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Treatment of Calcifying Tendinitis

Fig. 18.14a-f. US-guided treatment of calcifying tendinitis aspiration irrigation technique. Schematic drawings illustrate the standard sequence of a two-needle procedure, a Under real-time US observation, lidocaine is injected within the subacromial bursa (asterisk) by the first 18 gauge needle. The needle path should point toward the rotator cuff (rc) calcification (star) to be treated, b The same needle is advanced (black arrows) until its tip penetrates the calcification, c A second 20 gauge needle is inserted (black arrows) within the calcification. With this needle, multiple passages within the calcification and rotational movements are performed, d Injection (open arrows) of saline and lidocaine by the second needle and aspiration by the first needle is then performed in an effort to remove as much calcified material as possible, e When a substantial amount of calcium has been washed out, steroids are injected (open arrow) into the subacromial bursa to treat inflammation secondary to diffusion of calcium into the bursa. Then the needles are withdrawn (black arrows), e At the end of the procedure, residual calcific deposits remain within the tendon... [Pg.905]

Fig. 18.16a-c. US-guided treatment of calcifying tendinitis radiographic results. Series of anteroposterior standard radiographs of the shoulder obtained a before, b soon after the procedure and c 2 months later in a patient with a painful calcification (arrow) in the supraspinatus tendon. Although partial removal of the calcification is observed initially, most of the calcification then dissolves with time. (Courtesy of Dr. Giovanni Serafini, Pietra Ligure, Italy)... [Pg.907]

Some general considerations merit attention. First, only painful calcifications must be treated finding calcification within a rotator cuff tendon does not automatically mean that shoulder pain is related to it. A typical mistake is to treat calcifying tendinitis in patients with shoulder pain derived from other causes, including cervical spine disease. Remember that most calcifications are asymptomatic. Second, the best results are achieved on large calcifications. Treatment of clusters of smaller calcifications is almost invariably unsuccessful. Third, the goal of the procedure is to disrupt the calcification and to remove some but not all calcific material (Fig. 18.14f). Too many needle insertions to remove as much as possible of the calcification should be avoided to prevent tendon tears. Once ruptured, calcification almost invariably evolves toward resorption, and shoulder pain and disability improve in most cases (Fig. 18.16). [Pg.904]


See other pages where Treatment of Calcifying Tendinitis is mentioned: [Pg.891]    [Pg.901]    [Pg.901]    [Pg.904]    [Pg.904]    [Pg.906]    [Pg.891]    [Pg.901]    [Pg.901]    [Pg.904]    [Pg.904]    [Pg.906]    [Pg.270]   
See also in sourсe #XX -- [ Pg.903 , Pg.904 , Pg.905 ]




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