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      Artroscopia no tratamento da tendinite calcária refratária do ombro Translated title: Arthroscopy in thetreatment of refractory calcific tendonitis of the shoulder

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          Abstract

          OBJETIVOS: Analisar os resultados do tratamento artroscópico de pacientes com tendinite calcária do ombro. MÉTODOS: Entre setembro de 2001 e junho de 2006, 55 pacientes com tendinite calcária do ombro, resistentes ao tratamento conservador, foram avaliados, com seguimento de 12 a 70 meses. A média de idade foi de 42 anos, variando de 30 a 64 anos; 44 pacientes eram do sexo feminino (80%), sendo 37 ombros direitos (67,27%), com dominância em 63,63% dos casos. A dor foi o principal sintoma, sendo que o tempo decorrido entre o início dos sintomas e a artroscopia foi em média de 38 meses (cinco a 120 meses). Quanto aos tendões acometidos, o supraespinal em 42 casos, o infraespinal em 11 e a associação entre eles em dois casos. A acromioplastia foi realizada em apenas 12 casos (21,82%), enquanto a bursectomia subacromial, em todos os casos. RESULTADOS: Segundo os critérios da UCLA, houve 46 casos excelentes e seis bons, totalizando 52 resultados satisfatórios (94,54%). CONCLUSÃO: O tratamento artroscópico da tendinite calcária do ombro sugere ter altos índices de resultados satisfatórios, sendo um método eficaz. A acromioplastia associada não se faz necessária.

          Translated abstract

          OBJECTIVE: To evaluate the results of arthroscopic treatment in patients with calcific tendonitis of the shoulder. METHODS: Between September 2001 and June 2006, 55 patients with calcific tendonitis of the shoulder that was resistant to prior conservative treatment were evaluated, with follow-up of 12 to 70 months. The mean age was 42 years, ranging from 30 to 64 years; 44 patients were female (80%), with 37 right shoulders, with a predominance of 63.63% . Pain was the main symptom, and the mean time between onset of symptoms and arthroscopy was 38 months (five to 120 months). In relation to the affected tendons, the supraspinatus tendon was predominant, with 42 cases, the infraspinatus in 11, and an association between the two in 2 cases. Acromioplasty was carried out in 12 patients (21.82%) and subacromial bursectomy was performed in all cases. RESULTS: According to the UCLA evaluation system, 46 cases were classified as excellent and 6 as good, making a total of 52 satisfactory results achieved (94.54%). CONCLUSION: Arthroscopic treatment of calcific tendonitis of the shoulder appears to be an effective method, with high rates of satisfactory results. Associated acromioplasty is not necessary.

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          Most cited references23

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          Repair of the rotator cuff. End-result study of factors influencing reconstruction.

          In fifty patients who had fifty tears of the rotator cuff that had been repaired, we correlated the preoperative findings by history, physical examination, and radiography with the operative findings, the difficulty of the repair, and the results after an average follow-up of 3.5 years. The results, which were rated on the basis of pain, function, range of motion, strength, and satisfaction of the patient, were satisfactory in 84 per cent and unsatisfactory in 16 per cent. The correlations of the preoperative findings with the results showed that pain and functional impairment, the primary indications for repair, were significantly relieved. The longer the duration of pain was preoperatively, the larger the cuff tear and the more difficult the repair were. The strength of abduction and of external rotation before repair was of prognostic value: the greater the weakness, the poorer the result. The poorest results were in patients with strength ratings of grade 3 or less. Limitation of active motion preoperatively was also of prognostic value: in patients who were unable to abduct the shoulder beyond 100 degrees preoperatively, there was an increased risk of a poor result. An acromiohumeral distance of seven millimeters or less (measured on the anteroposterior radiograph) suggested a larger tear and the likelihood that after repair there would be less strength in flexion, less active motion, and lower scores. Single or double-contrast arthrography was not consistently accurate in estimating the size of the tear. After so-called watertight repair and anterior acromioplasty, successful results can be anticipated in a high percentage of patients.
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            Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon.

