Pakos Emilios, Gkiatas Ioannis, Rakkas Georgios, Papadopoulos Dimitrios, Gelalis Ioannis, Vekris Marios, Korompilias Anastasios
Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece.
Physiotherapy Department, Salamagka 4, Ioannina, Greece.
SICOT J. 2018;4:45. doi: 10.1051/sicotj/2018043. Epub 2018 Oct 19.
Calcified tendinopathy of the rotator cuff is one of the most common conditions concerning the shoulder pathology. It is characterized by a reactive calcification that affects the tendons being part of the rotator cuff. The reported prevalence varies from 2.7% to 22%. Most of the patients can be treated effectively with non-operative measures such as anti-inflammatory drugs, subacromial injection of steroid, physiotherapy, extracorporeal shock wave therapy (ESWT) and needle aspiration irrigation. Results of a treatment combining some of these methods have not been reported.
The purpose of this study is to present the radiological as well as the clinical results of our proposed protocol which combines drilling of the calcium deposits with xylocaine under ultrasound guidance, with a specific program of physiotherapy for 1 month without the use of NSAIDs.
Sixty-six consecutive patients (68 shoulders) were treated for calcified tendinitis of supraspinatus, which was diagnosed clinically and radiologically, with needle drilling using xylocaine under ultrasound guidance. After the drilling the patient followed a physiotherapy protocol with ESWT which included five visits within a month. After the end of the physiotherapy, the patients were evaluated clinically and radiologically. The Visual Analogue Scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were measured before and after the end of the therapy.
All the patients showed clinical improvement of the symptoms at the follow-up. The mean VAS score showed improvement from 8.1 to 3.3 whereas the mean DASH score was 27 and after the end of the therapy 5. Radiologically all but one calcific deposits were disappeared.
The ultrasound-guided drilling of the calcific deposit using xylocaine, in combination with physiotherapy using ESWT provides a reliable alternative treatment for the calcific tendinitis of the supraspinatus.
肩袖钙化性肌腱病是肩部病理学中最常见的病症之一。其特征是影响肩袖肌腱的反应性钙化。报道的患病率从2.7%到22%不等。大多数患者可通过非手术措施有效治疗，如抗炎药、肩峰下注射类固醇、物理治疗、体外冲击波疗法（ESWT）和针吸冲洗。尚未报道联合使用其中一些方法的治疗结果。
本研究的目的是展示我们提出的方案的影像学及临床结果，该方案结合了在超声引导下用利多卡因钻孔清除钙沉积物，并进行为期1个月不使用非甾体抗炎药的特定物理治疗方案。
连续66例患者（68个肩部）接受了超声引导下用利多卡因针钻治疗临床和影像学诊断的冈上肌钙化性肌腱炎。钻孔后，患者遵循包括ESWT的物理治疗方案，在一个月内进行五次就诊。物理治疗结束后，对患者进行临床和影像学评估。在治疗结束前后测量疼痛视觉模拟量表（VAS）和手臂、肩部和手部功能障碍（DASH）评分。
所有患者在随访时症状均有临床改善。VAS评分均值从8.1改善至3.3，而DASH评分均值治疗前为27，治疗结束后为5。影像学上，除一处外所有钙沉积物均消失。
超声引导下用利多卡因钻孔清除钙沉积物，联合ESWT物理治疗为冈上肌钙化性肌腱炎提供了一种可靠的替代治疗方法。
