable performance (optimism-corrected Harrell's C discrimination = 0.66 and Calibration Slope = 0.99). CONCLUSION The inadequate recovery rate in RC tendinopathy (under 50%) indicates a necessity for enhancements in treatment strategies for this condition. Demographic variables and shoulder pain severity are not useful factors to predict RC tendinopathy recovery. However, clinicians may consider assessing baseline health status and activity level to guide decision-making as these variables partially predict recovery. Strategies to include these factors in intervention development should be considered.
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Affiliation(s)
- Mehmet Delen
- Sport and Exercise Medicine, Queen Mary University of London, London, UK
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Türkiye
| | - Abdulhamit Tayfur
- Sport and Exercise Medicine, Queen Mary University of London, London, UK
- Orthopaedics Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Halime Gulle
- Sport and Exercise Medicine, Queen Mary University of London, London, UK
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Essex, UK
| | | | - Dylan Morrissey
- Sport and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
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Kim JH, Yang D, Lee JH. Quantitative Spatial Analysis on Radiographic Features of Rotator Cuff Calcifications: An Exploratory Study. Biomedicines 2025; 13:551. [PMID: 40149528 PMCID: PMC11939922 DOI: 10.3390/biomedicines13030551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 02/02/2025] [Accepted: 02/14/2025] [Indexed: 03/29/2025] Open
Abstract
Background/Objectives: Plain radiography is the primary diagnostic tool for calcific tendinitis of the shoulder. Several qualitative grading methods have been proposed to represent the pathophysiologic phase and guide treatment decisions. However, these methods have demonstrated low reliability, complicating their effectiveness for such purposes. This study aims to perform the first quantitative analysis of calcific lesions using radiographic imaging and explore their correlation with ultrasonographic parameters to enhance their diagnostic utility. Methods: A total of 57 shoulders presenting with painful calcific tendinitis in either the supraspinatus or subscapularis tendon were reviewed. The calcific deposits and tendon regions of interest were meticulously identified and annotated. Image brightness was reduced to 256 grayscale levels, and descriptive and heterogeneity parameters, including skewness, kurtosis, complexity, and entropy, were quantified and analyzed. Results: In the region of calcification, the average grayscale values were 21.69 units higher than those of tendon tissue. All spatial heterogeneity parameters, except for skewness, demonstrated statistically significant differences when compared with the adjacent tendon. Notably, entropy and complexity were the most distinctive features, with an area under the curve of 0.93 and cut-off values of 4.62 and 4.18, respectively. Significant correlations were observed between the heterogeneity parameters and ultrasonographic findings, such as bursal contact and peri-calcific hypoattenuation. Conclusions: Calcific deposits demonstrated not only increased brightness in grayscale levels but also distinct spatial heterogeneity. The correlation with ultrasonographic findings indicates that these heterogeneity parameters may reflect underlying pathophysiological characteristics. Future prospective research could explore the whole temporal changes of calcifications more thoroughly.
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Affiliation(s)
- Ju-Hyeon Kim
- Department of Physical Medicine and Rehabilitation, Kosin University Gospel Hospital, Busan 49267, Republic of Korea;
| | - Dahae Yang
- Department of Laboratory Medicine, Kosin University Gospel Hospital, Busan 49267, Republic of Korea;
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan 49267, Republic of Korea
| | - Jae-Hyun Lee
- Department of Physical Medicine and Rehabilitation, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
- Department of Artificial Intelligence Convergence, Pukyong National University, Busan 48513, Republic of Korea
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Forogh B, Karami A, Bagherzadeh Cham M. Effect of extracorporeal shock wave therapy and ultrasound-guided percutaneous lavage in reducing the pain of rotator cuff calcific tendinopathy; an updated systematic review and meta-analysis. J Orthop 2024; 56:151-160. [PMID: 38882231 PMCID: PMC11169081 DOI: 10.1016/j.jor.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/26/2024] [Indexed: 06/18/2024] Open
Abstract
Background Extracorporeal shockwave therapy (ESWT) and ultrasound-guided percutaneous lavage (UGPL or barbotage) are among those used to treat the pain of rotator cuff calcific tendinopathy (RCCT). This meta-analysis was done to review the effect ESWT and UGPL in reducing the pain of RCCT. Methods A comprehensive search was done based on the PRISMA. PubMed, Web of Science, Scopus, Cochrane Library and Google Scholar were reviewed for articles published by Feb 1, 2024, on ESWT vs. UGPL. The main keywords searched are as follows: "rotator cuff calcific tendinopathy", "tendinitis", " ESWT", " ultrasound-guided percutaneous lavage", " RCCT ″, " UGPL", " extracorporeal shock wave therapy" and titles or abstracts may contain one or a mix of these elements. This study was registered at PROSPERO with code" CRD42022385068". STATA version 13 was applied to analyze. Results In general, 779 patients from 22 studies were analyzed. The mean age was 51.85 ± 3.41 years. The patients were referred after 18.69 months of suffering from tendinopathy symptoms. Right-sided and supraspinatus locations were affected more. ESWT has been effective in a decrease of calcium deposit (-1.70 SMD after 1 week for ESWT, -0.96 SMD after 12 weeks for ESWT and -1.20 SMD after 12 weeks UPGL). ESWT has been effective in decreasing VAS by -4.32 SMD after 1 week while UPGL showed -0.23 SMD reductions in VAS After 1 week but in time >1 week, UPGL showed better effect by more reduction in VAS. ESWT has been effective in an increase of CMS by 1.60 SMD after 4-6 weeks, by 1.79 SMD after 12 weeks, by 2.44 SMD after 24 weeks, and 2.53 SMD after 48 weeks. Conclusion Based on the results, ultrasound-guided lavage is more effective in reducing pain than ESWT, and this effect becomes more evident in the long term. In terms of CMS score, over time, the efficiency of ESWT becomes more visible. In long-term follow-up, UPGL had a better effect on the calcium deposit reduction.
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Affiliation(s)
- Bijan Forogh
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Karami
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Bagherzadeh Cham
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Orthotics & Prosthetics Department, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
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Wang X, Jia S, Cui J, Xue X, Tian Z. Effect of extracorporeal shock wave combined with autologous platelet-rich plasma injection on rotator cuff calcific tendinitis: study protocol for a randomized controlled trial. Trials 2024; 25:616. [PMID: 39294797 PMCID: PMC11409635 DOI: 10.1186/s13063-024-08407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/16/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Rotator cuff calcific tendinitis (RCCT) is a common shoulder disease whose main symptoms include shoulder pain, limited mobility, and calcification deposits in the shoulder. Traditional treatment methods have certain limitations, so finding new treatment methods has become the focus of research. Extracorporeal shock wave (ESW) and platelet-rich plasma (PRP) treatments have attracted much attention due to their non-invasive and tissue repair-promoting properties; however, the efficacy of their combined treatment in RCCT remains unclear. METHODS This study is designed as a single-center, assessment-blind, randomized controlled clinical trial with three parallel groups. Sixty subjects will be recruited and randomly divided into the ESW group, PRP group, and ESW combined with PRP group, in a 1:1:1 ratio. The entire intervention period is 4 weeks, and the follow-up period is 4 weeks. Outcomes will be measured at baseline (T0), after 1 week of intervention (T1), after 2 weeks of intervention (T2), after 4 weeks of intervention (T3), and after an additional 4 weeks of follow-up period (T4). The primary endpoint is the VAS score. Secondary endpoints are ASES, CMS, UCLA, and the location and size of calcified areas. DISCUSSION This study aims to evaluate the efficacy of ESW therapy combined with PRP in treating RCCT. We compare the effects of single and combined treatments to explore their impact on disease symptoms, functional improvement, and calcification regression. This provides a scientific basis for identifying more effective treatment options. TRIAL REGISTRATION ClinicalTrials.gov NCT06372600. Registered on April 17, 2024; version 1.
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Affiliation(s)
- Xiaofang Wang
- Department of Rehabilitation Medicine (Jianhua), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Shuya Jia
- Department of Rehabilitation Medicine (Jianhua), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Jianhui Cui
- Department of Rehabilitation Medicine (Jianhua), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Xiali Xue
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Zhiguang Tian
- Department of Orthopedics, Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China.
