Keywords:
Musculoskeletal soft tissue, Musculoskeletal system, Interventional non-vascular, Ultrasound, Puncture, Calcifications / Calculi
Authors:
E. Fabbro1, G. Ferrero1, D. Orlandi1, C. Martini1, G. Serafini2, E. Silvestri3; 1Genova/IT, 2Pietra Ligure /IT, 3Genoa/IT
DOI:
10.1594/ecr2013/C-1695
Purpose
To evaluate the effectiveness of an US-guided percutaneous treatment of calcific tendinopathy in tendons outside the rotator cuff.
The term “calcific tendinitis” refers to the intratendinous deposition of calcium,
predominantly carbonate apatite,
that can affect every tendon in the body and especially the rotator cuff (RC,
20% of painful shoulder),
where the most frequently affected tendon is supraspinatus (80%).
With a similar pathogenesis to RC calcific tendinitis ( Fig. 4 ),
the most accepted theory for this condition is the "hypovascular theory",
where particular portions of the tendon are relatively less vascularized and thus exposed to a higher stress during lifetime,
leading to intratendinous fibrocartilaginous metaplasia (pre-calcific stage) with resulting calcification (calcific stage).
After variable time (and low-grade,
subacute pain referred by the patient),
triggered by unknown factors,
there is resorption of the deposit,
accompanied by vascular invasion,
migration of phagocytic cells with dissolution of the calcific focus (resulting in a “toothpaste” appearance of the calcific deposit),
and edema from intratendinous pressure,
with a sharp acute painful phase.
After resorption,
in the post-calcific or reparative phase,
fibroblasts restore the normal tendinous collagen pattern.
The percutaneous lavage of calcific deposits performed during the acute phase of this condition is intended to accelerate such physiological process and readily remove pain that otherwise would last for a long time before the complete restitutio ad integrum is done.