scholarly journals Current treatment concepts of calcifying tendinitis of the shoulder

2021 ◽  
Author(s):  
Markus Loew ◽  
Marc Schnetzke ◽  
Sven Lichtenberg
Keyword(s):  
Rotator Cuff ◽  
Treatment Options ◽  
Tendon Repair ◽  
Supraspinatus Tendon ◽  
Current Treatment ◽  
Treatment Recommendation ◽  
Calcifying Tendinitis ◽  
Therapeutic Concepts ◽  
Shoulder Region ◽  
Treatment Concepts

AbstractCalcifying tendinitis is a very common pathology in the shoulder region, which may be acute or chronic. The rotator cuff, particularly the supraspinatus tendon, is most frequently affected. The tendons of the rotator cuff undergo a natural cycle of destruction and regeneration. The development of calcifying tendinitis is caused by defective tendon repair. Typical is a chronic course with acute pain exacerbation, which leads to medical presentation. Treatment options range from conservative therapy including rest, physical therapy, nonsteroidal anti-inflammatory drugs, and shock wave therapy, to surgical therapy with arthroscopic removal of the calcific focus. This article discusses the current stage-dependent therapeutic concepts and provides a treatment recommendation.

scholarly journals Human Tendon Repair Following Injection of Autologous, Unmodified Stem Cells: A Comprehensive Immunohistochemical Evaluation

2020 ◽  
Author(s):  
Eckhard Alt ◽  
Ralf Rothoerl ◽  
Matthias Hoppert ◽  
Hans-Georg Frank ◽  
Christopher Alt ◽  
...  
Keyword(s):  
Stem Cells ◽  
Rotator Cuff ◽  
Adult Stem Cells ◽  
Treatment Options ◽  
Tendon Repair ◽  
Immunohistochemical Analysis ◽  
Supraspinatus Tendon ◽  
Tendon Tissue ◽  
Human Tendon ◽  
Regenerative Cells

Current clinical treatment options for symptomatic rotator cuff tear offer only limited potential for true tissue healing and improvement of clinical results. In animal models, injections of adult stem cells isolated from adipose tissue into tendon injuries evidenced histological regeneration of tendon tissue. However, it is unclear whether such beneficial effects could also be observed in a human tendon treated with autologous, adipose derived regenerative cells. Here we demonstrate, for the first time, a comprehensive histological and immunohistochemical analysis of the biopsy of a supraspinatus tendon of a 66-year-old subject with traumatic rotator cuff injury, taken ten weeks after local injection of fresh, uncultured, autologous, adipose derived regenerative cells (UA-ADRCs), prepared at the point of care. Our analysis demonstrated clear evidence towards regenerative healing of the injured supraspinatus tendon. Of note, no formation of adipocytes was observed. These findings indicate that injected autologous, unmodified stem cells can indeed form new tendon tissue and regenerate an injured human tendon.

scholarly journals Calcifying tendinitis of the shoulder: arthroscopic needling versus complete calcium removal and rotator cuff repair. A prospective comparative study

Joints ◽  
2015 ◽  
Vol 03 (04) ◽  
pp. 166-172 ◽  
Author(s):  
Alessandro Castagna ◽  
Silvana De Giorgi ◽  
Raffaele Garofalo ◽  
Marco Conti ◽  
Silvio Tafuri ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Comparative Study ◽  
Clinical Outcomes ◽  
Tendon Repair ◽  
Complete Removal ◽  
Calcium Deposit ◽  
Calcifying Tendinitis ◽  
Clinical Scores ◽  
Prospective Comparative Study

Purpose: the aim of the present study was to verify the differences in the clinical outcomes of two arthroscopic techniques used to treat calcifying tendinitis of the shoulder: needling versus complete removal of the calcium deposit and tendon repair. Methods: from September 2010 to September 2012, 40 patients with calcifying tendinitis of the rotator cuff were arthroscopically treated by the same surgeon using one of the two following techniques: needling (Group 1) and complete removal of the calcium deposit and tendon repair with suture anchors (Group 2). Both groups followed the same rehabilitation program. The two groups were compared at 6 and 12 months of follow-up for the presence of residual calcifications and for the following clinical outcomes: Constant score, American Shoulder and Elbow Surgeons Evaluation Form (ASES) shoulder score, University of California Los Angeles (UCLA) shoulder rating scale, Simple Shoulder Test (SST) and Visual Analogue Scale (VAS). Results: all the clinical scores (Constant, ASES, UCLA, SST and VAS scores) improved significantly between baseline and postoperative follow-up, both at 6 and at 12 months. no differences at final follow-up were found between the two groups. Conclusions: both the techniques were effective in solving the symptoms of calcifying tendinitis of the shoulder. Clinical scores improved in both groups. Residual calcifications were found in only a few cases and were always less than 10 mm. Level of evidence:Level II, prospective comparative study.

