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2013年2月11日江苏徐州骨科运动创伤、关节镜Journal club预告
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Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten-Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany, maurice.balke@gmail.com.
The purpose of this study was to evaluate whether the morphology of the acromion in calcific tendinitis differs from controls without subacromial pathology and matches subacromial impingement.
METHODS:Digital radiographs of 150 shoulders were evaluated with the open source DICOM-Viewer OsiriX. 50 patients had symptomatic calcifictendinitis of the shoulder, 50 had subacromial impingement without calcifications or rotator cuff tears, 50 with bruised shoulder that were previously asymptomatic served as controls. Acromial shape according to Bigliani et al. acromial tilt (AT) according to Kitay et al. and Aoki et al. acromion index (AI) according to Nyffeler et al. and lateral acromial angle (LAA) according to Banas et al. were measured.
RESULTS:Both calcific (0.72; P = 0.001) and impingement groups (0.73; P = 0.008) were significantly different from controls (0.67) using AI measure, while only the calcific group (79.5°) was different from controls (84.1°) using LAA (P < 0.001), and only the impingement group (32.9°) was different from controls (29.2°) using AT (P < 0.001). An LAA <70° only occurred in two patients with calcific tendinitis.
CONCLUSION:The hypothesis of this study was that the morphology of the acromion in calcific tendinitis differs from controls without subacromial pathology and matches subacromial impingement was only confirmed for the AI. The AI of shoulders with calcific tendinitis is comparable to that of shoulders with subacromial impingement.
Department of Orthopaedics and Traumatology, University of Rome 'Tor Vergata' School of Medicine, Viale Oxford 81, Rome, Italy.
In calcific tendinopathy (CT), calcium deposits in the substance of the tendon, with chronic activity-related pain, tenderness, localized edema and various degrees of decreased range of motion. CT is particularly common in the rotator cuff, and supraspinatus, Achilles and patellar tendons. The presence of calcific deposits may worsen the clinical manifestations of tendinopathy with an increase in rupture rate, slower recovery times and a higher frequency of post-operative complications. The aetiopathogenesis of CT is still controversial, but seems to be the result of an active cell-mediated process and a localized attempt of the tendon to compensate the original decreased stiffness. Tendon healing includes many sequential processes, and disturbances at different stages of healing may lead to different combinations of histopathological changes, diverting the normal healing processes to an abnormal pathway. In this review, we discuss the theories of pathogenesis behind CT. Better understanding of the pathogenesis is essential for development of effective treatment modalities and for improvement of clinical outcomes.
Department of Orthopedics and Traumatology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands. t.gosens@elisabeth.nl
Calcifying tendonitis of the shoulder is a common, acute or chronic, painful disorder characterized by calcifications in the rotator cuff tendons. A natural cycle exists during which the tendon repairs itself. In chronic calcific tendonitis, however, this cycle is blocked at one of the healing stages. Because chronic presentation with exacerbations is usual, initial treatment should be conservative, including rest, physical therapy, nonsteroidal anti-inflammatory drugs, and, in later stages, subacromial infiltration with corticosteroids. Surgery is recommended when conservative treatment fails. This article discusses advances in imaging and medical, physical, and surgical management, as well as current evidence for the treatment of calcifying tendonitis of the shoulder.
Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Longoni, 83, 00155 Rome, Italy. f.franceschi@unicampus.it
Calcific tendinitis is a common disorder of the rotator cuff. Conservative treatment is frequently successful. For the patients remaining symptomatic after conservative treatment, excision of the calcium deposits offers a generally reliable pain relief. While calcific tendinitis is seen commonly affecting the supraspinatus tendon, it has been rarely reported involving the subscapularis tendon. We report on the clinical features, radiographic findings, arthroscopic treatment and results of one patient who presented a calcific tendonitis involving the subscapularis tendon of the left shoulderunresponsive to conservative treatment and associated subcoracoid stenosis and coracoid impingement.
The Hughston Clinic, PC, 6262 Veterans Parkway, Columbus, GA 31909, USA.
Calcific tendinitis of the shoulder is a process involving calcium deposition commonly in the rotator cuff tendons. It is a cell-mediated process that is often chronic in nature, but it is usually self-limiting with regard to its acute pain states. Nonoperative management is still the treatment of choice and is successful in up to 90% of patients. When conservative measures fail, a needling technique or surgical removal may be indicated; the trend is toward arthroscopic management. Acromioplasty should not be performed without radiographic signs of impingement. If a resulting large rotator cuff defect is found after removal of the calcific deposit, it may be worthwhile to close the defect arthroscopically with suture to prevent cuff tear progression and to promote healing.
School of Health and Rehabilitation Science, University of Pittsburgh, PA, USA.
Calcific deposits located within the tendons of the rotator cuff are frequently seen in patients presenting with shoulder pain. The pathogenesis of calcific tendinitis and the optimum management of patients presenting with acute symptoms are unclear. This paper reviews the incidence, proposed etiologies, and a unique treatment approach of rotator cuff calcific tendinitis. A case report of a patient with acute calcific tendinitis and subsequentshoulder motion and strength deficits is presented. A rational evaluation and treatment plan is outlined, which includes management and posttreatment changes, and radiographic findings are discussed. A team-management approach by physical therapy and orthopaedics services is emphasized.
Department of Radiology, San Carlo Hospital, Piazzale Gianasso, 16158 Genoa, Italy.
We describe a case of inferior glenohumeral subluxation or drooping shoulder secondary to acute calcific tendinitis of the rotator cuff. The various etiologies of drooping shoulder and the specific causes determining glenohumeral widening in our report are discussed. The importance in recognizing this uncommon complication of a common abnormal finding and correction by aspiration is stressed.
School of Health and Rehabilitation Science, University of Pittsburgh, PA, USA.
Calcific deposits located within the tendons of the rotator cuff are frequently seen in patients presenting with shoulder pain. The pathogenesis of calcific tendinitis and the optimum management of patients presenting with acute symptoms are unclear. This paper reviews the incidence, proposed etiologies, and a unique treatment approach of rotator cuff calcific tendinitis. A case report of a patient with acute calcific tendinitis and subsequentshoulder motion and strength deficits is presented. A rational evaluation and treatment plan is outlined, which includes management and posttreatment changes, and radiographic findings are discussed. A team-management approach by physical therapy and orthopaedics services is emphasized.
https://blog.sciencenet.cn/blog-394169-659562.html
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