US guided treatment in calcific tendinopathy of body tendons: Techniques and follow-up
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1 US guided treatment in calcific tendinopathy of body tendons: Techniques and follow-up Poster No.: C-2369 Congress: ECR 2010 Type: Scientific Exhibit Topic: Musculoskeletal - Soft Tissue Authors: T. De Zordo, N. Ahmad, M.-T. Girtler, R. Chhem, A. Klauser, W. Jaschke, C. Romagnoli ; Innsbruck/AT, London, ON/CA, 3 Vienna/AT Keywords: calcific tendinosis, lavage, ultrasound Keywords: Musculoskeletal soft tissue, Musculoskeletal system DOI: /ecr2010/C-2369 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 16
2 Purpose 1. Background Calcific tendinopathy is a condition characterized by the deposition of calcium hydroxyapatite within tendons. Self-limiting disease --> usually resolves spontaneously Some patients experience a cyclic, progressive course that can result in acutely disabling pain and loss of function. # Different treatment options available. 2. US-guided Puncture an Lavage Usually #involves direct percutaneous puncture of the calcific deposit. #One or two needles are inserted into the lesion and repeated cycles of injection and aspiration of saline are performed to dissolve the calcification and aspirate the fluid with the calcium crystals. #Clinical success rates of 60-91%, with follow-up times ranging from 2 weeks to 1 year. 3. Purpose #To analyze the effectiveness and complication rate of Ultrasound (US)guided perforation and lavage by using a two-needle technique with 16-18G needles in the treatment of patients with calcific tendinopathy in the shoulder, elbow, hip, and knee by radiological and clinical follow up. Page 2 of 16
3 Methods and Materials A retrospective chart review was performed and 40 patients (13 male, 27 female; mean age, 53.5 years; range years) were identified as having received US-guided perforation and lavage due to symptomatic calcific tendinopathy. Radiographic outcome was assessed by comparison of the size and quality of the calcification before and 6 weeks after the procedure. On US images, the quality of the acoustic shadow was assessed, together with other alterations of the tendon and surrounding tissue. Patients were interviewed by telephone to assess the clinical outcome regarding pre- and post-treatment pain and tendon function. Page 3 of 16
4 Results 34 shoulder tendons and 6 non-shoulder tendons were identified. Twenty-six supraspinatus tendons, 5 supra- and infraspinatus tendons, 3 subscapularis tendons, 3 patellar tendons, 1 common extensor tendon, 1 common flexor tendon, 1 triceps tendon, and 1 rectus femoris tendon were identified. Mean calcium reduction was 39.9 mm 2 (range, 0-215; p<0.001), whereas 80% of patient showed a resolution of more than 60% resulting in good clinical improvement. A very low complication rate was found (1 partial tear). Fig. References: Medical University Innsbruck, Diagnostic Radiology - Innsbruck/AT Page 4 of 16
5 Images for this section: Fig. 0: 54-year old woman showing a calcific deposit at the level of the left supraspinatus tendon. On radiographs a solid calcification was present before the procedure, showing a strong acoustic shadow on US. Six weeks after the US-guided perforation and lavage the size decreased and a change of quality was present on radiographs. Page 5 of 16
6 Fig. 0: 54-year old woman showing a calcific deposit at the level of the left supraspinatus tendon. On radiographs a solid calcification was present before the procedure, showing a strong acoustic shadow on US. Six weeks after the US-guided perforation and lavage the size decreased and a change of quality was present on radiographs. Page 6 of 16
7 Fig. 0: 54-year old woman showing a calcific deposit at the level of the left supraspinatus tendon. On radiographs a solid calcification was present before the procedure, showing a strong acoustic shadow on US. Six weeks after the US-guided perforation and lavage the size decreased and a change of quality was present on radiographs. Page 7 of 16
8 Fig. 0: 50-year old woman with a calcification of the supraspinatus and infraspinatus tendons. Radiograph at baseline reveals a large a sharply outlined, irregular calcification (arrow). On US a "non-shadowing" calcification (thick arrow) was present. Thin arrow shows the needle during US guided perforation and lavage. Six weeks after the procedure only a small residual calcification was present. Page 8 of 16