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Verstraelen F, Bemelmans Y, Lambers Heerspink O, van der Steen M, Jong B, Jansen E, Schotanus M. Comparing midterm clinical outcome of surgical versus ultrasound guided needle aspiration of the calcific deposits for therapy resistant calcifying tendinitis of the shoulder. A comparative cohort study. J Orthop Sci 2024; 29:802-808. [PMID: 37080824 DOI: 10.1016/j.jos.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Comparing the midterm clinical outcome of surgical treatment versus ultrasound guided needle aspiration of the calcific deposits (NACD) treatment for conservative therapy resistant calcifying tendinitis (CT) of the shoulder. The hypothesis is that both surgical treatment and NACD treatment led to a comparable good clinical outcome. METHODS A comparative cohort study was performed (n = 76). The allocation to surgical group (n = 35) or NACD group (n = 41) was the result of a shared decision-making strategy. Primary outcome was decrease in VAS for pain (pVAS). Secondary outcomes were EQ-5D index, DASH score, ASES, VAS for satisfaction, recommendation of treatment, adverse events, cross-over between groups, additional treatments, and symptomatology after care as usual. RESULTS At midterm follow-up (5.5 years, SD 0.5 years) decrease in pVAS did not differ (p = 0.20) between two groups (60.6 mm, SD 23.3 mm vs 53.4 mm, SD 24.2 mm). Secondary clinical outcomes were also comparable. In 68.3% surgical treatment was avoided. At final follow-up none of the outcome scores differed significantly between the crossed-over patients (n = 13, 31.7%) and the initial surgical group. DISCUSSION At midterm follow-up surgical and NACD treatment result in comparable clinical outcomes. In 68.3% a surgical treatment could be avoided. In 31.7% the patient eventually needed a surgical treatment after failed NACD treatment. After midterm follow-up these patients showed comparable good clinical outcomes. In our opinion, both NACD and surgical treatment could be considered as a next step treatment option for conservative therapy resistant CT of the shoulder. Though, one should be aware that after a midterm follow-up a high number of patients cross-over to surgical treatment after a NACD treatment.
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Affiliation(s)
- Freek Verstraelen
- Zuyderland MC, Dr. H. van der Hoffplein 1, 6162 BG Sittard, the Netherlands; ZorgSaam Terneuzen, Wielingenlaan 2, 4535 PA Terneuzen, the Netherlands.
| | - Yoeri Bemelmans
- Zuyderland MC, Dr. H. van der Hoffplein 1, 6162 BG Sittard, the Netherlands
| | | | - Marieke van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima MC, PO box 90052, 5600 PD Eindhoven, the Netherlands
| | - Bob Jong
- Zuyderland MC, Dr. H. van der Hoffplein 1, 6162 BG Sittard, the Netherlands
| | - Edwin Jansen
- Zuyderland MC, Dr. H. van der Hoffplein 1, 6162 BG Sittard, the Netherlands
| | - Martijn Schotanus
- Zuyderland MC, Dr. H. van der Hoffplein 1, 6162 BG Sittard, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Science, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
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Sperr A, Erber B, Horng A, Glaser C. [Calcific tendinitis]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:125-133. [PMID: 37819397 DOI: 10.1007/s00117-023-01218-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
CLINICAL ISSUE Calcific tendinitis (TC) is a common-usually self-limiting-musculoskeletal disease, histopathologically characterized by both deposition and subsequent inflammatory breakdown of calcium crystals in tendons. The disease can cause acute, sometimes excruciating pain and restricted movement in the shoulder joint. Furthermore, 10-30% of patients have a complicated course of the disease. STANDARD RADIOLOGICAL METHODS Imaging-based assessment by X‑ray and ultrasound is required to establish the initial diagnosis and differential diagnosis as well as for follow-up. METHODOLOGICAL INNOVATIONS Magnetic resonance imaging (MRI) and, to a lesser degree, computed tomography (CT) complete the imaging work-up for establishing differential diagnoses and detecting complications. PRACTICAL RECOMMENDATIONS The combined evaluation of clinical symptoms and imaging findings is crucial to assess prognosis, plan therapy and detect potential complications. This article provides an overview of imaging-based morphology as related to the different stages of TC, relevant complications and potential pitfalls with respect to comorbidities and differential diagnoses.
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Affiliation(s)
- Andreas Sperr
- Klinik und Poliklinik für Radiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Bernd Erber
- Klinik und Poliklinik für Radiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
| | - Annie Horng
- RZM - Radiologisches Zentrum München, München, Deutschland
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Chen F, Deng Z, Liu Y, Chen R, Chen K, Xu J. Arthroscopic Surgery Versus Nonoperative Treatment for Calcific Tendinitis of the Shoulder: A Retrospective Cohort Study. Am J Sports Med 2024; 52:461-473. [PMID: 38426316 DOI: 10.1177/03635465231217733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Treatment options for calcific tendinitis (CT) of the shoulder remain controversial. A consensus for an operative indication for this condition is lacking. PURPOSE To compare nonoperative versus operative treatment for shoulder CT and analyze factors affecting the prognosis after treatment. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 180 patients diagnosed with symptomatic CT between January 2017 and September 2021 were evaluated in this retrospective cohort study. There were 103 patients treated nonoperatively at our institution, which included the use of nonsteroidal anti-inflammatory drugs, acupuncture, steroid injections, extracorporeal shock wave therapy, and ultrasound-guided needle aspiration/percutaneous irrigation. However, 77 patients were treated with arthroscopic surgery after 6 months of failed nonoperative treatment. The visual analog scale (VAS) for pain, the Constant-Murley score, and imaging were used to assess and evaluate outcomes. Descriptive data, functional outcomes, and imaging findings were compared between the operative and nonoperative groups before and after propensity score matching. Additionally, prognostic factors including calcium deposit size, tendon infiltration by calcium deposits, involvement of single or multiple tendons, and occurrence of rotator cuff tears were analyzed by comparing the groups to determine their effect on treatment options and recovery. RESULTS Magnetic resonance imaging showed that the supraspinatus tendon (66.7%) was most commonly involved, followed by the infraspinatus (42.8%) and subscapularis (21.1%) tendons. Tendon infiltration by calcium deposits was observed in 84.4% of the patients, and rotator cuff tears occurred in 30.0% of the patients. After propensity score matching, there was no significant difference in changes in the Constant-Murley score (48.1 ± 25.4 vs 49.0 ± 22.8, respectively; P = .950) and VAS score (4.9 ± 2.3 vs 4.5 ± 1.9, respectively; P = .860) between the operative and nonoperative groups at the final follow-up. However, for patients with shoulder CT and without rotator cuff tears, there was a significant difference in changes in the Constant-Murley score (52.93 ± 25.18 vs 42.13 ± 22.35, respectively; P = .012) and VAS score (5.21 ± 2.06 vs 3.81 ± 1.98, respectively; P < .001) between the operative and nonoperative groups, but the recovery time in the operative group was longer than that in the nonoperative group (86.92 ± 138.56 vs 30.42 ± 54.97 days, respectively; P = .016). The results also showed that calcium deposit size, involvement of multiple tendons, and tendon infiltration by calcium deposits did not affect the recovery time after treatment. The survival analysis showed that rotator cuff tears affected the complete recovery of shoulder function. CONCLUSION This study demonstrated no significant difference between nonoperative and operative treatment for patients with shoulder CT, on the whole. However, for patients with shoulder CT and without rotator cuff tears, the effect of operative treatment was better than that of nonoperative treatment; yet, operative treatment was shown to prolong the recovery time. Calcium deposit size, tendon infiltration by calcium deposits, and involvement of multiple tendons did not correlate with recovery time or the recovery of function. A rotator cuff tear was the only factor affecting the complete recovery of shoulder function.
