Minimally Invasive Treatment Reduces Shoulder Pain From Tendonitis

Thursday, November 29, 2007 General News
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CHICAGO, Nov. 28 Radiologists are using a new minimallyinvasive procedure to treat tendonitis in the shoulder. Ultrasound-guidednon-surgical therapy significantly reduces pain from calcific tendonitis ofthe rotator cuff and restores mobility, according to a study presented todayat the annual meeting of the Radiological Society of North America (RSNA).

"This is a quick, successful and inexpensive therapy for tendoncalcifications," said Luca M. Sconfienza, M.D., from the Department ofRadiology at A.O. Ospedale Santa Corona in Pietra Ligure and the Department ofExperimental Medicine at the University of Genova in Italy. "It providessignificant and long-lasting reduction of symptoms."

Calcific tendonitis is a condition that causes the formation of smallcalcium deposits within the tendons of the rotator cuff in the shoulder. It ismost common in adults 30 to 40 years old. In most cases, the deposits becomepainful and can restrict mobility of the shoulder. In minor cases, physicaltherapy or anti-inflammatory medications may be sufficient to address theproblem until the calcifications break apart spontaneously. In severe cases,patients may require shockwave treatment or open surgery to remove thecalcium.

Ultrasound-guided percutaneous (through the skin) therapy represents aneffective and inexpensive alternative to surgery that is less stressful forthe patient. For the 10-minute procedure, the shoulder is anesthetized and,with ultrasound guidance, a radiologist injects a saline solution into therotator cuff to wash the area and break up the calcium. A second needle isused to aspirate, or withdraw, the calcium residue. Recovery time is about anhour. Calcifications that are completely treated do not ever return.

"Calcifications can break up on their own. Unfortunately, this can takefrom a few months to several years," Dr. Sconfienza said. "This means the paincould persist for years before its spontaneous resolution."

In addition, when untreated calcifications break up, the calcium is notextracted but spreads along the tendon and lodges in the subacromial bursa, afluid sac that helps lubricate the tendon. Calcium buildup in the tendon andbursa can cause bursitis, a painful condition with a long recovery time and ahigh grade of disability.

For the study, Dr. Sconfienza and colleagues used ultrasound-guidedpercutaneous therapy to treat 2,543 shoulders in 1,607 women and 938 men (meanage 42) with calcific tendonitis. All of the patients had shoulder pain thatwas unresponsive to previous medical treatment. One-year follow-up wasreported for 2,018 of the patients in the study.

The results showed that in 71.7 percent of the patients, the calcificationwas fully aspirated in one treatment with a considerable reduction in pain andsignificant improvement to mobility of the affected limb. In 23.6 percent ofpatients, a second procedure was performed because of the presence of morethan one calcification. In 3.8 percent of patients, the calcification haddissolved or moved before treatment could take place. In 0.9 percent ofpatients, no resolution of symptoms occurred because of the presence of atendon tear.

While Ospedale Santa Corona and the University of Genova are among fewinstitutions currently offering this new therapy, Dr. Sconfienza says thattheoretically, the procedure could be performed in any hospital or clinic thathas ultrasound equipment with a superficial probe.

"As people age, many complain of pain in the shoulders. This pain iscommonly caused by calcium build-up," Dr. Sconfienza said. "This procedure canallow them to feel better immediately with little cost."

Co-authors are F. Lacelli, M.D., M. Gravano, M.D., G. Serafini, M.D., G.Garlaschi, M.D., and E. Silvestri, M.D.

Note: Copies of RSNA 2007 news releases and electronic images will beavailable online at RSNA.org/press07 beginning M


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