Skip to main content

Advertisement

SpringerLink
Log in

Calcific tendinopathy of the shoulder with intraosseous extension: outcomes of ultrasound-guided percutaneous irrigation

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objectives

Rotator cuff calcific tendinopathy (RCCT) with intraosseous extension is a rare complication of tendinous and peritendinous involvement. The purpose of our study is to evaluate the outcome of ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in patients with intraosseous involvement.

Materials and methods

From January 2011 to June 2014, patients with a clinical and imaging diagnosis of RCCT were prospectively categorised in two groups based on imaging findings: group A (10 patients) with intraosseous RCCT and group B (control group 35 patients) without osseous involvement. US-PICT followed by subacromial injection was applied to all patients in groups A and B. During a 1-year follow-up, treatment outcome in terms of pain and functional improvement was evaluated at 3 weeks, 3 months, 6 months, and 1 year, with the use of a four-grade scale. The study has been approved by our hospital’s ethics committee.

Results

Mean improvement scores of group A were significantly lower than those of group B at all time points (p < 0.0001). Improvement of group B was noted mainly within the first 3 months post-treatment (p = 0.016).

Conclusion

Outcomes of ultrasound-guided treatment in cases of RCCT with intraosseous extension are significantly less favourable than in purely tendinous or peritendinous disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

Abbreviations

RC:

Rotator cuff

BME:

Bone marrow oedema

NSAIDs:

Non-steroidal anti-inflammatory drugs

SSP:

Supraspinatus

ISP:

Infraspinatus

US-PICT:

Ultrasound-guided percutaneous irrigation of calcific tendinopathy

RCCT:

Rotator cuff calcific tendinopathy

ESWT:

Extracorporeal shockwave therapy

References

  1. Merolla G, Bhat MG, Paladini P, Porcellini G. Complications of calcific tendinitis of the shoulder: a concise review. J Orthop Traumatol. 2015;16:175–83.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sussmann AR, Cohen J, Nomikos GC, Schweitser ME. Magnetic resonance imaging of shoulder arthropathies. Magn Reson Imaging Clin N Am. 2012;20:349–71.

    Article  PubMed  Google Scholar 

  3. Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis, and management. J Am Acad Orthop Surg. 1997;5:183–91.

    Article  PubMed  Google Scholar 

  4. Porcellini G, Paladini P, Campi F, Pegreffi F. Osteolytic lesion of greater tuberosity in calcific tendinitis of the shoulder. J Shoulder Elbow Surg. 2009;18:210–5.

    Article  PubMed  Google Scholar 

  5. Seyahi A, Demirhan M. Arthroscopic removal of intraosseous and intratendinous deposits in calcifying tendinitis of the rotator cuff. Arthroscopy. 2009;25:590–6.

    Article  PubMed  Google Scholar 

  6. Lansa E, Banfi G, Serafini G, et al. Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting. Eur Radiol. 2015;25:2176–83.

    Article  Google Scholar 

  7. Kim Y-S, Lee H-J, Kim Y, Kong C-G. Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. J Shoulder Elbow Surg. 2014;23:1640–6.

    Article  PubMed  Google Scholar 

  8. Gerdesmeyer L, Wagenpfeil S, Haake M, et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA. 2003;290:2573–80.

    Article  CAS  PubMed  Google Scholar 

  9. Balke M, Bielefeld R, Schmidt C, Dedy N, Liem D. Calcifying tendinitis of the shoulder: midterm results after arthroscopic treatment. Am J Sports Med. 2012;40:657–61.

    Article  PubMed  Google Scholar 

  10. Serafini G, Sconfienza LM, Lacelli F, Aliprandi A, Sardanelli F. Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle US-guided percutaneous treatment−nonrandomized controlled trial. Radiology. 2009;252:157–64.

  11. Sanja MR, Mirjana Z-C. Ultrasonographic study of the painful shoulder in patients with rheumatoid arthritis and patients with degenerative shoulder disease. Acta Rheumatol Port. 2010;35:50–8.

    Google Scholar 

  12. Martinoli C. Musculoskeletal ultrasound: technical guidelines. Insights Imaging. 2010;1:99–141.

    Article  PubMed  PubMed Central  Google Scholar 

  13. MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology. 2009;252:647–61.

    Article  PubMed  Google Scholar 

  14. Hayes CW, Rosenthal DI, Plata MJ, Hudson TM. Calcific tendinitis in unusual sites associated with cortical bone erosion. AJR Am J Roentgenol. 1987;149:967–70.