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Affiliation(s)
- Fanglin Chen
- Department of Orthopaedics, Liuzhou Workers' Hospital/The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Zhenhan Deng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Liu
- Department of Sports Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Renqiang Chen
- Department of Orthopaedics, Liuzhou Workers' Hospital/The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Kenian Chen
- Department of Orthopaedics, Liuzhou Workers' Hospital/The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Jian Xu
- Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Mathews S, Rodriguez-Sein A, Pak G, Vu DM, Zelenko N, Opsha O. Calcific Peritendinitis in the Gluteus Maximus Tendon. J Emerg Med 2024; 66:225-228. [PMID: 38278683 DOI: 10.1016/j.jemermed.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/04/2023] [Accepted: 10/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Calcific tendinitis is classically a painful condition that most commonly affects the rotator cuff, but may infrequently involve other tendons. CASE REPORT We discuss a 57-year-old man who presented to the emergency department with a 4-day history of right hip pain, described as the "worst pain in (his) life." The pain was first noticed at night and had progressively worsened. History, physical examination, and initial laboratory workup indicated an inflammatory vs. infectious process. Continued investigations with imaging techniques revealed the source of pain as calcific tendinitis involving the gluteus maximus tendon. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Symptoms of musculoskeletal pain in the emergency department are ubiquitous. In the proper clinical context, the diagnosis of calcific tendinitis, although uncommon, should be considered once emergent conditions are ruled out. Proper imaging techniques will facilitate accurate diagnosis, expedited pain management, and proper outpatient follow-up.
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Affiliation(s)
- Shibin Mathews
- Department of Radiology, Maimonides Medical Center, Brooklyn, New York
| | | | - Gunnye Pak
- Department of Radiology, Maimonides Medical Center, Brooklyn, New York
| | - David M Vu
- Department of Radiology, Maimonides Medical Center, Brooklyn, New York
| | - Natalie Zelenko
- Department of Radiology, Maimonides Medical Center, Brooklyn, New York
| | - Oleg Opsha
- Department of Radiology, Maimonides Medical Center, Brooklyn, New York
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ten Hove FL, de Witte PB, Reijnierse M, Navas A. Needling and Lavage in Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Technique. JBJS Essent Surg Tech 2024; 14:e23.00029. [PMID: 38268769 PMCID: PMC10805427 DOI: 10.2106/jbjs.st.23.00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Background Rotator cuff calcific tendinitis (RCCT) is a commonly occurring disease, with a prevalence of up to 42.5% in patients with shoulder pain1,2. RCCT is characterized by hydroxyapatite deposits in the tendons of the rotator cuff and is considered a self-limiting disease that can be treated nonoperatively3. However, in a substantial group of patients, RCCT can have a very disabling and long-lasting course1,4, requiring additional treatment. Ultrasound-guided percutaneous needling and lavage (i.e., barbotage) is a safe and effective treatment option for RCCT5. In the present article, we focus on the 1-needle barbotage technique utilized in combination with an injection of corticosteroids in the subacromial bursa. Description It must be emphasized that symptomatic RCCT should be confirmed before barbotage is performed. Therefore, we recommend a diagnostic ultrasound and/or physical examination prior to the barbotage. Barbotage is performed under ultrasound guidance with the patient in the supine position. After sterile preparation and localization of the calcified deposit(s), local anesthesia in the soft tissue (10 mL lidocaine 1%) is administered. Next, the subacromial bursa is injected with 4 mL bupivacaine (5 mg/mL) and 1 mL methylprednisolone (40 mg/mL) with use of a 21G needle. The deposit(s) are then punctured with use of an 18G needle. When the tip of the needle is in the center of the deposit(s), they are flushed with a 0.9% saline solution and the dissolved calcium re-enters the syringe passively. This process is repeated several times until no more calcium enters the syringe. In the case of solid deposits, it may not be possible to aspirate calcium; if so, an attempt to fragment the deposits by repeated perforations, and thus promote resorption, can be made. Postoperatively, patients are instructed to take analgesics and to cool the shoulder. Alternatives RCTT can initially be treated nonoperatively with rest, nonsteroidal anti-inflammatory drugs, and/or physiotherapy3. If the initial nonoperative treatment fails, extracorporeal shockwave therapy (ESWT), corticosteroid injections, and/or barbotage can be considered8. In severe chronic recalcitrant cases, arthroscopic debridement and/or removal can be performed as a last resort. Rationale Both barbotage and ESWT result in a reduction of calcific deposits, as well as significant pain reduction and improvement of function8. No standard of care has been established until now; however, several prior meta-analyses concluded that barbotage is the most effective treatment option, with superior clinical outcomes after 1 to 2 years of follow-up9-11. No difference in complication rates has been reported between the various minimally invasive techniques. The purpose of barbotage is to stimulate the resorption process, which is promoted by the perforation of the deposits. Clinical outcomes are not associated with the success of the aspiration7,12. Patients with ≥1 larger deposit show greater improvement following barbotage than patients with small deposits12, in contrast with ESWT, in which larger deposits have been associated with worse outcomes. The inferior outcome of barbotage in patients with small deposits remains the subject of debate, but outcomes may be confounded by the fact that patients with smaller deposits might be less symptomatic at baseline and are therefore less likely to demonstrate improvement4. Expected Outcomes In the first weeks after barbotage, there is generally a substantial reduction in symptoms. Symptoms can recur at around 3 months, presumably because the effect of the corticosteroids is temporary5. After 6 months and 1 year, patients show substantial improvement in pain, shoulder function, and quality of life, with results superior to those shown for subacromial injections and ESWT9,10,13,14. At 5 years postoperatively, there are no significant differences in outcomes between barbotage and subacromial injections15. This may demonstrate a self-limiting course in the long term. Important Tips Good candidates for barbotage are those with RCCT who have ≥1 large calcific deposit.If a patient has a solid deposit, the physician can gently rotate and repeatedly puncture the deposit to promote disaggregation and fragmentation.Barbotage generally results in adequate pain relief and functional improvement even in patients in whom calcium deposits cannot be aspirated12. Acronyms and Abbreviations SAI = injection in the subacromial bursaNSAIDs = nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
| | - Pieter Bas de Witte
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ana Navas
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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10
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Kim SC, Kim HG, Park JH, Kim JS, Kim JI, Yoo JC. Arthroscopic Repair of Large Subscapularis Tear Over the First Facet. Am J Sports Med 2023; 51:3383-3392. [PMID: 37849244 DOI: 10.1177/03635465231203702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Long-term studies on arthroscopic repair of large subscapularis (SSC) tears over the first facet with or without supraspinatus (SSP) tear are limited. PURPOSE To assess the structural and clinical outcomes of arthroscopic repair of large SSC tears using magnetic resonance imaging (MRI) and identify the factors related to SSC retear and poor outcomes. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study involved 109 patients (84.0 ± 36.2 months of follow-up) who underwent arthroscopic repair of large SSC tears (Yoo and Rhee classification type III [n = 81] or IV [n = 28]) between 2011 and 2019. All patients underwent MRI at 6.1 ± 0.4 months after surgery, and 79 of 109 patients (72.5%) were followed up over 7 years. Clinical outcomes (active range of motion, functional scores, and belly press strength) and final poor clinical outcomes (reoperation, osteoarthritic change, and poor clinical outcome) were recorded. SSP tear size, rotator cuff atrophy and fatty infiltration (Goutallier classification), SSC tendon integrity (intact, intermediate, definite tear), and SSP tendon integrity (Sugaya classification) were evaluated by MRI. RESULTS The overall SSC retear rate was 8.3% (9/109) (type III, 2/81 [2.5%]; type IV, 7/28 [25.0%]; P < .001). SSC Goutallier grade 4 showed a higher retear rate than grade 3 (7/33 [21.2%] vs 2/33 [6.1%]; P = .149). A large SSP tear (in millimeters) (odds ratio [OR], 1.5; P = .003), SSC Goutallier grade 4 (OR, 10.8; P = .047), and SSP Goutallier grade 3 or 4 (OR, 0.02; P = .013) were independent factors for SSC retear. Clinical outcomes, except for external rotation, were poorer in patients with SSC retear than in those without retear. Final poor clinical outcomes were observed in 27 of 79 patients (34.2%); female sex (OR, 7.7; P = .007), SSC retear (OR, 8.2; P = .025), and SSP retear (OR, 4.7; P = .031) were independent factors. CONCLUSION Arthroscopic repair of large SSC tears has shown promising structural outcomes for type III tears but not type IV tears. SSC retear was affected by SSC atrophy, as well as SSP tear size and atrophy. Approximately one-third of the final poor clinical outcomes could be predicted, and SSC retear, SSP retear, and female sex were associated with long-term poor clinical outcomes, underscoring the importance of carefully selecting patients for arthroscopic repair of large SSC tears.
