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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
A Journal on Physical Medicine and Rehabilitation after Pathological Events
Official Journal of the , , , ,
In association with
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Europa Medicophysica 2002 June;38(2):65-72
A clinical and diagnostic approach to calcific tendinitis of the shoulder using fine needle aspiration and ultrasound-guided fragmentation
Siliotto R., Giacomoni P., Dalla Nora S., Ortolani M.
From the Physiatrics and Rehabilitation Service
*Radiology Service, Ospedale S. Camillo, Trento
**University of Padua and Autonomous Orthopedic Rehabilitation Service, Azienda Ospedaliera di Padova
Background. The aim of this study was to evaluate the clinical manoeuvres and instrumental tests required for a correct diagnosis of calcific tendinitis and to present the US-guided technique of aspiration and fragmentation of symptomatic calcifications in the supraspinous tendon.
Methods. Between January 1997 and February 2001, 133 patients aged between 26 and 79 years old with a clinical and instrumental diagnosis of supraspinous calcific tendinitis with chronic pain underwent US-guided percutaneous treatment using a single needle technique. The dimensions of calcifications ranged from 6 mm to 33 mm and, after US-guided puncture, their consistency was soft in 36 patients and hard in 97 patients. During the physical examination, all patients complained of chronic pain, especially nocturnal pain associated with reduced articular excursion; positive results were always obtained using the manoeuvres described by Neer, Hawkins and Jobe. The selection criteria for treatment included chronic pain and functional limitation of the arm, the size of calcifications (>6 mm) and the integrity of the supraspinous tendon: due to onset of pain, not linked to other causes, such as adhesive capsulitis; lack of results from conservative treatment using physiotherapy. All patients underwent a physical examination and control X-ray and ultrasonography one day, eight days and two months after treatment; 16 patients were controlled after an interval of 19-28 months and 31 patients were also examined approximately four years later. All patients underwent a physical examination and control radiological and ultrasonographic imaging one day, eight days and two months after treatment.
Results. Treatment resulted in the remission of pain and functional limitation in 77 out of 133 patients (58%); 38 patients (28.5%) reported the remission of pain and a residual deficit in joint excursion only in the last degrees of movement; 14 patients (10.5%) presented slight residual pain associated with articular deficit in abduction and extension; 4 patients (3%) showed no significant improvement. The disappearance of the calcifications was confirmed by radiographic controls in 71 patients (53.5%); a significant volumetric reduction (60-90%) in the size of calcifications was documented in 44 patients (33%); the reduction of calcification was not very marked (20-60%) in 16 patients (12%); the reduction in the volume of calcifications was regarded as not significant in 2 patients (1.5%). No patient presented an onset of subsequent calcifications in the site of intervention at controls performed as much as 4 years later.
Conclusions. In the light of the results obtained, we affirm that percutaneous treatment with fragmentation and US-guided aspiration is indicated as the treatment of first resort in cases of supraspinous calcific tendinitis that have failed to respond to medical treatment, owing to mini-invasive nature, excellent efficacy and easy reproducibility.