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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2013 March;172(3):211-8


language: English

Is calcifing tendinitis of shoulder best treated with ultrasound guided percutaneous needling as first line approach? A Case report

Di Lorenzo L. 1, 2, Forte A. M. 3, Forte F. 3, Corbisiero A. 1, Foti C. 2, Pappagallo M. 4

1 Rehabilitation with Sport Medicine Unit RUMMO Hospital DEA II Livello, Benevento, Italy; 2 University of Rome, Policlinico Tor Vergata, Rome, Italy; 3 CE.FI.SA Gruppo Forte Rehabilitation Grismed.it, Salerno, Italy; 4 Department of Biotechnology Sciences, La Sapienza University, Rome, Italy; 5 Pain Management and Medical Mentoring, New York, NY, USA


Calcification tendinitis of shoulder is a common condition with characteristic clinical and radiological findings. It is a self limited condition along years and rehabilitation advices are essentials. First line therapies include physical therapy, ultrasound, local and systemic application of NAISDs and percutaneous needle aspiration. Extra corporeal shock wave therapy has been recommended as conjunct or second-line therapy, and there is enough evidence of its effectiveness as a treatment option before surgery. Our patient, a 45 years old non professional tennis player Caucasian female, suffered for a painful calcification tendinitis of supraspinatus muscle treated with ultrasound guided percutaneous needling technique later after shock-waves therapy and NAISDs without any relevant effect. The case description is accompanied by a long review of the available literature reporting a fairly detailed analysis of the pathophysiological mechanisms which review help often to generate hypotheses on treatment options even if such hypotheses must be assessed by clinical trials before becoming recommended treatments. If considered as solely procedure description, it could appear of minor interest because at least one previous controlled trial focused on the effectiveness of combined needling technique plus shock wave therapy in calcifying tendinitis of the shoulder. Instead, this case report compared to previous reported evidence adds a patient’ x ray study over 1 year and provides rehabilitation advices. The longlasting effect and the evidence of limited and slow disappearance of calcifications after 1 year despite the almost complete pain relief reinforces our belief based on anecdotal and personal experience that the shock waves do not significantly modify the calcification’s biological cycle as described by Uthoff and its outcomes while the needling procedure modifies it through the fragmentation and partial removal of calcified concretions, so we prefer more and more often to offer the patient the needling as a first line approach whileehabilitation remain an essential part of the post procedures treatment.

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