scholarly journals Irreparable rotator cuff tears: Current treatment options

2019 ◽  
Vol 11 (3) ◽  
Author(s):  
Tristan Juhan ◽  
Michael Stone ◽  
Omid Jalali ◽  
Will Curtis ◽  
John Prodromo ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Reverse Shoulder Arthroplasty ◽  
Treatment Options ◽  
Current Treatment ◽  
Rotator Cuff Tears ◽  
Biceps Tenotomy ◽  
Common Causes ◽  
Cuff Repair ◽  
Term Data

Rotator cuff disease is one of the most common causes of shoulder pain, yet controversy still exists regarding treatment of “irreparable” tears. Nonoperative management, including physical therapy and steroid injections, should be reserved for those without significant pain or functional impairment. Debridement may be used for low-demand patients, and should be performed with partial cuff repair, subacromial decompression, and/or acromioplasty to maximize outcomes. Biceps tenotomy and/or tenodesis have been shown to reduce postoperative pain and improve satisfaction when performed in conjunction with rotator cuff repairs, with no difference in functional outcome comparatively. Tendon transfers have been advocated with the potential benefit to improve function and decrease pain. More recently, extracellular matrix and human-derived dermal allografts have been used off-label as patch grafts in irreparable tears. Superior capsular reconstructive techniques and subacromial balloon spacers serve a similar function by acting to depress the humeral head in a cuff-deficient shoulder, however long-term data is needed before widespread adoption of these procedures. Finally, reverse shoulder arthroplasty serves as a salvage option for low demand elderly patients.

Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes

2015 ◽  
Vol 24 (9) ◽  
pp. 1493-1505 ◽  
Author(s):  
Joshua A. Greenspoon ◽  
Maximilian Petri ◽  
Ryan J. Warth ◽  
Peter J. Millett
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Treatment Options ◽  
Current Treatment ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears

scholarly journals GENETICS IN ENDOCRINOLOGY: Gain and loss of function mutations of the calcium-sensing receptor and associated proteins: current treatment concepts

2016 ◽  
Vol 174 (5) ◽  
pp. R189-R208 ◽  
Author(s):  
Bernhard Mayr ◽  
Dirk Schnabel ◽  
Helmuth-Günther Dörr ◽  
Christof Schöfl
Keyword(s):  
Calcium Supplementation ◽  
Current Treatment ◽  
Loss Of Function ◽  
Calcium Sensing Receptor ◽  
Calcium Sensing ◽  
Therapeutic Concepts ◽  
Sigma 1 ◽  
Associated Proteins ◽  
Treatment Concepts

The calcium-sensing receptor (CASR) is the main calcium sensor in the maintenance of calcium metabolism. Mutations of theCASR, the G protein alpha 11 (GNA11) and the adaptor-related protein complex 2 sigma 1 subunit (AP2S1) genes can shift the set point for calcium sensing causing hyper- or hypo-calcemic disorders. Therapeutic concepts for these rare diseases range from general therapies of hyper- and hypo-calcemic conditions to more pathophysiology oriented approaches such as parathyroid hormone (PTH) substitution and allosteric CASR modulators. Cinacalcet is a calcimimetic that enhances receptor function and has gained approval for the treatment of hyperparathyroidism. Calcilytics in turn attenuate CASR activity and are currently under investigation for the treatment of various diseases. We conducted a literature search for reports about treatment of patients harboring inactivating or activating CASR, GNA11 or AP2S1 mutants and aboutin vitroeffects of allosteric CASR modulators on mutated CASR. The therapeutic concepts for patients with familial hypocalciuric hypercalcemia (FHH), neonatal hyperparathyroidism (NHPT), neonatal severe hyperparathyroidism (NSHPT) and autosomal dominant hypocalcemia (ADH) are reviewed. FHH is usually benign, but symptomatic patients benefit from cinacalcet. In NSHPT patients pamidronate effectively lowers serum calcium, but most patients require parathyroidectomy. In some patients cinacalcet can obviate the need for surgery, particularly in heterozygous NHPT. Symptomatic ADH patients respond to vitamin D and calcium supplementation but this may increase calciuria and renal complications. PTH treatment can reduce relative hypercalciuria. None of the currently available therapies for ADH, however, prevent tissue calcifications and complications, which may become possible with calcilytics that correct the underlying pathophysiologic defect.

