Electroacupuncture for the treatment of supraspinatus calcific tendonitis

BackgroundConservative treatment of calcific tendonitis includes rest, medications, and physical therapy. Several physiotherapy interventions such as shockwave therapy are commonly used. The aim of this study was to investigate the efficacy of an electrotherapy method called electroacupuncture, in the treatment of calcific tendonitis.Methods40 patients with calcific tendonitis were randomly divided to receive either a combination of medications and electroacupuncture, or just a course of medications. Evaluated outcomes included pain using the visual analog scale, shoulder range of motion with the use of goniometer, and quality of life along with functional status using the Instrumental Activities of Daily Living Scale (IAOLDS) and the Beck Depression Inventory (BDI). Radiological evaluation for the progression of the calcific deposits was also performed. All these evaluations were performed before and at the end of treatment. A final interview with the patients regarding any recurrent episodes was performed 18–24 months after the end of treatment.ResultsThe intervention group showed greater improvement in pain intensity (2.8 points), range of motion (forward flexion, +30; abduction +29) when compared with the control group (for all, P < .05) while there was no statistically significant difference regarding the quality of life (IOLDS +0.2; BDI 0). Radiological evaluation demonstrated total or nearly total absorption of calcific deposits in 15 patients of the intervention group and in 8 patients of the control group.ConclusionThe successful clinical results of electroacupuncture and the regression of calcific depositions after treatment showed that electroacupuncture may have a role as a treatment modality in calcific tendonitis.     

冲击波疗法对训练伤冈上肌肌腱炎的疗效

 目的 探讨冲击波疗法对训练伤所致冈上肌肌腱炎的疗效。方法 回顾性分析武警特色医学中心骨科收治的236例训练伤冈上肌肌腱炎的病例,其中非钙化冈上肌肌腱炎158例(非钙化组),钙化冈上肌肌腱炎78例(钙化组),均行同样参数冲击波治疗,对比两组治疗前,治疗后6、12个月视觉模拟评分(VAS)、Constant肩关节评分。结果 与治疗前相比,治疗后6、12个月,两组VAS评分均明显降低,肩关节Constant评分显增加,差异有统计学意义(P<0.05);且治疗后6、12个月,钙化组与非钙化组比较,VAS评分更低、Constant评分更高,差异有统计学意义(P<0.05)。结论 冲击波疗法能够明显缓解训练伤冈上肌肌腱炎的疼痛症状,提高患侧肩关节功能;且对钙化性冈上肌肌腱炎疗效更好。     

Nonodontogenic Odontalgia Referred from the Temporal Tendon: A Case Report

IntroductionTemporal tendonitis (TT) is an orofacial pain disorder that can refer pain to the maxillary and mandibular molars, temporomandibular joint, masticatory muscles, eye, or ear. Patients often present to a dentist or physician with complaints reflecting these referral patterns, yet many healthcare providers are unfamiliar with TT because of the scarcity of literature published on this clinical entity. This may lead to diagnostic confusion, iatrogenic harm, and prolonged patient suffering.Methods and ResultsThis case report describes TT that presented as maxillary and mandibular posterior tooth pain, preauricular pain, and decreased mandibular range of motion. Patient history and examination were suggestive of TT. Local anesthetic injection adjacent to the tendon eliminated all pain complaints and improved range of motion. The patient was given education on the condition and self-care instructions. At 1-week follow-up, the patient reported resolution of her pain complaint.ConclusionsAs healthcare providers familiarize themselves with appropriate diagnostic and treatment options for TT, delayed or unnecessary care can be avoided, and proper management strategies can be implemented.     

Fluoroscopically Guided Supraglenoid Tubercle Steroid Injections for the Management of Biceps Tendonitis

Background: The management of bicipital tendonitis can be challenging to the clinician. Traditionally, blind injections near the bicipital groove have been performed by clinicians with risk of bicipital tendon rupture or atrophy. Because of the inaccuracy and risk associated with blind bicipital tendon steroid injections, we sought to ascertain whether a fluoroscopically guided steroid injection into the region of the origin of the long head of the bicipital tendon (supraglenoid tubercle) was efficacious. Methods: A retrospective chart review of 6 consecutive patients with a diagnosis of bicipital tendonitis was performed. All patients underwent a fluoroscopically guided steroid/anesthetic injection into the supraglenoid tubercle of the shoulder. The main outcome measure was post‐procedure change in visual analog pain scale; the secondary outcome was the physical examination (presence of a Speed's test). Results: Ten cases were identified, but only 6 had complete data and were included in the analysis. Five of the 6 patients experienced a reduction in pain by 50% at follow‐up. Discussion: A fluoroscopically guided block injected into the supraglenoid tubercle may be effective in the management of bicipital tendonitis.     

Common Overuse Injuries in the Pediatric and Adolescent Athlete

With the ever-increasing participation of children and adolescents in organized and recreational sports, physicians can expect to see a significant number of sports-related overuse injuries. An understanding of the unique aspects of the growing musculoskeletal system will provide a framework for diagnosing and treating young injured athletes. Many of these injuries, such as tendonitis, apophysitis, PFPS, and stress fractures, respond to conservative treatment including activity modification and rehabilitation.     

