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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 2002 June;38(2):65-72


language: English

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.

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