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Affiliation(s)
- Su Cheol Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Gon Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong Hun Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Soo Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji In Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Robinson DM, McInnis KC, Rhim HC, Tsitsilianos N. Lavage treatments for calcific rotator cuff tendinopathy. BMJ 2023; 383:2248. [PMID: 37821118 DOI: 10.1136/bmj.p2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- David M Robinson
- Department of Physical Medicine and Rehabilitation and Division of Sports Medicine, Mass General Brigham and Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
| | - Kelly C McInnis
- Department of Physical Medicine and Rehabilitation and Division of Sports Medicine, Mass General Brigham and Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
| | - Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Nicholas Tsitsilianos
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA, USA
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12
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Dong J, Zhang L, Jia H, Zhu Y, Xiang R, Li P. Effects of adjuvant application of corticosteroid and ozone after ultrasound-guided puncture and lavage for the treatment of rotator cuff calcific tendinitis: study protocol for a non-inferiority randomized controlled trial. Trials 2023; 24:375. [PMID: 37277813 DOI: 10.1186/s13063-023-07401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Steroid injection after percutaneous irrigation of calcific deposits is a common method for the treatment of rotator cuff calcific tendinitis (RCCT). However, steroids may prevent calcification resorption and cause potentially irreversible damage to tendons. Recent studies have confirmed the positive effects of ozone injection in shoulder tendinopathies, but no RCCTs have been reported. Thus, our study aims to evaluate the non-inferiority of ozone versus steroid injection. METHODS This is a prospective, randomized, parallel control and non-inferiority trial. A total of 100 patients with unilateral symptomatic RCCT will be enrolled and randomized in a 1:1 ratio to two groups: ultrasound-guided injection with ozone or corticosteroid. The primary outcome is the numeric rating scale for pain (NRS) at 1 week and 3 months following the procedure. Secondary outcomes include a multi-dimensional evaluation of shoulder disability and quality of life improvement, the degree of calcification absorption after treatment, and the number of multiple treatments. DISCUSSION The results of this study will provide short-term and long-term evidence for the effectiveness of ozone treatment in RCCT in relieving pain or improving shoulder function. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200063469. Registered on 7 September 2022.
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Affiliation(s)
- Jing Dong
- Department of Anesthesiology, Sichuan Provincial Orthopedic Hospital, No. 132 West First Section First Ring Road, Chengdu, China
| | - Lan Zhang
- Department of Anesthesiology, Sichuan Provincial Orthopedic Hospital, No. 132 West First Section First Ring Road, Chengdu, China
| | - Haibin Jia
- Department of Anesthesiology, Sichuan Provincial Orthopedic Hospital, No. 132 West First Section First Ring Road, Chengdu, China
| | - Yuanjiang Zhu
- Department of Anesthesiology, Sichuan Provincial Orthopedic Hospital, No. 132 West First Section First Ring Road, Chengdu, China
| | - Rui Xiang
- Department of Anesthesiology, Sichuan Provincial Orthopedic Hospital, No. 132 West First Section First Ring Road, Chengdu, China
| | - Peiyu Li
- Department of Anesthesiology, Sichuan Provincial Orthopedic Hospital, No. 132 West First Section First Ring Road, Chengdu, China.
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Janeiro J, Barreira S, Martins P, Sarmento M, Campos J, Fonseca JE. Ultrasound findings and prognosis of shoulder pain: A role for Doppler signal? JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:837-844. [PMID: 36715681 DOI: 10.1002/jcu.23436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 06/02/2023]
Abstract
PURPOSE To find ultrasound prognostic factors for shoulder pain. METHODS This was an observational, prospective study, comparing the evolution of ultrasound findings with clinical outcomes, in patients with shoulder pain. Data were collected in two appointments, from February 2018 to March 2021. Two-tailed non-parametric statistics were used, and p values <0.05 were considered significant. RESULTS A total of 79 participants were included in this study (median age 59 years, range 24-70, 61 women). A positive Doppler signal on tendons (p = 0.002) and absent tendon heterogeneity (p = 0.01) were associated with the patient's self-reported improvement. Tendon calcifications with poorly defined contours (p = 0.03) and sparse distribution (p = 0.001) were associated with VAS improvement. A reduction in the number of calcifications (p = 0.004), in the supraspinatus tendon thickness (p = 0.01), in subacromial effusions (p = 0.03), and in color Doppler grade (p = 0.02), between initial and follow-up exams, was found in patients with an improved DASH outcome. CONCLUSION A positive Doppler signal on shoulder tendons can be a marker for a better prognosis in shoulder pain. Poorly defined and sparsely distributed calcifications can also indicate a better course of the disease.
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Affiliation(s)
- João Janeiro
- Serviço de Imagiologia Geral, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Sofia Barreira
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Patrícia Martins
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Marco Sarmento
- Serviço de Ortopedia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Jorge Campos
- Serviço de Imagiologia Neurológica, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
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Mediators and Moderators of Education Plus Exercise on Perceived Improvement in Individuals With Gluteal Tendinopathy: An Exploratory Analysis of a 3-Arm Randomized Trial. J Orthop Sports Phys Ther 2022; 52:826-836. [PMID: 36306175 DOI: 10.2519/jospt.2022.11261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To investigate mediators and moderators of effects of an education-plus-exercise program compared to corticosteroid injections or wait and see on perceived improvement in individuals with gluteal tendinopathy. METHODS: Exploratory analysis from a clinical trial (n = 204) comparing education plus exercise, corticosteroid injection, and wait and see on global rating of change at 52 weeks. Potential mediators measured at baseline and 8 weeks were hip active abduction range, abductor muscle torque, pain self-efficacy, pain constancy, and patient-specific function. Potential moderators at baseline were Victorian Institute of Sport Assessment for gluteal tendinopathy, menopausal status, symptom duration, magnetic resonance imaging-determined tendon pathology, and pain catastrophizing. RESULTS: There is evidence from mediation analysis that the beneficial effect of education plus exercise on global rating of change relative to corticosteroid injection or wait and see may be due to changes in patient-specific function (indirect effect relative risk; 95% CI: 1.14 [1.05-1.29], 1.29 [1.12-1.58], respectively), pain constancy (1.12 [1.03-1.27], 1.2 [1.08-1.41]), and pain self-efficacy (1.1 [1.02-1.25], 1.18 [1.04-1.44])-not active hip movement/muscle torque. Moderation analysis did not support our included patient characteristics. CONCLUSION: Education plus exercise is likely to improve global rating of change for persons with gluteal tendinopathy relative to corticosteroid injection and wait and see through improvements in patient-specific function, pain self-efficacy, and reduced pain constancy. We found no evidence of differences in the effect of education plus exercise in patient subgroups based on disability, menopausal status, symptom duration, tendon pathology, or pain catastrophizing. J Orthop Sports Phys Ther 2022;52(12):826-836. Epub: 17 October 2022. doi:10.2519/jospt.2022.11261.
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Calcific Tendinopathy of the Shoulder: A Retrospective Comparison of Traditional Barbotage Versus Percutaneous Ultrasonic Barbotage. Clin J Sport Med 2022; 32:458-466. [PMID: 35533134 DOI: 10.1097/jsm.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to compare a traditional barbotage technique with percutaneous ultrasonic barbotage (PUB) for the treatment of rotator cuff (RC) calcific tendinopathy. DESIGN Three-year retrospective review. SETTING Participants aged 18 to 75 presenting at 2 highly specialized outpatient orthopedic referral centers with symptomatic RC calcific tendinopathy. PATIENTS There were 75 patients included (23 patients in the traditional barbotage group; 52 patients in the PUB group) with an average age of 55.3(6.5) and 55.9(9.8), respectively. There was no significant difference in demographics between groups. INTERVENTIONS Traditional barbotage or PUB. MAIN OUTCOME MEASURES Primary outcome measure was pain rated on the Numeric Pain Rating Scale (NPRS) with secondary outcomes investigating patient satisfaction. RESULTS The barbotage and PUB group demonstrated a significant improvement in pain (barbotage 2.4, P = 0.01; PUB = 2.6, P < 0.001) with no statistically significant difference between the 2 treatment modalities (95% CI: -1.8 to 2.2; P = 0.83, P = 0.83). Median follow-up for NPRS recordings was 17-weeks in the barbotage group and 8-weeks in the PUB group ( P = 0.004). Both groups demonstrated similar patient-reported satisfaction, without major complications. CONCLUSION The traditional barbotage and PUB procedures improved pain with a high patient satisfaction rate. LEVEL OF EVIDENCE Level III.
