Long-term evolution of calcific tendinitis of the rotator cuff: clinical and radiological evaluation 10 years after diagnosis

ZTE MRI improves detection of calcific deposits and differentiation between resorptive and formative phases in calcific tendinitis of shoulder

The purpose of study was to evaluate the diagnostic value of the ZTE sequence of shoulder MRI in patients with calcific tendinitis by comparing conventional sequences. Seventy-nine patients (43 patients with calcific tendinitis and 36 control group) who underwent both radiography and MRI including ZTE sequence were enrolled in our study. Two radiologists assessed the SNR, image quality, presence, size, multiplicity, shape, margin, signal intensity, composition, and location of calcific deposits on ZTE image, FSPDWI, and T2WI. The diagnostic performance was calculated with radiography as the standard of reference. The inter-reader agreement and differentiation of the resorptive phase and formative phase on ZTE were compared to that on FSPDWI and T2WI. A total 59 calcific deposits in 43 patients were found on radiography and classified into type 1 resorptive phases (n = 20) and type 2 formative phases (n = 39). ZTE image quality was for diagnostic use with substantial inter-reader agreement. Sensitivity and detection rate of ZTE image was better than those of FSPDWI and T2WI. The inter-reader agreement of ZTE image was equal to FSPDWI and better than T2WI. The features of calcific deposits on ZTE images were significantly different between two phases. In the resorptive phase, a greater percentage of calcific deposits showed irregular shapes, ill-defined margin, heterogeneous compositions on ZTE images. In conclusion, ZTE sequence may provide useful information for the diagnosis of calcific tendinitis of the shoulder.

Nurse practitioner applies extracorporeal shock wave therapy for patients with frozen shoulder: A randomized controlled trial

BACKGROUND

Nurse practitioners (NPs) have increasingly applied extracorporeal shockwave therapy (ESWT) to treat patients with frozen shoulders in acute care settings. However, the effectiveness of NPs using ESWT in patients has not yet been examined.

PURPOSE

To determine the efficacy of NP-led ESWT and identify optimal impulse dosages on pain and joint mobility in patients with frozen shoulders.

METHODOLOGY

A single-blind, randomized controlled trial including 52 patients with frozen shoulders was conducted. The patients were randomly allocated equally to a high-dose ESWT (H-ESWT) or a low-dose ESWT (L-ESWT). The visual analog scale evaluated patients' pain, and joint mobility was measured with the Constant-Murley score.

RESULTS

All groups significantly improved pain and joint mobility after the interventions. However, the H-ESWT group reported significantly lower pain than the L-ESWT groups only 4 and 8 weeks after intervention. In addition, the H-ESWT group showed a significantly higher improvement in joint mobility than the L-ESWT groups at pro-intervention, 1 and 2 weeks after intervention.

CONCLUSIONS

Nurse practitioners applied ESWT to treat patients with frozen shoulder, effectively improving pain and joint mobility. High-dose ESWT is superior to L-ESWT in symptom improvement. This study verified the care outcomes of NPs in caring for patients with frozen shoulders.

IMPLICATIONS

Nurse practitioners could be trained and implement ESWT to treat patients with frozen shoulder for symptom improvement. Health care organizations would empower or support NPs to perform the ESWT in clinical settings. Hospitals need to recognize and credit the care outcomes of NPs in caring for patients with frozen shoulders.

Clinical features in rotator cuff calcific tendinopathy: A scoping review

Introduction

The main goal of this scoping review is to highlight the clinical features of subjects with rotator cuff calcific tendinopathy (RCCT), in order to identify and map this condition clinical criteria, and thus to be able to hypothesize such pathology before imaging investigations.

Methods

Four databases were consulted up to January 2023. The obtained results were reported following the PRISMA-ScR and the Joanna Briggs Institute reviewer's manual was used as guideline for conducting the review. No time and geographical restrictions were applied.