9 Fig. 0: 50-year old woman with a calcification of the supraspinatus and infraspinatus tendons. Radiograph at baseline reveals a large a sharply outlined, irregular calcification (arrow). On US a "non-shadowing" calcification (thick arrow) was present. Thin arrow shows the needle during US guided perforation and lavage. Six weeks after the procedure only a small residual calcification was present. Page 9 of 16
10 Fig. 0: 50-year old woman with a calcification of the supraspinatus and infraspinatus tendons. Radiograph at baseline reveals a large a sharply outlined, irregular calcification (arrow). On US a "non-shadowing" calcification (thick arrow) was present. Thin arrow shows the needle during US guided perforation and lavage. Six weeks after the procedure only a small residual calcification was present. Page 10 of 16
11 Fig. 0: 24-year old woman with calcific tendinopathy of the right triceps tendon. Radiograph before the intervention shows a thin calcification at the insertion of the triceps tendon (arrow). US image during the procedure with the thin arow showing the needle and the thcik arrow showing the calcification. Radiograph at the 6 week follow-up reveaks complete resorption of the calcium. Page 11 of 16
12 Fig. 0: 24-year old woman with calcific tendinopathy of the right triceps tendon. Radiograph before the intervention shows a thin calcification at the insertion of the triceps tendon (arrow). US image during the procedure with the thin arow showing the needle and the thcik arrow showing the calcification. Radiograph at the 6 week follow-up reveaks complete resorption of the calcium. Page 12 of 16
13 Fig. 0: 24-year old woman with calcific tendinopathy of the right triceps tendon. Radiograph before the intervention shows a thin calcification at the insertion of the triceps tendon (arrow). US image during the procedure with the thin arow showing the needle and the thcik arrow showing the calcification. Radiograph at the 6 week follow-up reveaks complete resorption of the calcium. Page 13 of 16
14 Conclusion US-guided perforation and lavage is an effective and safe treatment for rotator cuff calcifications as well as for other body tendons. Although the two-needle technique and large needles were used in this study a very low complication rate was detected. Page 14 of 16
15 References Uhthoff H.K. Calcifying tendinitis. In: The shoulder. Eds.: Rockwood, M., Matson, EA, Philadelphia, Saunders, 1990; Farin PU, Jaroma H, Soimakallio S (1995) Rotator cuff calcifications: treatment with ultrasound-guided technique. Radiology 195: Aina R, Cardinal E, Bureau NJ, Aubin B, Brassard P (2001) Calcific shoulder tendinosis: treatment with modified US-guided fine-needle technique. Radiology 221: Cardinal E, Chhem RK, Beauregard CG (1998) Ultrasound-guided interventional procedures in the musculoskeletal system. Radiol Clin North Am;36: Lin JT, Adler RS, Bracilovic A, Cooper G, Sofka C, Lutz GE (2007) Clinical outcomes of ultrasound-guided aspiration and lavage in calcific tendinosis of the shoulder. HSSJ;3: Giacomoni P, Siliotto R (1999) Echo-guided percutaneous treatment of chronic calcific tendinosis of the shoulder. [Italian] Radiol Med (Torino) 98: del Cura JL, Torre I, Zabala R, Legórburu A (2007) Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results. AJR Am J Roentgenol.189(3):W Serafini G, Sconfienza LM, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F (2009) Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial. Radiology;252: Page 15 of 16
16 Personal Information Tobias De Zordo: Department of Radiology, Medical University Innsbruck, Innsbruck, Austria and Department of Diagnostic Radiology, University of Western Ontario, London, ON, Canada N. Ahmad, M.-T. Girtler, C. Romagnoli: Department of Diagnostic Radiology, University of Western Ontario, London, ON, Canada A. Klauser, W. Jaschke: Department of Radiology, Medical University Innsbruck, Innsbruck, Austria R. Chhem: Department of Radiology, Medical University Vienna, Vienna, Austria Page 16 of 16
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