Evaluation and Nonsurgical Management of Rotator Cuff Calcific Tendinopathy

Greis, Ari C.; Derrington, Stephen M.; McAuliffe, Matthew

doi:10.1016/j.ocl.2014.11.011

Cited by 48 publications

(38 citation statements)

References 45 publications

(58 reference statements)

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“…When symptomatic, calcific tendinopathy can be treated with different approaches. Oral nonsteroidal anti-inflammatory drugs may be used to control low-grade symptoms, whereas extracorporeal shockwave therapy, surgery, or image-guided procedures can be used in advanced cases (35)(36)(37). Since its first description by Bradley et al in 1995 (15), US-guided percutaneous irrigation of calcific tendinopathy has been reported in several studies with slight variations among them (12,13).…”

Section: Treatment Results and Follow-upmentioning

confidence: 99%

Rotator Cuff Calcific Tendinopathy: Randomized Comparison of US-guided Percutaneous Treatments by Using One or Two Needles

Orlandi¹,

Mauri²,

Lacelli

et al. 2017

Radiology

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Purpose To determine whether the use of one or two needles influences procedure performance and patient outcomes for ultrasonography (US)-guided percutaneous irrigation of calcific tendinopathy. Materials and Methods Institutional review board approval and written informed patient consent were obtained. From February 2012 to December 2014, 211 patients (77 men and 134 women; mean age, 41.6 years ± 11.6; range, 24-69 years) with painful calcific tendinopathy diagnosed at US were prospectively enrolled and randomized. Operators subjectively graded calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous irrigation of calcific tendinopathy (local anesthesia, needle lavage, intrabursal steroid injection) was performed in 100 patients by using the single-needle procedure and in 111 patients by using the double-needle procedure. Calcium dissolution was subjectively scored (easy = 1; intermediate = 2; difficult = 3). Procedure duration was recorded. Clinical evaluation was performed by using the Constant score up to 1 year after the procedure. The occurrence of postprocedural bursitis was recorded. Mann-Whitney U, χ, and analysis of variance statistics were used. Results No difference in procedure duration was seen overall (P = .060). Procedure duration was shorter with the double-needle procedure in hard calcifications (P < .001) and with the single-needle procedure in fluid calcifications (P = .024). Ease of calcium dissolution was not different between single- and double-needle procedures, both overall and when considering calcification appearance (P > .089). No clinical differences were found (Constant scores for single-needle group: baseline, 55 ± 7; 1 month, 69 ± 7; 3 month, 90 ± 5; 1 year, 92 ± 4; double-needle group: 57 ± 6; 71 ± 9; 89 ± 7; 92 ± 4, respectively; P = .241). In the single-needle group, nine of 100 cases (9%) of postprocedural bursitis were seen, whereas four of 111 cases (3.6%) were seen in the double-needle group (P = .180). Conclusion The only difference between using the single- or double-needle procedure when performing US-guided percutaneous irrigation of calcific tendinopathy is procedure duration in hard and fluid calcifications. Clinical outcomes are similar up to 1 year. RSNA, 2017.

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Section: Treatment Results and Follow-upmentioning

confidence: 99%

Rotator Cuff Calcific Tendinopathy: Randomized Comparison of US-guided Percutaneous Treatments by Using One or Two Needles

Orlandi¹,

Mauri²,

Lacelli

et al. 2017

Radiology

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“…Calcific Tendinitis.-Calcific tendinitis is a dynamic process characterized by calcium hydroxyapatite crystal deposition that most commonly affects the RC in patients aged 30-50 years (60). Although the exact pathogenesis of this condition remains unknown, it is probably multifactorial-likely being related to degeneration, reactive change, predisposing medical conditions, and genetics (60).…”

Section: Partial-thickness Rc Tear-partial-thicknessmentioning

confidence: 99%

Comprehensive Shoulder US Examination: A Standardized Approach with Multimodality Correlation for Common Shoulder Disease

Lee¹,

Sheehan²,

Orwin³

et al. 2016

RadioGraphics

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1Shoulder pain is one of the most common musculoskeletal conditions encountered in primary care and specialty orthopedic clinic settings. Although magnetic resonance (MR) imaging is typically the modality of choice for evaluating the soft-tissue structures of the shoulder, ultrasonography (US) is becoming an important complementary imaging tool in the evaluation of superficial softtissue structures such as the rotator cuff, subacromial-subdeltoid bursa, and biceps tendon. The advantages of US driving its recent increased use include low cost, accessibility, and capability for realtime high-resolution imaging that enables dynamic assessment and needle guidance. As more radiologists are considering incorporating shoulder US into their practices, the development of a standardized approach to performing shoulder US should be a priority to facilitate the delivery of high-quality patient care. Familiarity with and comfort in performing a standardized shoulder US examination, as well as knowledge of the types of anomalies that can be evaluated well with US, will enhance the expertise of those working in musculoskeletal radiology practices and add value in the form of increased patient and health care provider satisfaction. This review describes the utility and benefits of shoulder US as a tool that complements MR imaging in the assessment of shoulder pain. A standardized approach to the shoulder US examination is also described, with a review of the basic technique of this examination, normal anatomy of the shoulder, common indications for shoulder US, and characteristic US findings of common shoulder diseases-with select MR imaging and arthroscopic correlation. Abbreviations: AC = acromioclavicular, IST = infraspinatus tendon, LHBT = long head of the biceps tendon, RC = rotator cuff, SASD = subacromial-subdeltoid, SST = supraspinatus tendon, SubST = subscapularis tendon