            The purpose of this study was to analyze the outcome of arthroscopic removal of calcifying tendinitis of the rotator cuff, to document the postoperative pain evolution, and to analyze structural changes of the supraspinatus tendon by use of ultrasonography. Fifty-four of 58 patients with a mean age of 45.4 years (+/-8 years) enrolled in the study were available for follow-up. The calcific deposits were exclusively located in the supraspinatus tendon. Shoulder function was evaluated by using the Constant score. Radiographs were obtained preoperatively, immediately postoperatively, and at 3, 6, 12, and 24 months. The integrity of the rotator cuff was assessed by using ultrasonography. Shoulder function according to the Constant score improved from 32.8 points (+/-19.8) preoperatively to 90.9 (+/-13.0) at 24 months (P < 0.001). The evolution of postoperative pain was very irregular; 31% of the patients were pain free or reached their minimum pain level after 3 months, 17% after 6 months, 20% after 9 months, and 28% after 12 months; 78% of the patients returned to work within 6 weeks, irrespective of their profession. At the final follow-up 92% of the patients were very satisfied with the outcome. Ultrasonography revealed minor structural changes of the supraspinatus tendon in 66% of the patients. The study confirmed previously reported successful results of arthroscopic treatment of calcifying tendinitis of the rotator cuff. Complete intraoperative removal of the deposit did not appear to be essential. Even if most of the patients were able to return to work within 6 weeks, postoperative recovery was prolonged over several months in most of the patients. The clinical relevance of the ultrasonographic changes of the supraspinatus tendon has not yet been determined. Level IV, therapeutic case series.
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              Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder.

              A prospective quasirandomized study was performed to compare the effects of surgical extirpation (Group I, 29 patients) with the outcome after high-energy extracorporeal shock wave therapy (Group II, 50 patients; 3,000 impulses of an energy flux density of 0.6 mJ/mm2) in patients with a chronic calcifying tendinitis in the supraspinatus tendon. Symptoms and demographic data of the two groups were comparable. According to the University of California Los Angeles Rating System, the mean score in Group I was 30 points with 75% good or excellent results after 12 months, and 32 points with 90% good or excellent results after 24 months. Radiologically, there was no calcific deposit in 85% of the patients after 1 year. In Group II, the mean score was 28 points with 60% good or excellent results after 12 months, and 29 points with 64% good or excellent results after 2 years. Radiologically, complete elimination of the deposit was observed in 47% of the patients after 1 year. Clinically, according to the University of California Los Angeles score, there was no significant difference between both groups at 1 year. At 2 years, there was a significantly better result in Group II. Both groups then were subdivided into patients who had a homogenous deposit as seen on radiographs and patients who had an inhomogenous deposit before treatment. Surgery was superior compared with high-energy shock wave therapy for patients with homogenous deposits. For patients with inhomogenous deposits, high-energy extracorporeal shock wave therapy was equivalent to surgery and should be given priority because of its noninvasiveness.
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                Author and article information

                Journal
                rbort
                Revista Brasileira de Ortopedia
                Rev. bras. ortop.
                Sociedade Brasileira de Ortopedia e Traumatologia (São Paulo, SP, Brazil )
                0102-3616
                1982-4378
                2010
                : 45
                : 1
                : 53-60
                Affiliations
                [02] orgnameHospital Geral de Goiânia
                [01] orgnameHospital Ortopédico de Goiânia orgdiv1Grupo de Ombro e Cotovelo
                Article
                S0102-36162010000100010 S0102-3616(10)04500110
                3ee1c721-acdf-4ea6-b33c-884cb1a34ad3

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 8
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                SciELO Brazil

                Self URI: Texto completo somente em PDF (PT)
                Categories
                Artigos Originais

                Arthroscopy,Diagnóstico por imagem,Tendinopatia,Tendinopathy,Diagnostic imaging,Ombro,Artroscopia,Shoulder

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