Shockwave application in calcifying tendinitis of the shoulder - prediction of outcome by imaging

Citation
M. Maier et al., Shockwave application in calcifying tendinitis of the shoulder - prediction of outcome by imaging, ARCH ORTHOP, 120(9), 2000, pp. 493-498
Citations number
16
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine
Journal title
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
ISSN journal
0936-8051 → ACNP
Volume
120
Issue
9
Year of publication
2000
Pages
493 - 498
Database
ISI
SICI code
0936-8051(200008)120:9<493:SAICTO>2.0.ZU;2-9
Abstract
This prospective study examined 62 patients (65 shoulders) with chronic cou rses of calcifying tendinitis of the shoulder before and after low-energy e xtracorporeal shockwave application (ESWA) in order to identify variables a ssociated with the outcome of this treatment. Before ESWA, radiographs and contrast-enhanced magnetic resonance imaging (MRI) of the affected shoulder s were obtained in order to document the size and morphology of the calcifi cations and the contrast media reactions in areas of interest (deposit, syn ovia, bursae), respectively. In addition, a clinical evaluation was perform ed. After ESWA (mean follow-up 18.2 months), clinical evaluations of all 65 shoulders revealed an increase in the Constant score from 44% to 78% (p < 0.0001). While size (p = 0.61) and morphology (p = 0.7) of the deposits bef ore ESWA were not associated with the clinical outcome, negative contrast r eactions around the deposits (p 0.0001), synovia (p = 0.0049) and bursae (p < 0.01) were associated with improved clinical outcomes. After the total s tudy group was divided into two groups, one with Constant scores greater th an or equal to 75% (n = 43) and the other with scores < 75% (n = 22), the p ositive predictive value (ppv), specificity (sp) and sensitivity (se) were determined for the negative reaction around the deposit (ppv: 0.94; sp: 0.9 5; se: 0.38), synovia (ppv: 0.84; sp: 0.82; se: 0.39) and bursae (ppv: 0.86 ; sp: 0.86; se: 0.44). In 5 cases (7.7%), surgery of the affected shoulder during the follow-up period was performed. No major side-effects were seen in the study group. In conclusion, our results suggest that in patients wit h chronic calcifying tendinitis, the absence of contrast enhancement, espec ially around the deposit, is a strong predictive parameter of a positive cl inical outcome of ESWA.