Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Assessment of Calcific Tendonitis of Rotator Cuff by Ultrasonography: Comparison Between Symptomatic and Asymptomatic Shoulders
Le Goff1, Benoit, Berthelot Jr.2, Jean-Marie, Guillot2, Pascale, Glemarec2, Joelle, Maugars2, Yves
Calcific tendonitis of rotator cuff is observed on plain radiographs in 10% of adults, but remains asymptomatic in half these cases. Whereas US is widely used for the diagnosis of rotator cuff tears and tendonitis, few studies evaluated this technique in the management of calcific tendonitis. We looked for differences on ultrasound (US) and power Doppler findings between symptomatic and asymptomatic cases of shoulder calcific tendonitis to search for US features associated with pain.
Sixty-two patients (81 shoulders) with symptomatic (N = 57) or asymptomatic (N = 24) calcific tendonitis were included. From each patient, we recorded: demographic data, onset and duration of symptoms, intensity of the pain and nocturnal pain. Ultrasonography of the shoulders was performed using a multifrequential linear transducer (5 to 12 Mhz). Calcific plaque morphology, power Doppler signaling, and widening of the subacromial-subdeltoid bursa (SSB) were recorded. US-guided steroid injection into the SSB (N = 21) or needle puncture of calcific deposits (N = 29) was performed at the end of US evaluation in 50 of the 57 patients with symptomatic shoulders, and a questionnaire was sent to each patient after 11 +/-6 months. For statistic analysis, Wilcoxon' signed rank test and Fisher's exact test were used. The p value less than 0.05 was considered statistically significant.
The distal supraspinatus tendon was the most common site of calcification deposit (89%). The mean longitudinal (p<0.0001) and transverse (p=0.0015) measurements of the plaques were significantly higher in symptomatic than in asymptomatic shoulders. Fragmented calcifications were also associated with pain (p=0.01). A power Doppler signal was identified in 21 of the 57 symptomatic calcification (36%), but in none of the cases of asymptomatic calcification (p<0.005). It was associated with the existence of nocturnal pain (p=0,03) and the longitudinal size of the calcification (p=0,03). A widening of the SSB was found in 17 of the 57 symptomatic calcification (30%) but in none of the asymptomatic calcification (p<0.005). At least, Doppler signal or widening of the SSB was present in 31 of the 57 (54%) symptomatic shoulders (p<0.001). Long term outcome was favourable for 60% of our patients after steroid injection. However, no correlation was found between the evolution of the pain and the US characteristics at the first evaluation.
We found that ultrasonographic findings associated with symptomatic calcific tendonitis are a larger size and a fragmented aspect of the calcification. Positive power Doppler signal within the calcific deposit and SSB widening are also US features strongly associated with pain with a high specificity. US can help physicians to confirm that calcification is responsible for shoulder pain.
To cite this abstract, please use the following information:
Le Goff, Benoit, Berthelot Jr., Jean-Marie, Guillot, Pascale, Glemarec, Joelle, Maugars, Yves; Assessment of Calcific Tendonitis of Rotator Cuff by Ultrasonography: Comparison Between Symptomatic and Asymptomatic Shoulders [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1462