中老年原发性冻结肩及肩袖钙化症的肩关节镜治疗

目的探讨中老年原发性冻结肩及肩袖钙化症的肩关节镜手术技巧与疗效。方法对非手术治疗无效的15例原发性冻结肩行肩关节镜下关节囊松解,4例合并肩袖钙化症,均行钙化灶清除及肩峰成形术。术前、术后采用ASES、VAS评分法和Constant肩关节功能评分法评估。结果术后平均随访27.3个月。术后疼痛程度及功能评分均有显著提高,肩关节活动度亦有较明显改善(P<0.01)。结论中老年原发性冻结肩及肩袖钙化症的肩关节镜治疗是一种损伤小、恢复快,安全有效的方法。     

Influence of deposit stage and failed ESWT on the surgical results of arthroscopic treatment of calcifying tendonitis of the shoulder

The purpose of the present study is the evaluation of a possible influence of the preoperative deposit stage, the postoperative deposit elimination and failed preoperative extracorporeal shockwave therapy on the surgical outcome of arthroscopic treatment of tendinosis calcarea. From 1997 to 2004, 65 patients underwent arthroscopic resection of calcific deposits of the shoulder after failed conservative treatment. Patients with rotator cuff tears, major cartilage damage, or previous surgery were excluded. Out of 50 patients 45 (17 men, 28 women) that could be contacted with a mean age of 49 ± 8 years could be followed-up with a mean of 36 months (14–89) after surgery. A total of 24 patients (53.3%) underwent preoperative extracorporeal shock-wave therapy (ESWT). For the clinical evaluation the Constant and Murley Score, the Simple Shoulder Test, the Western Ontario Rotator Cuff Index (WORC) and visual analog scales for pain, function and satisfaction were used. For the radiological evaluation, the classifications according to Gaertner and Bosworth were used. Statistical analysis was done with the Wilcoxon test, the Mann–Whitney test and ANOVA. The Constant and Murley Score improved significantly from preoperative 63.5 ± 11.4 to postoperative 93.9 ± 9.9 points (P < .0001) at follow-up, the Simple Shoulder Test from 1.7 ± 2 to 9.9 ± 2.8 points (P < .0001), the WORC score from 1,591.2 ± 337.4 to 345.4 ± 392 points (P < .0001). The visual analog scales for pain, function and patient satisfaction also significantly improved (P < .0001). Preoperative radiological evaluation according to the Gaertner classification revealed 37 type I deposits, 6 type II and 2 type III deposits; postoperative no calcific deposits were seen in 37 patients, 6 type I and 2 type III deposits. According to the Bosworth classification 13 type I, 19 type II and 13 type III deposits were seen preoperatively. Postoperative X-rays showed 6 type I and 1 type II and III deposits. There was no significant correlation of the clinical results with the pre- or postoperative findings. The 24 patients who underwent ESWT before surgery did not show significantly better results than patients without ESWT. In conclusion, arthroscopic removal of calcific deposits of the shoulder shows good clinical results for pain reduction, shoulder function and patient satisfaction. The type of calcific deposit and the preoperative treatment of the shoulder with ESWT did not have any significant impact on the postoperative results. Presented at the ISAKOS Meeting, 23–29 May 2007, Florence, Italy.     

Diagnosis and treatment of peroneal tendon disorders

Peroneal tendon disorders are a common cause of lateral hindfoot pain and dysfunction that are often overlooked and misdiagnosed. Disorders can be divided into instability, inflammation and tears but often occur concurrently or as a result of each other. A detailed history and examination is required with an early level of suspicion as there are several differential diagnoses with similar presentations. Investigations such as ultrasound and MRI are useful to confirm diagnosis. Understanding of the pathophysiology and evidence-based management of peroneal disorders is mostly backed by opinion-based medical literature. The majority of acute disorders can be managed non-operatively with rest and physiotherapy but in many cases arthroscopic or open surgery is needed. If not managed appropriately the problem can become chronic and very challenging to treat. Early recognition of the characteristic clinical findings and the appropriate use of investigations and treatments is therefore essential to prevent this. This review article focuses on current understanding of common peroneal tendon pathologies, their diagnosis and treatment.     

Arthroscopic management of calcific tendinitis of the subscapularis tendon

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 shoulder unresponsive to conservative treatment and associated subcoracoid stenosis and coracoid impingement.     

Calcific tendonitis of the longus colli muscle: a cause of atraumatic neck pain

Retropharyngeal calcific tendonitis is a not-infrequent cause of atraumatic neck pain. Two patients presented with neck pain and stiffness, one with associated dysphagia. Cervical spine radiographs showed calcification anterior to the dens, establishing the diagnosis of calcific tendonitis of the longus colli muscle. Treatment with analgesics and antiinflammatory agents brought relief of symptoms within one week. A review of the literature shows that these patients had courses similar to those in previously reported cases.