    Article  CAS  PubMed  Google Scholar 

  15. Chadwick CJ. Tendinitis of the pectoralis major insertion with humeral lesions. A report of two cases. J Bone Joint Surg (Br). 1989;71-B:816–8.

    Google Scholar 

  16. El-Essawy MT, Vanhoenacker FM. Calcific tendinopathy of the pectoralis major insertion with intracorticalprotrusion of calcification. JBR-BTR. 2012;95:374.

    CAS  PubMed  Google Scholar 

  17. Kraemer EJ, El-Khoury GY. A typical calcific tendinitis with cortical erosions. Skeletal Radiol. 2000;29:690–6.

    Article  CAS  PubMed  Google Scholar 

  18. Chan R, Kim DH, Millett PJ, Weissman BN. Calcifying tendinitis of the rotator cuff with cortical bone erosion. Skeletal Radiol. 2004;33:596–9.

    Article  PubMed  Google Scholar 

  19. Flemming DJ, Murphey MD, Shekitka KM, Temple HT, Jelinek JJ, Kransdorf MJ. Osseous involvement in calcific tendinitis: a retrospective review of 50 cases. AJR Am J Roentgenol. 2003;181:965–72.

    Article  PubMed  Google Scholar 

  20. Durr HR, Lienemann A, Silbernagi H, Herlich A, Refior HJ. Acute calcific tendinitis of the pectoralis major insertion associated with cortical bone erosion. Eur Radiol. 1997;7:1215–7.

    Article  CAS  PubMed  Google Scholar 

  21. Porcellini G, Paladini P, Campi F, Paganelli M. Arthroscopic treatment of calcifying tendinitis of the shoulder: clinical and ultrasonographic follow-up findings at two to five years. J Shoulder Elbow Surg. 2004;13:503–8.

    Article  PubMed  Google Scholar 

  22. Seil R, Litzenburger H, Kohn D, Rupp S. Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy. 2006;22:521–7.

    Article  PubMed  Google Scholar 

  23. Moseley HF. Shoulder lesions. 3rd ed. London: Livingstone; 1969. p. 318.

    Google Scholar 

  24. Malghem J, Omoumi P, Lecouvet F, Van de Berg B. Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series. Skeletal Radiol. 2015;44:1403–12.

    Article  PubMed  Google Scholar 

  25. Cacchio A, Rompe D, Serafini G, Sconfienza LM, Sardanelli F. US-guided percutaneous treatment of shoulder calcific tendonitis: some clarifications are needed. Radiology. 2010;254:990–1.

    Article  PubMed  Google Scholar 

  26. Maier M, Schmidt-Ramsin J, Glaser C, Kunz A, Kuchenhoff H, Tischer T. Intra- and interobserver reliability of classification scores in calcific tendinitis using plain radiographs and CT scans. Acta Orthop Belg. 2008;74:590–5.

    PubMed  Google Scholar 

  27. Klontzas ME, Vassalou EE, Zibis AH, Karantanas AH. Hydroxyapatite deposition disease around the hip: outcomes of CT-guided treatment. Diagn Interv Radiol. 2016;22:466–70.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Author notes

  1. Michail E. Klontzas

    Present address: Department of Chemical Engineering, Imperial College London, London, UK

Authors and Affiliations

  1. Department of Medical Imaging, University Hospital and Department of Radiology, University of Crete, 71110, Heraklion, Crete, Greece

    Michail E. Klontzas, Evangelia E. Vassalou & Apostolos H. Karantanas

Authors
  1. Michail E. Klontzas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Evangelia E. Vassalou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Apostolos H. Karantanas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Apostolos H. Karantanas.

Ethics declarations

Conflicts of interest

No conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Klontzas, M.E., Vassalou, E.E. & Karantanas, A.H. Calcific tendinopathy of the shoulder with intraosseous extension: outcomes of ultrasound-guided percutaneous irrigation. Skeletal Radiol 46, 201–208 (2017). https://doi.org/10.1007/s00256-016-2538-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-016-2538-9

Keywords

Search

Navigation