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Dong S, Li J, Zhao H, Zheng Y, Chen Y, Shen J, Yang H, Zhu J. Risk Factor Analysis for Predicting the Onset of Rotator Cuff Calcific Tendinitis Based on Artificial Intelligence. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8978878. [PMID: 35449743 PMCID: PMC9017518 DOI: 10.1155/2022/8978878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/31/2022] [Indexed: 12/19/2022]
Abstract
Background Symptomatic rotator cuff calcific tendinitis (RCCT) is a common shoulder disorder, and approaches combined with artificial intelligence greatly facilitate the development of clinical practice. Current scarce knowledge of the onset suggests that clinicians may need to explore this disease thoroughly. Methods Clinical data were retrospectively collected from subjects diagnosed with RCCT at our institution within the period 2008 to 2020. A standardized questionnaire related to shoulder symptoms was completed in all cases, and standardized radiographs of both shoulders were extracted using a human-computer interactive electronic medical system (EMS) to clarify the clinical diagnosis of symptomatic RCCT. Based on the exclusion of asymptomatic subjects, risk factors in the baseline characteristics significantly associated with the onset of symptomatic RCCT were assessed via stepwise logistic regression analysis. Results Of the 1,967 consecutive subjects referred to our academic institution for shoulder discomfort, 237 were diagnosed with symptomatic RCCT (12.05%). The proportion of women and the prevalence of clinical comorbidities were significantly higher in the RCCT cohort than those in the non-RCCT cohort. Stepwise logistic regression analysis confirmed that female gender, hyperlipidemia, diabetes mellitus, and hypothyroidism were independent risk factors for the entire cohort. Stratified by gender, the study found a partial overlap of risk factors contributing to morbidity in men and women. Diagnosis of hyperlipidemia, diabetes mellitus, and hypothyroidism in male cases and diabetes mellitus in female cases were significantly associated with symptomatic RCCT. Conclusion Independent predictors of symptomatic RCCT are female, hyperlipidemia, diabetes mellitus, and hypothyroidism. Men diagnosed with hyperlipidemia, diabetes mellitus, and hypothyroidism are at high risk for symptomatic RCCT, while more medical attention is required for women with diabetes mellitus. Artificial intelligence offers pioneering innovations in the diagnosis and treatment of musculoskeletal disorders, and careful assessment through individualized risk stratification can help predict onset and targeted early stage treatment.
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Affiliation(s)
- Shengtao Dong
- Department of Spine Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Jie Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Haozong Zhao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Yuanyuan Zheng
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Yaoning Chen
- Department of Spine Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Junxi Shen
- Department of Spine Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
| | - Hua Yang
- Department of Otolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian 116000, China
| | - Jieyang Zhu
- Department of Spine Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
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Vishal K, Arumugam A, Sole G, Jaya SS, Maiya AG. Sensory and motor profiles of the contralateral upper limb and neuroplastic changes in individuals with unilateral rotator cuff related shoulder pain – a systematic review protocol. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2044609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kavitha Vishal
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS–Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Sustainable Engineering Asset Management Research Group, RISE-Research Institute of Sciences and Engineering, University of Sharjah, Sharjah, United Arab Emirates
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Shetty Shrija Jaya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Arun G. Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Catapano M, Robinson DM, Schowalter S, McInnis KC. Clinical evaluation and management of calcific tendinopathy: an evidence-based review. J Osteopath Med 2022; 122:141-151. [PMID: 35119231 DOI: 10.1515/jom-2021-0213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/29/2021] [Indexed: 11/15/2022]
Abstract
Calcific tendinopathy (CT) is an important musculoskeletal condition most commonly seen in the shoulder girdle, accounting for 10-42% of all shoulder pain. Despite the high prevalence within the shoulder region, CT has been demonstrated in many tendons throughout the axial and appendicular skeleton. Unlike degenerative tendinopathies, CT appears to be a self-limiting condition that affects otherwise-healthy tendon with deposition of calcium hydroxyapatite crystals between healthy tenocytes. In patients with functionally limiting symptoms or pain, the clinical course may be accelerated through a multitude of treatments including physical therapy and pain management, extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage (UGPL), and operative debridement. Currently, the most efficacious and frequently utilized treatment for shoulder CT is UGPL due to its ability to effectively reduce calcium burden and pain while limiting soft-tissue damage. However, more evidence regarding the treatment and course of CT is needed before determining the most appropriate treatment at all potential sites of CT.
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Affiliation(s)
- Michael Catapano
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
| | - David M Robinson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
| | - Kelly C McInnis
- Department of Physical Medicine and Rehabilitation and Division of Sports Medicine, Massachusetts General Hospital and Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
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Compagnoni R, Menon A, Radaelli S, Lanzani F, Gallazzi MB, Tassi A, Randelli PS. Long-term evolution of calcific tendinitis of the rotator cuff: clinical and radiological evaluation 10 years after diagnosis. J Orthop Traumatol 2021; 22:42. [PMID: 34698958 PMCID: PMC8548447 DOI: 10.1186/s10195-021-00604-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Calcific tendinitis of the shoulder has a tendon involvement that could evolve to rotator cuff tear and shoulder osteoarthritis. This study aimed to evaluate the prevalence of glenohumeral osteoarthritis and rotator cuff tears in patients affected by calcific tendinitis at a minimum follow-up of 10 years after diagnosis. METHODS Patients diagnosed with calcific tendinitis of the shoulder with a minimum follow-up of 10 years were contacted and invited for a clinical and radiological evaluation. Information on the demographics, affected and dominant side, bilateral shoulder pain, type of treatment, habits, systemic or musculoskeletal diseases, reoperation of the index shoulder, and subjective satisfaction was collected. The clinical evaluation was performed using Constant-Murley score (CMS), American Shoulder and Elbow Surgeons Score (ASES), and numerical rating scale (NRS); isometric strength in forwarding flexion and abduction was also measured. Each patient also underwent an ultrasound examination to evaluate rotator cuff tendon integrity and a shoulder radiograph to evaluate osteoarthritis. RESULTS Seventy-nine patients were available for a phone interview, and 35 agreed to be examined. The mean age was 58.89 (± 7.9) years at follow-up. The prevalence of glenohumeral osteoarthritis was 17.14% in the study population, with significant progression in 14.29% of the cases, without rotator cuff full-thickness tears. x-Ray examination showed residual calcifications in 31 patients, with a mean diameter of 5.54 mm. In 30 cases, there was a reduction of the diameter; in 4 cases, the calcification increased in size; and in 1 case, the size did not change. The mean ASES score was 74.1 (± 22.7) in the group with calcifications larger than 2 mm and 89.4 (± 8.2) in patients with smaller calcifications (p = 0.08) without correlation with the type of treatment performed. CONCLUSIONS Calcific tendinitis is a self-resolving disease without rotator cuff tears at long-term follow-up or degenerative glenohumeral progression. LEVEL OF EVIDENCE 3, cohort study.
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Affiliation(s)
- Riccardo Compagnoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1a Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1a Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Simone Radaelli
- U.O.C. Week Surgery di Ortopedia e Traumatologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Francesco Lanzani
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1a Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Mauro B. Gallazzi
- U.O.C. Radiodiagnostica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alberto Tassi
- U.O.C. Week Surgery di Ortopedia e Traumatologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Pietro S. Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1a Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
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Robinson DM, Schowalter S, McInnis KC. Update on Evaluation and Management of Calcific Tendinopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00317-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kim SC, Lee SM, Park GT, Jang MC, Yoo JC. Ultrasound-guided needle decompression and steroid injection for calcific tendinitis of the shoulder: risk factors for repeat procedures and outcome analysis. Clin Shoulder Elb 2021; 24:55-65. [PMID: 34078012 PMCID: PMC8181847 DOI: 10.5397/cise.2021.00101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background Although ultrasound-guided needle decompression (US-GND) can treat calcific tendinitis of the shoulder effectively, repeat procedures might be required for unresolved symptoms. We evaluated the overall clinical outcomes of US-GND with subacromial steroid injection and the final results and factors predisposing toward repeat procedures. Methods Ninety-eight patients who underwent US-GND for calcific tendinitis of the supraspinatus/infraspinatus were analyzed between March 2017 and December 2018. The clinical outcomes (pain visual analog scale, functional visual analog scale [FVAS], and American Shoulder and Elbow Surgeons [ASES] score) and final subjective satisfaction were compared between groups A (single US-GND) and B (repeat US-GND). The factors predisposing toward repeated US-GNDs were analyzed. Results We found that 59.3% (58/98) of patient ASES scores were ≥80, and 73.5% of patients (72/98) were satisfied with the outcome. Group B (n=14) demonstrated a significantly higher rate of dominant-arm involvement compared to group A (78.6% vs. 48.8%, p=0.046). However, initial calcification size, shape, number, density, subscapularis involvement, lavage, and procedure time did not differ significantly between the groups. Group B showed poorer final FVAS (7 [interquartile range, 6–8] vs. 8 [interquartile range, 7–9], p=0.036) and subjective satisfaction compared to group A (satisfied: 5 [35.7%] vs. 67 [79.8%], p<0.001]. Conclusions US-GND with subacromial steroid injection is a viable treatment option for calcific tendinitis of the shoulder. Dominant-arm involvement was the only independent factor for repeated US-GND. Final outcome of repeated US-GND for unimproved patients was promising; however, these outcomes were poor compared to those of the patients who improved after the first procedure.
