Role of Radiographs and Ultrasound in Diagnosing Calcific Tendinitis and Periarthritis in the Wrist and Hand with Ultrasound-Guided Barbotage as Management Tool

Aim  To demonstrate the role of radiographs and ultrasound (USG) in the diagnosis of calcific tendinitis and periarthritis in the wrist and hand and the efficacy of USG-guided barbotage for its management. Materials and Methods  A retrospective chart review was performed in six patients who presented with acute-onset pain in the wrist and hand varying from 3 days to 2 weeks. Four patients had tenderness over pisiform and two patients had pain along the lateral aspect of the wrist and thumb. Radiographs and USG revealed calcific focus corresponding to the site of pain. USG-guided calcific barbotage and injection was performed for the same and pain relief was assessed immediately and through telephonic follow-up at 6 months using subjective satisfaction score. Data were analyzed using Microsoft Excel 2013. Results  Four patients with tenderness over pisiform had flexor carpi ulnaris calcific tendinitis and two patients with pain along the lateral aspect of the wrist and thumb had first metacarpophalangeal calcific periarthritis and abductor pollicis brevis calcific tendinitis on radiographs as well as USG. In post-USG-guided calcific barbotage and injection, all patients had significant immediate and 6 months delayed relief in symptoms with excellent satisfaction scores. Conclusion  Acute calcific tendinitis/periarthritis is a benign and self-limiting inflammatory condition. Radiographs are extremely helpful in identifying calcific focus. Ultrasonography in experienced hands is the best modality to identify, confirm the symptomatic calcific focus, and perform USG-guided intervention. USG-guided calcific barbotage is the simplest, quickest, and effective way to treat this condition and avoid compromised functional capacity.

[Clinical observation of warm acupuncture combined with yoga posture method in the treatment of periarthritis with frozen period]

OBJECTIVE

To observe the clinical efficacy of warm acupuncture combined with yoga posture method in the treatment of periarthritis with frozen period.

METHODS

Ninety patients with periarthritis who met the inclusion criteria were randomly divided into a control group 1, a control group 2 and an observation group, 30 cases in each group. Warm acupuncture was applied in the control group 1 (Jianzhen (SI 9), Jianyu (LI 15), Jianliao (TE 14), etc were selected), yoga posture method was applied in the control group 2, warm acupuncture combined with yoga posture method were given in the observation group, the treatment was given once a day, 10 times as a course with 2 days between courses and continuous for 2 courses. After 2 courses of treatment, the shoulder joint pain score and shoulder function grading were used to evaluate the clinical efficacy, and the clinical efficacy was observed.

RESULTS

①The pain scores of the three groups were significantly lower after treatment (all P<0.01), and scores in the observation group was better than that in the control group 1 and the control group 2 (P<0.05, P<0.01). There was no significant difference between the control group 1 and the control group 2 (P>0.05). ②After treatment, the functional classification of shoulder joints were significantly improved in the three groups (all P<0.01), and the functional classification of shoulder joint in the observation group and the control group 2 were better than that in the control group 1 (P<0.01, P<0.05). There was no significant difference between the observation group and the control group 2 (P>0.05). ③After 2 courses of treatment, the effective rate of the observation group was 86.7% (26/30), which was better than 70.0% (21/30) in the control group 1 and 76.7% (23/30) in the control group 2 (both P<0.05).

CONCLUSION

Warm acupuncture combined with yoga posture method can effectively relieve shoulder pain and improve dysfunction. The clinical comprehensive effect is better than simple acupuncture and yoga posture method.

[Acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) combined with local exercise for periarthritis]

OBJECTIVE

To compare the effect difference between acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) combined with local exercise and acupuncture.

METHODS

Sixty patients with periarthritis were randomly divided into an acupuncture group and an acupuncture combined with exercise group (active acupuncture group), 30 cases in each group. Acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) was given in both groups. The active shoulder joint during acupuncture was applied in the active acupuncture group. The treatment was given once every two days, 5 times as one course and a total of 2 courses were required. The activity-related pain (VAS score), shoulder joint activity (Melle score), and daily living ability (ADL score) were observed before and after treatment in the two groups.

RESULTS

The VAS score, Melle score and ADL score were significantly lower in the two groups after treatment compared with those before treatment (all P<0.05); the VAS score, Melle score, and ADL score in the active acupuncture group were lower than those in the acupuncture group (all P<0.05).

CONCLUSION

The curative effect of acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) combined with local exercise on periarthritis is superior to that of acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) alone.

Chronic calcific periarthritis of the elbow treated by cimetidine administration: Five cases

Calcific periarthritis or calcific tendinitis occurs most frequently in the shoulder and rarely in the elbow. Cimetidine was previously reported to be effective for chronic calcific periarthritis of the shoulder. Here, we present five patients with chronic calcific periarthritis of the elbow treated by administration of cimetidine; there were six affected elbows in these five patients. Although all patients had been treated with nonsteroidal anti-inflammatory drugs for at least 3 months, their symptoms were not relieved. All patients took oral administration of cimetidine 400 mg daily. The pain was completely relieved in an average of 1.8 months after the administration of cimetidine, and the calcification of the elbow disappeared in an average of 5.1 months. During the follow-up period, there were no symptoms suggesting a recurrence. Although the detailed mechanism of action of cimetidine on periarticular calcifications remains to be understood, cimetidine appears to be a potential therapeutic agent for chronic calcific periarthritis.

[Local injection therapy of damage of paraarticular tissue]

AIM

To evaluate the potential of local injection therapy with Alflutop in management of paraarticular tissue lesions (PTL).

MATERIAL AND METHODS

44 patients with various localization of PTL were examined and exposed to treatment.

RESULTS

As a result of local therapy with Alflutop, the majority of patients with PTL experienced a decrease in pain syndrome and an increase in the functional capabilities. There was no negative dynamic of symptoms.

CONCLUSION

Treatment with Alflutop was well tolerated by patients, easily applied, had a small number of side effects and was accompanied by a pronounced clinical effect.

Acute calcium deposits in the hand and wrist; comparison of acute calcium peritendinitis and acute calcium periarthritis

Acute calcium deposits are characterized by acute pain and a radiographic finding of amorphous calcification. A prospective, observational study was carried out on 30 consecutive patients undergoing conservative treatment for acute calcium deposits of the hand and wrist. Thirteen patients presented with acute calcific peritendinitis (Group A), and the other 17 with acute calcific periarthritis (Group B). All patients were followed for more than 12 months (mean 29 months). The average age at onset and recurrence rate of acute calcific peritendinitis were both significantly greater than for acute calcific periarthritis.

Acute calcific periarthritis of proximal interphalangeal joint in a professional golfer 's hand

This report describes a 22-yr-old professional golfer with acute calcific periarthritis of the proximal interphalangeal joint of the 4th finger. We considered that the major cause for this condition may be the repeated minor traumas to the affected site. Also, since this condition is self-limiting, a correct diagnosis is required to avoid unnecessary tests and surgery.