CALCIFIC ROTATOR CUFF TENDINITIS:
215 PERCUTANEOUS TREATMENTS UNDER
SONOGRAPHIC-GUIDANCE IN 176 OUTPATIENTS

OVERVIEW TREATMENT ADVANTAGES OF REAL-TIME SONOGRAPHIC GUIDANCE MATERIAL AND METHOD TECHNIQUE RESULTS CONCLUSION REFERENCES TYPICAL CASE (with pictures) Télécharger le poster [3.8Mb]

OVERVIEW

Common painful condition of the shoulder

• Affecting up to 10% of individuals [22, 23]
• Asymptomatic calcification in controlateral shoulder : 34 % [1]
• Usually in women after the 4th decade
• Deposition of hydroxyapatite crystals
• Mostly in the supraspinatus tendon
• All calcifications larger than 1.5 cm produce symptoms at some time [5]
• Self-healing condition [16] : pain coincide with spontaneous resorption [25]
• Mean symptoms duration as long as 29 [9] and even 43 months [17]
• May be resistant to conservative treatment
• But : responds well to percutaneous needle treatment

TREATMENT

• Medical treatment
  • None gives uniformly acceptable results
• Shockwave lithotripsy [15]
  • Improvement in only 30%
• Pulsed Ultrasound
  • Only short term good results [8]
• Surgical treatment : open [16], arthroscopy [2, 17,21,24,27]
  • Long period of disability
  • Risk of reflex sympathetic dystrophy
  • Not as primary procedure
• Percutaneous needle aspiration
• Minimally invasive, effective therapy [18,20]
• Blind needle removal aspiration [13,14, 19]
• Fluoroscopy guidance : good results in 60-70 % [6, 7]
  • few happy customers due to pain [26]
  • 18% failure to identify the deposit [9, 17]
• Sonographic guidance
  • Less aggressive
  • Not widely used, only few reports :
    • 1995 2 cases , Farin [10]
    • 1995 12 cases, Bradley [3]
    • 1996 62 cases, Farin [12]
    • 2001 30 cases, Aina [1]

ADVANTAGES OF REAL-TIME SONOGRAPHIC GUIDANCE

• Precise localization of calcification, even tiny
• Relationship with tendons, bicipital groove, bony structures
• Most direct way to the target
• Excellent visualization of the needle tip
• Precise advancement of the needle into the calcification
• Minimal damage to tendon
• Identification of associated conditions : bursitis, tear (rare)
• No technical failure
• Non ionizing technique

MATERIAL AND METHOD

• Period : 6 years, May 1996 to May 2002
• US devices : Acuson 128 XP 10 and ATL HDI 5000, 7 MHz probe
• Patients :

Dorsal decubitus, arm along the body, internal rotation
Anesthesia (lidocaïne-adrenaline)
Insertion of a 18 Gauge needle attached to the syringe into the calcification
Lavage/aspiration with Lidocaïne/ NaCl
Infiltration with corticoïd (Diprophos®) in the subacromial bursa

Easy and less invasive than fluoroscopic guidance
Good results during our six years experience on 215 procedures
Should be more widely used.

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