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Affiliation(s)
- Su Cheol Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gun Tae Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Chang Jang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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22
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Yoo YS, Park JY, Kim MS, Cho NS, Lee YB, Cho SH, Park KJ, Cho CH, Lee BG, Shin DJ, Kim HH, Lim TK. Calcific tendinitis of the shoulder in the Korean population: demographics and its relation with coexisting rotator cuff tear. Clin Shoulder Elb 2021; 24:21-26. [PMID: 33652508 PMCID: PMC7943381 DOI: 10.5397/cise.2020.00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 12/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background To evaluate the demographics, clinical and radiographic features of calcific tendinitis of the shoulder in the Korean population, specifically focusing on the incidence of coexisting rotator cuff tear. Methods Between October 2014 and January 2015, we performed a prospective multicenter study with 506 patients from 11 training hospitals in Korea. We collected data of demographics and radiographic analysis based on simple radiographs, clinical assessments based on visual analog scale (VAS) and the American Shoulder Elbow Surgeons (ASES) score, and treatment modalities that are used currently. We also evaluated coexisting rotator cuff tear by ultrasonography (US) or magnetic resonance imaging (MRI) images. Results There were 402 female patients (79%) with mean age of 55 years (range, 31–87 years). Mean duration of symptoms was 16 months. Mean size of calcific materials was 11.4 mm (range, 0–35 mm). Mean value of VAS and ASES scores were 6.5 (range, 1–10) and 47 (range, 8–95), respectively. Of 383 patients (76%), 59 (15%) had rotator cuff tear including 15 full-thickness tears on US or MRI. Patients with rotator cuff tears were significantly associated with older age, recurrent symptoms, menstrual disorders in females, and having undergone calcification removal surgery and rotator cuff repair (all p<0.05). Conclusions This study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in Korean population, which were not different from those of Western population. Coexisting rotator cuff tear was found with 15% incidence in this large series, suggesting that further radiographic study to evaluate rotator cuff tear might be needed in some calcific tendinitis patients of older age and presenting with recurrent symptoms.
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Affiliation(s)
- Yon-Sik Yoo
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jin-Young Park
- Global Center for Shoulder, Elbow and Sports at Neon Orthopaedic Clinic, Seoul, Korea
| | - Myung-Sun Kim
- Department of Orthopaedics, Chonnam National University College of Medicine, Gwangju, Korea
| | - Nam-Su Cho
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Yong-Beom Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | | | | | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Bong Gun Lee
- Department of Orthopaedics, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Joo Shin
- Department of Orthopaedics, Daegu Fatima Hospital, Daegu, Korea
| | - Han-Hoon Kim
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Tae Kang Lim
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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23
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Dumoulin N, Cormier G, Varin S, Coiffier G, Albert JD, Le Goff B, Darrieutort-Laffite C. Factors Associated With Clinical Improvement and the Disappearance of Calcifications After Ultrasound-Guided Percutaneous Lavage of Rotator Cuff Calcific Tendinopathy: A Post Hoc Analysis of a Randomized Controlled Trial. Am J Sports Med 2021; 49:883-891. [PMID: 33719606 DOI: 10.1177/0363546521992359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Calcific tendinitis of the rotator cuff is a frequent cause of shoulder pain. Ultrasound-guided percutaneous lavage (UGPL) is an effective treatment, but factors associated with good clinical and radiological outcomes still need to be identified. PURPOSE To study the clinical, procedural, and radiological characteristics associated with improved shoulder function and the disappearance of calcification on radiograph after UGPL. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This is a post hoc analysis of the CALCECHO trial, a double-blinded randomized controlled trial conducted on 132 patients. The trial assessed the effect of corticosteroid injections after UGPL, and patients were randomly assigned to receive either corticosteroid or saline solution in the subacromial bursa. We analyzed all patients included in the randomized controlled trial as 1 cohort. We collected the patients' clinical, procedural, and radiological characteristics at baseline and during follow-up (3, 6, and 12 months). Univariable analysis, followed by multivariable stepwise regression through forward elimination, was performed to identify the factors associated with clinical success (Disabilities of the Arm, Shoulder and Hand [DASH] score <15) or the disappearance of calcification. RESULTS Good clinical outcomes at 3 months were associated with steroid injections after the procedure (odd ratio [OR], 3.143; 95% CI, 1.105-8.94). At 6 months, good clinical evolution was associated with a lower DASH score at 3 months (OR, 0.92; 95% CI, 0.890-0.956) and calcium extraction (OR, 10.7; 95% CI, 1.791-63.927). A lower DASH at 6 months was also associated with a long-term favorable outcome at 12 months (OR, 0.939; 95% CI, 0.912-0.966). Disappearance of calcification at 3 and 12 months occurred more frequently in patients in whom communication was created between the calcification and the subacromial bursa during the procedure (OR, 2.728 [95% CI, 1.194-6.234] at 3 months; OR, 9.835 [95% CI, 1.977-48.931] at 12 months). Importantly, an association between calcification resorption and good clinical outcome was found at each time point. CONCLUSION Assessing patients at 3 months seems to be an essential part of their management strategy. Calcium extraction and creating a communication between the calcific deposits and subacromial bursa are procedural characteristics associated with good clinical and radiological evolution.
