Bradford L. Boone, MD. Supraspinatus Infraspinatus Subscapularis Teres Minor.
Shoulder supraspinatus calcific tendinitis dr.sandeep agrawal agrasen hospital gondia maharashtra...
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Transcript of Shoulder supraspinatus calcific tendinitis dr.sandeep agrawal agrasen hospital gondia maharashtra...
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Calcific tendinitis
► Presence of macroscopic deposits of calcium hydroxyapatite crystal in any
tendon of the rotator cuff
► Self-limited disease
Incidence
7.5 to 20 percent of adults with no symptoms
6.8 percent of those with shoulder pain
most common among people between 30 - 60 years of age
Women > Men
sedentary work > manual work
Bilateral involved:13-47%
Etiology
► Still unknow Decreased local oxygen tension and hypoxia
Non degeneration
Non trauma
► Bursal side > articular site
► Usual involved Supraspinatus tendon 1-2 cm proximal to the tendon insertion on the
greater tuberosity (critical Zone)
Clinical Symptom
► shoulder pain
► restricted motion
► tenderness on greater tuberosity
Stage
► Stage I
precalcific phase
► Stage II
formative phase
► Stage III
resorptive phase
► Stage IV
postcalcific phase
Diagnosis
► History
► Physical Examination
► Radiography
Plain X-ray
CT
MRI
► Ultrasonography
DePalma and Kruper Classification
► Type I
Fluffy and amorphous
► Acute stages of the disease,
► calcific material may be liquid to semiliquid
► Type II
Defined and homogenous
► subacute or chronic disease
► calcific material forming a dry dense powder
Treatment
►Medical treatmentNSAIDCorticosteroid subacrominal injection
►Physical therapy
►Surgical treatmentOpenArthroscopy
►Ultrasound►ESW (Extracorporeal shock wave)►Needle aspiration
Blind aspirationSonographic guideFluoroscopic guide
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Ultrasound
► Ebenbichler N Engl J Med 1999
Double blind control study
► Ultrasound vs control
Pain relief and function result are better in ultrasound group
The result was no different after 9 months follow-up
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Extracorporeal Shock Wave
► Loew M, J Bone Joint Surg [Br] 1999;81 30-70% of patients obtained pain relief 20-77% of cases, the calcific deposit disappeared or
disintegrated.
► Rompe JD, J Shoulder Elbow Surg 1998 Good result
►High energy group 68%►Low energy group 52%
Partial or complete disintegration of calcific deposit►High energy group 64%►Low energy group 50%
Extracorporeal Shock Wave
► Results of ECSW depend on the energy of the waves and on the number of pulses
► The optimal dose has not yet been established.
► AdvantageNon invasive Low complication
►hematomas develop in most patients (80% )
► Disadvantage PainMay need anesthesia for high energy
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Sonographic Guidance Aspiration
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Happiness is not something you postpone for the future; it is something
you design for the present. It is also like a butterfly; the more you chase
it, the more it will elude you, but if you turn your attention to other
things, it will come and sit softly on your shoulder.
Happiness comes when your work and words
are of benefit to yourself and others.