Calcific tendinitis is a painful condition that involves calcium deposits within the tendons. It most commonly affects the rotator cuff in the shoulders and can limit every day activities. The tendon calcification usually resolves itself on its own over time but pain and mobility can affect daily life, reports Beth Orenstein for "Radiology Today."
The Mayo Clinic reports that advances in ultrasound technology have contributed to the use of ultrasound imaging to both diagnose and treat many joint, muscle and tendon conditions.
Anti-inflammatory medications and physiotherapy are often used to treat minor cases of tendon calcification, says Beth Orenstein, while severe cases have been treated with shockwave treatment or open surgery.
About 50 to 70 per cent of patients may benefit from shockwave therapy or surgery but shockwaves can be extremely painful and surgery is costly and requires a long recovery period.
Ultrasound and Diagnosis
Ultrasound is a low-cost and effective imaging tool, says Mayo Clinic, for helping to evaluate ligaments, muscles, nerves and tendons. It doesn't use radiation and can be used to diagnose difficult or complex conditions so that the appropriate treatment is used.
Because ultrasound can be used during movement, it gives a clearer picture of what's going on dynamically during movement than what could be found with X-rays, CAT scans or MRIs.
Ultrasound to Guide Treatments
The biggest advance in ultrasound is its use in guiding other procedures. The Mayo Clinic explains that being able to see hard-to-reach areas on the ultrasound helps doctors to more accurately target aspirations and injections and use smaller needles. This is more comfortable and reduces risks.
Ultrasound-guided treatments include needle placement into joints, injections into tendon sheaths, injection into ganglion cysts, nerve blocks therapies and percutaneous treatment of calcific tendinitis.
Ultrasound-Guided Percutaneous Therapy
Italian researchers have come up with an alternative to conventional treatments for tendon calcification. Dr. Luca M. Sconfienza led the study and presented its results at the November 2007 meeting of the Radiological Society of North America.
Ultrasound was used to guide needles in percutaneous therapy for the treatment of calcific tendinitis in the shoulders of 2,543 people. The participants all had shoulder pain that hadn't responded to other treatments. The calcification was removed in 71.7 per cent of the patients in one treatment; in 23.6 per cent, a second treatment was needed; in 3.8 per cent of the participants the calcification had dissolved on its own and in 0.9 per cent the pain was due to a tendon tear.
The ultrasound-guided therapy was "quick, successful and inexpensive therapy for tendon calcifications," Sconfienza said, and provided "significant and long-lasting reduction of symptoms." The procedure takes only about 10 minutes, is relatively painless and shoulder pain is completely relieved within 24 to 36 hours.
Two needles are inserted with ultrasound guidance and saline solution is injected through one to melt down the calcification while the second needle extracts the calcium solution.
Treatments cost about £65 as compared to a £299 shockwave cycle or the £3,315 cost that surgery would entail.
Percutaneous Tenotomy and PRP Injections
The Mayo Clinic is combining ultrasound-guided percutaneous tenotomy and platelet-rich plasma (PRP) injections to treat tendon calcification.
Percutaneous tenotomy is also known as tendon fenestration. The doctor makes multiple passes through a degenerating tendon with needles to stimulate tissue healing, reports Dr. Jay Smith of the Mayo Clinic.
PRP injections are loaded with growth factors that facilitate healing. "The fenestration breaks up the abnormal tissue," say Smith, while the injected platelets encourage healing.
- Mayo Clinic: Ultrasound Offers Advantages in Musculoskeletal Disorders Diagnosis and Treatment; (2010)
- ScienceDaily: Minimally-Invasive Treatment Reduces Shoulder Pain From Tendonitis; (Nov. 29, 2007)
- "Radiology Today": Shoulder Relief --- Intervening to Tame Tendonitis; Beth W. Orenstein; (Jan. 14, 2008)