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“…Where necessary, for biggest deposits, one more needle was used to support needling or lavage. Once the washing phase was completed, one of the two needles was extracted from the shoulder and the other needle was slightly pulled out to place the tip into the subacromial/subdeltoid bursa and 1 ml of methylprednisolone acetate (40 mg ml 21 Depo-Medrol, Pfizer, New York, NY) was injected under direct ultrasound guidance. Finally, ultrasound examination was performed after the procedure to detect any potential immediate complication (abnormal bleeding, tendon ruptures etc.)…”

Section: Ultrasound-guided Proceduresmentioning

confidence: 99%

“…2,20 Ultrasound-guided needle aspiration and lavage techniques can remove calcium deposit and provide long-term improvement in pain and function in these patients. 21 The technique is based on shared mainstay; however, several technical features were independently introduced and can make the difference. [22][23][24] The adjunct of ultrasound-guided needling and lavage to ultrasoundguided corticosteroid injection in the subacromial/subdeltoid bursa was demonstrated to significantly improve clinical and radiographic outcomes at 1 year.…”

mentioning

confidence: 99%

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

Bazzocchi

Pelotti

Serraino

et al. 2016

BJR

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Objective: Rotator cuff calcific tendinitis (RCCT) is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. Between non-surgical and surgical treatment options, today a few minimal invasive techniques are available to remove the calcific deposit, and they represent a cornerstone in the management of this painful clinical condition. The aim of the work was a retrospective evaluation of double-needle ultrasoundguided percutaneous fragmentation and lavage (DNL), focused on understanding the factors which are of major importance in determining a quick and good response at 1 month. Methods: A series of 147 patients affected by RCCT and suitable for DNL were evaluated. A systematic review of anamnestic, clinical and imaging data was performed in 144 shoulders treated in a single-centre setting. Clinical reports and imaging examinations were revisited. The inclusion criteria were submission to DNL, therefore fitness for the percutaneous procedure, and following 1-month follow-up. There was no exclusion owing to risk of bias. The treatment was defined as successful for constant shoulder modified score (CSS) improvement of .50% at 1 month. Results: In 70% of shoulders, the treatment resulted in a quick and significant reduction of symptoms (successful). On the whole, CSS increase at 1 month was estimated at 91.5 6 69.1%. CSS variations were significantly related to age of patients (better results between 30 and 40 years old), calcification size (more relevant improvement for middle-sized calcifications, 12-17 mm), sonographic and radiographic features of calcific deposits (softer calcifications) and thickening of subacromial/subdeltoid bursa walls. In the final model of stepwise regression for CSS variation, ultrasound score pre-treatment and posttreatment, the distance between bursa and calcification before treatment and the size of post-treatment calcification area were shown to be independently correlated to success. Numeric rating scale score for pain showed similar results. Pain at admission was also related to age, calcification size, ultrasound and Gärtner score, power Doppler positivity, bursal wall thickening and biceps tenosynovitis. Conclusion: The success of the procedure with quick improvement in function and symptoms is warranted in soft and middle-sized calcifications, in young adults. Advances in knowledge: Ultrasound-guided percutaneous procedures for RCCT must be safe, effective and with prompt pain relief and function restoration. This study shows which clinical picture is more favourable to this purpose and actual prognostic factors for DNL (soft and middle-sized calcifications, in young adults, are more favourable). INTRODUCTIONRotator cuff calcific tendinitis (RCCT) is a common condition, occurring in up to 20% of painful shoulders and even present in up to 7.5% of asymptomatic shoulders.

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Evaluation and Nonsurgical Management of Rotator Cuff Calcific Tendinopathy

Cited by 48 publications

References 45 publications

Rotator Cuff Calcific Tendinopathy: Randomized Comparison of US-guided Percutaneous Treatments by Using One or Two Needles

Rotator Cuff Calcific Tendinopathy: Randomized Comparison of US-guided Percutaneous Treatments by Using One or Two Needles

Comprehensive Shoulder US Examination: A Standardized Approach with Multimodality Correlation for Common Shoulder Disease

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

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