Results

A total of 851 records have been identified, with 50 studies meeting the inclusion criteria. Subjects with RCCT mostly reported nightly, acute and severe pain with spontaneous onset. Symptoms were mostly unilateral. Subjects were mostly women aged between 30 and 60. Deficit in active and passive range of motion was reported, mainly during abduction and forward flexion. Endocrine and metabolic disorders were described as comorbidity, in particular diabetes and thyroid disorders.

Conclusion

In this scoping review, the most relevant RCCT clinical features were detected. These clinical criteria, predictive for shoulder RCCT, can be crucial to help all clinicians suspect this musculoskeletal disease early and with certainty, thus allowing for an appropriate and prompt diagnosis path.

Level of evidence

III.

Causal associations between 26 musculoskeletal disorders and gut microbiota: a Mendelian randomization analysis with Bayesian validation

Emerging evidence suggests that gut microbiota imbalances may influence the onset of musculoskeletal disorders (MSDs), yet conclusive evidence establishing causation remains limited. This study investigates the causal relationship between gut microbiota and a range of MSDs, aiming to identify potential therapeutic targets. Using data on 211 gut microbiome taxa from a genome-wide association study (GWAS) and summary statistics for 26 MSDs from the Finnish Biobank, we employed Mendelian randomization (MR) with inverse-variance weighting (IVW) as the primary analytical approach, complemented by Bayesian model validation to ensure robust results. Our MR analyses revealed significant causal associations between gut microbiota and nine MSDs within four categories, including osteoporosis (IVW-Beta = 0.011, P = 0.025), rheumatoid arthritis (IVW-Beta = - 0.016, P < 0.001), rotator cuff syndrome (IVW-Beta = - 0.007, P = 0.022), and calcific tendonitis of the shoulder (IVW-Beta = - 0.021, P = 0.034). Bayesian validation underscored the plausibility of these relationships, supporting the potential causal role of gut microbiota in the development of these disorders. Our findings present a library of causal associations that underscore the gut microbiome's role in MSD pathogenesis, providing genetic evidence that highlights specific gut microbiota taxa as prospective therapeutic targets. This research offers novel insights into the pathogenic mechanisms underlying MSDs and points toward new directions for future investigation into microbiome-based therapies.

[Calcific tendinitis]

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.

Arthroscopic Surgery Versus Nonoperative Treatment for Calcific Tendinitis of the Shoulder: A Retrospective Cohort Study

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.

Bibliometric and visual analysis of trends in tenosynovitis research from 1999 to 2021

BACKGROUND

Tenosynovitis is an acute or chronic inflammatory reaction of the tendon/tendon sheath. The purpose of this study is to summarize the current status, hotspots, and development trends in tenosynovitis related research.

METHODS

Data on tenosynovitis from 1999 to 2021 were identified from the Web of Science core collection (WoSCC) database and analyzed using bibliometric software. CiteSpace was utilized to identify the top 25 references with the strongest citation bursts, the top 25 keywords with the strongest citation bursts, the dual-map overlay of journals, and a timeline of keywords. VOSviewer was utilized to conduct co-citation, academic collaboration, and keyword analysis. Microsoft Excel was used to draw relevant charts.

RESULTS

A total of 4,740 publications were collected in this study. The United States ranked first in terms of the H-index, total citations, and total number of publications. The University of California System, University of London, and UDICE-French Research Universities were the major contributing institutions to tenosynovitis research. The Journal of Hand Surgery-American Volume, Skeletal Radiology, and American Journal of Sports Medicine were the main publishing channels for tenosynovitis-related articles. Moreover, Maffulli, N., Van der Helm-van Mil, Annette H.M., Ostergaard, M. were major contributing authors to tenosynovitis research. Finally, research on nonsurgical treatment for tenosynovitis appears to be a future hot spot.

CONCLUSION

Overall, the number of publications on tenosynovitis grew over the 1999-2021 period. Our study summarized the research status and global trends of tenosynovitis from multiple angles (i.e., countries, institutions, authors, publications). These considerations are helpful to better understand the research hotspots and development trends in the field.