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Oudelaar BW, Huis In 't Veld R, Ooms EM, Schepers-Bok R, Nelissen RGHH, Vochteloo AJH. Efficacy of Adjuvant Application of Platelet-Rich Plasma After Needle Aspiration of Calcific Deposits for the Treatment of Rotator Cuff Calcific Tendinitis: A Double-Blinded, Randomized Controlled Trial With 2-Year Follow-up. Am J Sports Med 2021; 49:873-882. [PMID: 33566629 DOI: 10.1177/0363546520987579] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Needle aspiration of calcific deposits (NACD) is a frequently used treatment for rotator cuff calcific tendinitis (RCCT). However, a substantial number of patients experience recurrent or persisting shoulder symptoms after NACD. PURPOSE To compare the effects of adjuvant application of platelet-rich plasma (PRP) after NACD (NACP+PRP) with those of conventional NACD with corticosteroids (NACD+corticosteroids) on pain, shoulder function, and quality of life (QoL). STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS In a single-center, double-blinded, randomized controlled trial, 80 adults with symptomatic RCCT were randomly allocated to receive NACD+corticosteroids or NACD+PRP. Pain, shoulder function, and QoL were assessed at baseline; 6 weeks; and 3, 6, 12, and 24 months after treatment using a numeric rating scale for pain (NRS); the Constant-Murley score (CMS); the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH); the Oxford Shoulder Score (OSS); and the EuroQol 5-dimension scale (EQ-5D). Additionally, resorption of calcific deposits and the integrity of rotator cuff tendons were assessed by using standard radiographs and ultrasound examination, respectively. The results were analyzed using noninferiority analysis for NRS scores and a mixed model for repeated measures. RESULTS Eighty patients were included (48 female; mean age, 49 ± 6 years; 41 patients in the NACD+PRP group). Both groups showed improvement of clinical scores at the 2-year follow-up (P < .001 for all clinical scores). NACD+PRP was found to be noninferior to NACD+corticosteroids with regard to the mean decrease of NRS scores (4.34 vs 3.56; P = .003). Mixed-model analysis showed a significant difference in favor of NACD+PRP (CMS, P < .001; DASH, P = .002; OSS, P = .010; EQ-5D, P < .001). However, clinically relevant differences in favor of NACD+PRP were only seen at the 6-month follow-up for NRS and CMS scores, whereas at the 6-week follow-up a clinically relevant difference in favor of NACD+corticosteroids was found for all clinical scores except for the NRS. Full resorption of calcific deposits was present in 84% of the NACD+PRP group compared with 66% in the NACD+corticosteroids group (P = .081). In the NACD+PRP group, 10 (24%) patients required a second NACD procedure compared with 19 (49%) patients in the NACD+corticosteroids group (P = .036). Six complications, of which 5 were frozen shoulders, occurred in the NACD+PRP group compared with 1 complication in the NACD+corticosteroids group (P = .11). CONCLUSION NACD+PRP resulted in worse clinical scores at the 6-week follow-up but better clinical scores at the 6-month follow-up compared with NACD+corticosteroids. At the 1- and 2-year follow-ups, the results were comparable between groups. Furthermore, PRP seemed to reduce the need for additional treatments but was associated with more complications. In conclusion, NACD+corticosteroids had a favorable early effect on pain and function combined with low comorbidity. Thus, it remains the treatment of choice for patients with RCCT. REGISTRATION NCT02173743 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Bart W Oudelaar
- Centre for Orthopaedic Surgery OCON, Hengelo, the Netherlands
| | | | - Edwin M Ooms
- Centre for Orthopaedic Surgery OCON, Hengelo, the Netherlands
| | | | - Rob G H H Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
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Ji JH, Kim JH. Is common the rotator cuff tear in the calcific tendinitis? Clin Shoulder Elb 2021; 24:1-3. [PMID: 33652504 PMCID: PMC7943384 DOI: 10.5397/cise.2021.00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jae-Hoon Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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Furuhata R, Matsumura N, Yoshiyama A, Kamata Y, Takahashi M, Morioka H. Seasonal variation in the onset of acute calcific tendinitis of rotator cuff. BMC Musculoskelet Disord 2020; 21:741. [PMID: 33183291 PMCID: PMC7659130 DOI: 10.1186/s12891-020-03773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Calcific tendinitis of the rotator cuff is a disorder that causes acute onset of shoulder pain when spontaneous resorption of the calcification occurs. However, factors that trigger calcium resorption have not been clarified. The present study aimed to investigate the association between the onset of calcium resorption in calcific tendinitis and the season of onset. Methods We retrospectively reviewed 195 patients (female, 116; male, 79; mean age, 62.6 ± 14.2 years; median age, 62 [52, 73] years) diagnosed with the postcalcification stage of calcific tendinitis, which was defined as acute calcific tendinitis in this study, between 2006 and 2018. The onset date of acute calcific tendinitis for each patient was collected from clinical notes. We evaluated the incidence of acute calcific tendinitis in each season and month. Furthermore, we investigated the correlation between the incidence of acute calcific tendinitis and the mean monthly temperature or humidity levels for each year. Results The most common season of acute calcific tendinitis onset was summer (35.4%), followed by spring (24.6%), autumn (24.1%), and winter (15.9%) (P = 0.002). Monthly analyses showed the highest peak of onset was in July (15.4%) and the lowest peak was in February (3.1%) (P = 0.022). The incidence of acute calcific tendinitis had a weak association with mean monthly temperature (R2 = 0.066; P = 0.001) but was not associated with mean monthly humidity levels (R2 = 0.018; P = 0.099). Conclusions This study provides new information on seasonal variation of acute calcific tendinitis onset. The results of this study indicated that the onset of calcium resorption occurs most frequently in the summer in Japan; however, the reasons for seasonal variation remain unclear, and further studies will be needed. Level of evidence Level III. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03773-6.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Akira Yoshiyama
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Yusaku Kamata
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Masaaki Takahashi
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
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Ultrasound-guided percutaneous irrigation of calcific tendinopathy: redefining predictors of treatment outcome. Eur Radiol 2020; 31:2634-2643. [PMID: 33040221 DOI: 10.1007/s00330-020-07334-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/19/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To identify prognostic factors affecting the clinical outcome in patients treated with rotator cuff ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT), by evaluating the degree of calcium removal, the size and consistency of calcific deposits, and baseline level of shoulder pain and functionality. METHODS From January 2017 to December 2019, 79 patients (23 males, 56 females; mean age, 45.7 years) who underwent US-PICT were prospectively enrolled. The calcifications' location, consistency, and size were evaluated. For US-PICT, local anesthesia, lavage of calcific material, and intrabursal steroid injection were performed. The degree of calcium removal was graded as total/partial. Shoulder pain and functionality were assessed with the visual analogue scale (VAS) in all and Constant score (CS) in a subset of patients, respectively, at 4 time-points. Mann-Whitney U test, Fisher's test, and linear and binary logistic regression were utilized for analysis. RESULTS Pain improvement correlated with the presence of larger calcifications and lower baseline VAS score, at 1 week (p = 0.001, p < 0.001, respectively) and 1 year (p < 0.001, p = 0.002, respectively). Improved functionality correlated with total calcification retrieval, higher baseline CS, and fluid/soft calcific consistency at 1 week (p = 0.013, p = 0.003, p = 0.019, respectively). Increased calcification size, cystic appearance, and lower baseline VAS scores independently predicted complete pain resolution at 1 year. CONCLUSION Large calcifications and low-grade pain at baseline correlated with short- and long-term pain improvement. The degree of calcium removal did not impact pain or functional improvement beyond 1 week. Increased calcification size, cystic appearance, and low-grade baseline pain predicted complete pain recovery at 1 year. KEY POINTS • The presence of larger calcifications and lower-grade baseline pain appear to correlate with pain improvement at 1 week and 1 year after ultrasound-guided irrigation of rotator cuff calcific tendinopathy (US-PICT). • Total calcification retrieval, less affected baseline shoulder functionality, and presence of fluid/soft consistency of calcific deposits appear to correlate with improved shoulder functionality at 1 week post-treatment. • Baseline pain intensity and calcifications' morphologic characteristics, but not the degree of calcium retrieval, represent predictors of complete pain recovery at 1 year after US-PICT.
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Oudelaar BW, Huis In 't Veld R, Schepers-Bok R, Ooms EM, Nelissen RGHH, Vochteloo AJH. Prognostic factors for the outcome of needle aspiration of calcific deposits for rotator cuff calcific tendinitis. Eur Radiol 2020; 30:4082-4090. [PMID: 32140816 PMCID: PMC7305078 DOI: 10.1007/s00330-020-06669-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/23/2019] [Accepted: 01/22/2020] [Indexed: 01/01/2023]
Abstract
Objective To identify prognostic factors for the effectiveness of needle aspiration of calcific deposits (NACD) for rotator cuff calcific tendinitis (RCCT) Methods One hundred forty-nine patients with symptomatic RCCT were included in a prospective cohort study. Pain (VAS), shoulder function (SST and DASH), and quality of life (EQ-5D) were assessed at baseline and at 3, 6, and 12 months post-NACD. Univariate analyses (independent t tests or Mann-Whitney U tests depending on the distribution of data) were performed to build a multivariable linear regression model. Stepwise regression analysis through backward elimination was performed to evaluate the effect of predefined prognostic factors on the outcome. Results Patients who underwent multiple NACD procedures had less reduction of pain (p < 0.01). Furthermore, a larger reduction in VAS pain scores at 3 months post-NACD was associated with a larger reduction in VAS pain scores at 12 months (p < 0.01). More improvement of SST and DASH scores at 3 months was associated with better SST, DASH, and EQ-5D scores at 12 months (p < 0.01). Smaller-size calcific deposits were associated with less improvement of DASH (p = 0.03) and EQ-5D scores (p = 0.01). A longer duration of symptoms prior to NACD was associated with less improvement of EQ-5D scores (p = 0.01). Conclusions A good initial response after NACD is associated with better outcomes at 12 months. Patients with a longer duration of symptoms prior to NACD and patients who require multiple procedures showed inferior outcomes in terms of pain reduction and improvement of quality of life. Smaller-size calcific deposits are associated with a less favorable outcome of shoulder function and quality of life scores and might therefore be less susceptible for NACD. Key Points • A good initial response to NACD is associated with a better outcome in the longer term. • A longer duration of symptoms and the need for multiple NACD procedures are associated with inferior outcomes. • Smaller-size calcific deposits seem less susceptible for NACD. Electronic supplementary material The online version of this article (10.1007/s00330-020-06669-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bart W Oudelaar
- Centre for Orthopaedic Surgery OCON, Geerdinksweg 141, P.O. Box 546, 7550 AM, Hengelo, The Netherlands.
