Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Seongnam, Korea.
Clin Orthop Surg. 2023 Apr;15(2):281-289. doi: 10.4055/cios22107. Epub 2022 Oct 28.
Negative effects of extracorporeal shock wave therapy (ESWT) on vulnerable tendon structures have been reported. Meanwhile, tears of the posterior rotator cuff tendon, which is thinner than the anterior, are not common, and the clinical features remain poorly understood. Therefore, we evaluated the relationship between ESWT and posterior rotator cuff tears (RCTs) by investigating the risk factors.
Of 294 patients who underwent rotator cuff repair between October 2020 and March 2021, a posterior RCT more than 1.5 cm from the biceps tendon or an isolated infraspinatus tear was identified in 24 (8.1%, group P). Sixty-two patients (21%) with an anterior RCT within 1.5 cm of the biceps tendon were analyzed as a control group (group A). Preoperative clinical characteristics were assessed to determine the risk factors of posterior RCTs.
Calcific deposits were more frequently observed in group P (n = 7, 29.2%) than group A (n = 6, 9.7%, = 0.024). Further, those in group P were more likely to undergo ESWT (n = 18, 75.0%) than those in group A (n = 15, 24.2%, < 0.001). Of these, 7 patients experiencing calcific tendinitis from group P (29.2%) and 4 from group A (6.5%, = 0.005) underwent ESWT for calcification removal. Furthermore, 11 patients experiencing tendinopathy from group P (45.8%), and 11 from group A (17.7%, = 0.007) underwent ESWT for pain relief. The mean level of fatty infiltration of the supraspinatus was significantly higher in group A than group P (1.8 vs. 1.0, < 0.001).
Since a high prevalence rate of posterior RCTs was related to ESWT, it should be carefully considered when treating calcific tendinitis or pain in patients experiencing tendinopathy.
已有报道称体外冲击波疗法（ESWT）对脆弱的腱结构有不良影响。同时，由于后肩袖肌腱比前肩袖肌腱薄，所以此处发生撕裂并不常见，且其临床特征仍知之甚少。因此，我们通过研究风险因素来评估 ESWT 与后肩袖撕裂（RCT）之间的关系。
在 2020 年 10 月至 2021 年 3 月期间接受肩袖修复的 294 名患者中，我们发现有 24 名患者（8.1%，组 P）的后肩袖撕裂距离二头肌肌腱超过 1.5cm，或存在孤立的冈下肌撕裂。作为对照组（组 A），我们分析了 62 名（21%）前肩袖撕裂距离二头肌肌腱 1.5cm 以内的患者。我们评估了术前临床特征，以确定后肩袖撕裂的危险因素。
组 P（n=7，29.2%）中钙化沉积的发生率明显高于组 A（n=6，9.7%， =0.024）。此外，组 P 中有 18 名（75.0%）患者比组 A 中有 15 名（24.2%）患者更有可能接受 ESWT（ ＜0.001）。在组 P 中，有 7 名患有钙化性肌腱炎的患者（29.2%）和 4 名患有组 A 的患者（6.5%， =0.005）因钙化切除而行 ESWT。此外，组 P 中有 11 名患有肌腱病的患者（45.8%）和 11 名患有组 A 的患者（17.7%， =0.007）因缓解疼痛而行 ESWT。组 A 中冈上肌的脂肪浸润程度明显高于组 P（1.8 比 1.0， ＜0.001）。
由于后肩袖撕裂的高患病率与 ESWT 有关，因此在治疗患有肌腱病或疼痛的钙化性肌腱炎患者时，应慎重考虑。
