Sobel Noah E, Li Wei, Williams Jordyn
Department of Emergency Medicine, University of Connecticut School of Medicine, Farmington, USA.
Department of Sports Medicine, Hartford HealthCare Medical Group, Bristol, USA.
Cureus. 2024 Sep 8;16(9):e68934. doi: 10.7759/cureus.68934. eCollection 2024 Sep.
Rotator cuff calcific tendinopathy (RCCT) is a common disorder of the rotator cuff causing shoulder pain and dysfunction. RCCT is characterized by calcium deposition on and around the tendons of the rotator cuff muscles. Treatment is typically conservative, consisting of anti-inflammatory drugs (NSAIDs) and physical therapy, although certain patients require more invasive treatment. If first-line treatments do not resolve the pain, second-line treatments such as glucocorticoid injections, extracorporeal shock wave therapy (ESWT), barbotage, and surgery may be considered; however, there is no gold standard treatment for these refractory cases. In this case study, a 36-year-old female patient with confirmed RCCT achieved symptom remission with ultrasound-guided methylprednisolone injection followed by adjunctive physical therapy. Ultrasonography enabled precise, targeted delivery of steroids to the calcified lesions, with near 100% resolution of deposits on repeat radiography. With additional physical therapy, the patient was completely pain-free with a full range of motion and the ability to perform daily activities. This case report demonstrates that ultrasound-guided glucocorticoid injection can be an efficacious treatment option for refractory cases of RCCT.
肩袖钙化性肌腱病（RCCT）是一种常见的肩袖疾病，可导致肩部疼痛和功能障碍。RCCT的特征是在肩袖肌肉肌腱上及其周围有钙沉积。治疗通常是保守的，包括使用抗炎药物（非甾体抗炎药）和物理治疗，不过某些患者需要更具侵入性的治疗。如果一线治疗不能缓解疼痛，可以考虑二线治疗，如糖皮质激素注射、体外冲击波疗法（ESWT）、灌洗和手术；然而，对于这些难治性病例，尚无金标准治疗方法。在本病例研究中，一名确诊为RCCT的36岁女性患者通过超声引导下注射甲基强的松龙，随后辅以物理治疗，实现了症状缓解。超声检查能够将类固醇精确、靶向地输送到钙化病变部位，在重复影像学检查中沉积物的分辨率接近100%。通过额外的物理治疗，患者完全无痛，活动范围正常，能够进行日常活动。本病例报告表明，超声引导下糖皮质激素注射对于RCCT难治性病例可能是一种有效的治疗选择。
