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Calcific rotator cuff tendinitis : 215 percutaneous treatments under sonographic-guidance in 176 outpatients

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.

1.  

   • Aina R., Cardinal E., Bureau J.N., et al. Calcific shoulder tendinitis : treatment with modified US-guided fine needle technique. Radiology 2001 ; 221 : 455-461
   • Ark J.W., Flock T.J., Ftatow E.L., Bigliani L.U., Arthroscopic treatment of calcific tendinitis of the shoulder. Arthroscopy 1992, 8 : 183-188
   • Bradley M., Bahmra M.S., Robson M.J. Ultrasound guided aspiration of symptomatic supraspinatus calcific deposits. BJR 1995, 68: 716-719
   • Chiou H.J., Chou Y.H., Wu J.J., Huang T.F., Ma H.L., Hsu C.C. The role of high-resolution ultrasonography in management of calcifications of the rotator cuff. Ultrasound Med Biol 2001; 27 (6): 735-743
   • Codman E.A. The pathology of the subacromial bursa. In : The shoulder. Boston : Thomas Todd, 1934 : 68
   • Comfort T.H., Ruben P., Arafiles M.D. Barbotage of the shoulder with image intensified fluoroscopic control of needle placement for calcific tendinitis. Clin orthop 1978 ; 135 : 171-178.
   • Duvauferrier R., Berland M.C., Buhe T.H. Percutaneous extraction of rotator cuff calcifications. Diagn Intervent Radiol 1990 ; 2 : 101-105.
   • Ebenbichler G.R., Erdogmus CB., Resch KL., Funovics MA., Kainberger F. Ultrasound therapy for calcific tendinitis of the shoulder. N Engl J Med 1999 . 340 (20): 1533-8
   • Ellman H., Bigliani L.U., Flatow E. and al. Arthroscopic treatment of calcifying tendinitis. The american experience. 5th international conference on shoulder surgery. Paris 1992
   • Farin P.U., Jaroma H. Rotator cuff calcifications : treatment with US-guided technique. Radiology 1995 ; 195 : 841-843
   • Farin P.U. Consistency of rotator-cuff calcifications. Observations on plain radiography, sonography, computed tomography and at needle treatment. Investigative Radiology 1996. 31 (5): 300-304
   • Farin P.U., Räsänen H., Jaroma H., Harju A. Rotator cuff calcifications : treatment with ultrasound-guided percutaneous needle aspiration and lavage. Skeletal Radiol 1996, 25: 551-554
   • Flint J-M. Acute traumatic subdeltoïd bursites. A new and simple treatment. JAMA, 1913, 60 :1224-28
   • Harmon P.H., Methods and results in the treatment of 2580 painful shoulders with special reference to calcific tendinitis and the frozen shoulder. Am J Surg 1958; 95 : 527-544
   • Loew M., Jurgowski W., Mau H.C. and Thomsen M. Treatment of calcifying tendinitis of rotator cuff by extracorporeal shock waves: A preliminary report. J Shoulder Elbow Surg. 1995; 4 (2): 101-105.
   • McLaughlin H.E. The selection of calcium deposits for operation: the technique and resultant operations. Surg Clin N Am 1963; 43: l501.
   • Moke-Nancy D., Walch G., Kemp I.F. and al. Arthroscopic treatment of calcifying tendinitis. Results of the multicentric european study. 5th international conference on shoulder surgery. Paris 1992
   • Normandin C., Seban E., Laredo J.D. et al . Aspiration of tendinous calcific deposits. In : Bard M., Laredo J.D., eds. Interventional radiology in bone and joints. New York, NY. Springer Verlag 1988 ; 270-285.
   • Patterson R.L., Darrach W. Treatment of acute bursitis by needle irrigation. J. bone Joint Surg. 1937; 19: 993-1002
   • Pfister J., Gerber H. Treatment of calcific humero-scapular periarthropathy using needlle irrigation of the shoulder : retrospective study. Z Orthop Ihre Grenzgeb 1994; 132 : 300-305
   • Rochwerger A., Franceschi J.P., Viton J.M., Roux H., Mattei J.P. Surgical management of calcific tendinitis of the shoulder: an analysis of 26 cases. Clinical Rheumatology 1999 ; 18 (4): 313-316
   • Rowe C.R. Calcific tendinitis. AAOS Instr. Course Lect.;196, St. Louis, CV Mosby, 1985.
   • Simon W.H. Soft tissue disorders of the shoulder : frozen shoulder, calcific tendinitis and bicipital tendinitis. Orthop Clin North Am 1975 ; 6 : 521-539
   • Snyder S.J., Eppley R.A., Brewster S. Arthroscopic removal of subacromial calcification. J Arthroscopy 1991; 7 : 332
   • Uhthoff H.K. Sarkar K. Calcifying tendinitis: its pathogenetic mecanism and a rationale for its treatment. Int Orthop 1978;2: 187-93
   • Weber. S.,C., Arthroscopic treatment of calcific tendinitis AANA 17th Annual fall course Palm Desert 1998
   • Wittenberg H., Rubenthaler F., Wolk T. Chronic calcifying tendinitis of the shoulder : prospective randomized surgical treatments. J Arthroscopy 1998 : 14 : 454