| | - Rianne Huis In 't Veld
- Centre for Orthopaedic Surgery OCON, Geerdinksweg 141, P.O. Box 546, 7550 AM, Hengelo, The Netherlands
| | | | - Edwin M Ooms
- Centre for Orthopaedic Surgery OCON, Geerdinksweg 141, P.O. Box 546, 7550 AM, Hengelo, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Anne J H Vochteloo
- Centre for Orthopaedic Surgery OCON, Geerdinksweg 141, P.O. Box 546, 7550 AM, Hengelo, The Netherlands
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29
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Pakos E, Gkiatas I, Rakkas G, Papadopoulos D, Gelalis I, Vekris M, Korompilias A. Calcific deposit needling in combination with extracorporeal shock wave therapy (ESWT): A proposed treatment for supraspinatus calcified tendinopathy. SICOT J 2018; 4:45. [PMID: 30339523 PMCID: PMC6195344 DOI: 10.1051/sicotj/2018043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/10/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Calcified tendinopathy of the rotator cuff is one of the most common conditions concerning the shoulder pathology. It is characterized by a reactive calcification that affects the tendons being part of the rotator cuff. The reported prevalence varies from 2.7% to 22%. Most of the patients can be treated effectively with non-operative measures such as anti-inflammatory drugs, subacromial injection of steroid, physiotherapy, extracorporeal shock wave therapy (ESWT) and needle aspiration irrigation. Results of a treatment combining some of these methods have not been reported. Objectives: The purpose of this study is to present the radiological as well as the clinical results of our proposed protocol which combines drilling of the calcium deposits with xylocaine under ultrasound guidance, with a specific program of physiotherapy for 1 month without the use of NSAIDs. Methods: Sixty-six consecutive patients (68 shoulders) were treated for calcified tendinitis of supraspinatus, which was diagnosed clinically and radiologically, with needle drilling using xylocaine under ultrasound guidance. After the drilling the patient followed a physiotherapy protocol with ESWT which included five visits within a month. After the end of the physiotherapy, the patients were evaluated clinically and radiologically. The Visual Analogue Scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were measured before and after the end of the therapy. Results: All the patients showed clinical improvement of the symptoms at the follow-up. The mean VAS score showed improvement from 8.1 to 3.3 whereas the mean DASH score was 27 and after the end of the therapy 5. Radiologically all but one calcific deposits were disappeared. Conclusions: The ultrasound-guided drilling of the calcific deposit using xylocaine, in combination with physiotherapy using ESWT provides a reliable alternative treatment for the calcific tendinitis of the supraspinatus
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Affiliation(s)
- Emilios Pakos
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
| | - Ioannis Gkiatas
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
| | | | | | - Ioannis Gelalis
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
| | - Marios Vekris
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
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30
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de Witte PB, Kolk A, Overes F, Nelissen RGHH, Reijnierse M. Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Needling and Lavage Versus Subacromial Corticosteroids: Five-Year Outcomes of a Randomized Controlled Trial. Am J Sports Med 2017; 45:3305-3314. [PMID: 28898104 DOI: 10.1177/0363546517721686] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Barbotage (needling and lavage) is often applied in the treatment of calcific tendinitis of the rotator cuff (RCCT). In a previously published randomized controlled trial, we reported superior clinical and radiological 1-year outcomes for barbotage combined with a corticosteroid injection in the subacromial bursa (SAIC) compared with an isolated SAIC. There are no trials with a midterm or long-term follow-up of barbotage available. PURPOSE To compare the 5-year results of 2 regularly applied treatments of RCCT: ultrasound (US)-guided barbotage combined with a SAIC (group 1) versus an isolated US-guided SAIC (group 2). STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients were randomly assigned to group 1 or 2 and evaluated before and after treatment at regular time points until 12 months and also at 5 years using the Constant score (CS), the Western Ontario Rotator Cuff Index (WORC), and the Disabilities of the Arm, Shoulder and Hand (DASH). The calcification location and size and Gärtner classification were assessed on radiographs. The rotator cuff condition was evaluated with US. Results were analyzed using t tests, linear regression, and a mixed model for repeated measures. RESULTS Forty-eight patients were included (mean age, 52.0 ± 7.3 years; 25 [52%] female) with a mean baseline CS of 68.7 ± 11.9. After a mean follow-up of 5.1 ± 0.5 years, the mean CS was 90 (95% CI, 83.0-95.9) in group 1 versus 87 (95% CI, 80.5-93.5) in group 2 ( P = .58). The mean improvement in the CS in group 1 was 18 (95% CI, 12.3-23.0) versus 21 (95% CI, 16.2-26.2) in group 2 ( P = .32). There was total resorption in 62% of group 1 and 73% of group 2 ( P = .45). The US evaluation of the rotator cuff condition showed no significant differences between the groups. With the mixed model for repeated measures, taking into account the baseline CS and Gärtner classification, the mean treatment effect for barbotage was 6 (95% CI, -8.9 to 21.5), but without statistical significance. Follow-up scores were significantly associated with baseline scores and the duration of follow-up. Results for the DASH and WORC were similar. There were no significant complications, but 4 patients in group 1 and 16 in group 2 underwent additional treatment during the follow-up period ( P < .001). CONCLUSION No more significant differences were found in the clinical and radiological outcomes between barbotage combined with a SAIC versus an isolated SAIC after 5 years of follow-up. Registration: NTR2282 (Dutch Trial Registry).
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Affiliation(s)
- Pieter Bas de Witte
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjen Kolk
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Ferdinand Overes
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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31
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Koca TT, Arslan A, Özdemir F, Acet G. Clinical features of patients diagnosed with degenerative rotator cuff tendon disease: a 6-month prospective-definitive clinical study from turkey. J Phys Ther Sci 2017; 29:1433-1437. [PMID: 28878478 PMCID: PMC5574353 DOI: 10.1589/jpts.29.1433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/26/2017] [Indexed: 01/28/2023] Open
Abstract
[Purpose] In rotator cuff tendon disease (RCTD), anamnesis is as important as clinical
findings and anatomic/radio diagnostic examination. This study aimed to investigate the
clinical features of patients diagnosed with RCTD using clinical and radiological methods
between March 2015 and August 2015 at Malatya Research and Training Hospital Physical
Medicine and Rehabilitation department. [Subjects and Methods] The study included 178
patients who were diagnosed with RCTD (128 females and 50 males). A questionnaire
comprising 33 questions was given to each patient. [Results] Eighty-eight of the patients
(49.9%) had an involvement on their right side, eighty-four (47.1%) had an involvement on
their left side, and 6 had bilateral involvement. Mean visual analog scale (VAS) score was
found to be statistically significant in favor of female patients. A statistically
significant correlation was found between educational status and VAS. The body mass index
(BMI) of the female patients was found to be higher than that of the male patients.
Statistically significant correlation between doing risky work and gender showed that
males were at a higher risk. [Conclusion] RCDT is more seen in people who have high BMI
and are at their 50s. Pain complaint and BMI were found higher in female patients. DM,
thyroid and cardiac diseases were seen more in the patients who are diagnosed with RCTD
relative to the healthy population.
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Affiliation(s)
- Tuba Tülay Koca
- Physical Medicine and Rehabilitation Clinic, Research and Training Hospital, Turkey
| | - Aydın Arslan
- Orthopedics and Traumatology Clinic, Research and Training Hospital, Turkey
| | - Filiz Özdemir
- Department of Physical Medicine and Rehabilitation, Inonu University, Turkey
| | - Günseli Acet
- Physical Medicine and Rehabilitation Clinic, Research and Training Hospital, Turkey
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Slobodin G, Rosner I. Enthesis as a target organ in rheumatic diseases: an expanding frontier. Clin Rheumatol 2017; 36:2163-2165. [PMID: 28718044 DOI: 10.1007/s10067-017-3749-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, Technion, 37, Golomb St, 38041, Haifa, Israel.
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, Technion, 37, Golomb St, 38041, Haifa, Israel
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