scholarly journals Does the Interval Slide Procedure Reduce Supraspinatus Tendon Repair Tension?: A Biomechanical Cadaveric Study

2022 ◽  
Vol 10 (1) ◽  
pp. 232596712110668
Author(s):  
Felix Porschke ◽  
Philip Christian Nolte ◽  
Christian Knye ◽  
Christel Weiss ◽  
Stefan Studier-Fischer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Intervention Group ◽  
Tendon Repair ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Full Thickness ◽  
Time Points ◽  
Tendon Tears ◽  
And Control

Background: The benefits of the interval slide (IS) procedure in retracted rotator cuff tears remain controversial. Purpose: The purpose was to evaluate the effect of the IS procedure on repair tension (RT). It was hypothesized that the IS procedure (anterior IS [AIS], posterior IS [PIS], and intra-articular capsular release [CR]) would reduce the RT of a supraspinatus tendon. Study Design: Controlled laboratory study. Methods: A total of 31 Thiel-embalmed human cadaveric shoulders (mean age, 74 years; range, 68-84 years) were tested. Full-thickness supraspinatus tendon tears were created, and 1 cm of tendon was resected to simulate a retracted defect. Shoulders were randomized into intervention (n = 16) and control (n = 15) groups. In all shoulders, the load during tendon reduction to footprint was measured, an endpoint was defined as maximum tendon lateralization before 50 N was reached, and the RT (load during lateralization to endpoint) of the native tendon (t1) was evaluated. In the intervention group, AIS (t2), PIS (t3), and CR (t4) were performed in order, with RT measurement after each step. In the control group, RT was assessed at the same time points without the intervention. Results: A complete reduction of the tendon was not achieved in any of the shoulders. Mean maximum lateralization was 6.7 ± 1.30 mm, with no significant differences between groups. In the intervention group, the overall IS procedure reduced RT about 47.0% (t1 vs t4: 38.7 ± 3.9 vs 20.5 ± 12.3 N; P < .001). AIS reduced RT significantly (t1 vs t2: 38.7 ± 3.9 vs 27.4 ± 10.5 N; P < .001), whereas subsequent PIS (t2 vs t3: 27.4 ± 10.5 vs 23.2 ± 12.4 N; P = .27) and CR (t3 vs t4: 23.2 ± 12.4 vs 20.5 ± 12.3 N; P = .655) did not additionally reduce tension. Comparison between groups at t4 revealed a reduction of RT of about 47.8% (control vs intervention: 39.3 ± 4.0 vs 20.5 ± 12.3 N; P < .001). Conclusion: The IS procedure reduces RT of the supraspinatus tendon in human cadaveric shoulders. However, performing PIS and CR subsequent to AIS does not reduce tension additionally. Clinical Relevance: These findings provide surgeons with a biomechanical rationale regarding the efficacy of the IS procedure.

Management of bladder, bowel, and sexual dysfunction

2015 ◽  
pp. 281-313 ◽  
Author(s):  
Ulrich Mehnert
Keyword(s):  
Sexual Dysfunction ◽  
Clinical Symptoms ◽  
Treatment Options ◽  
Bowel Function ◽  
Current Treatment ◽  
Major Surgery ◽  
Therapeutic Principles ◽  
Treatment Knowledge ◽  
Treatment Concepts

This chapter provides an overview of the pathophysiological basis of bladder, bowel, and sexual dysfunction, relevant therapy principles, and treatment options. These dysfunctions are frequent sequelae of neurotrauma and neurodegenerative diseases that require adequate management and treatment. Knowledge of basic neurophysiological and pathophysiological processes involved is important for understanding and interpretation of clinical symptoms and findings and for understanding current treatment concepts. Treatment is mandatory and therapy options range from simple conservative measures to major surgery. The main therapeutic principles include protection of kidney function, reduction of urinary and/or faecal incontinence, independent management of bladder and bowel function, ability to sustain a satisfactory sexual relationship, fertility support, and improvement of quality of life. To comply with such principles and to select, initiate, maintain, and eventually adapt the ‘optimal’ treatment regimen for each patient requires a specialized multidisciplinary team.

Preoperative Radiographic Risk Factors for Incomplete Arthroscopic Supraspinatus Tendon Repair in Massive Rotator Cuff Tears

2018 ◽  
Vol 34 (4) ◽  
pp. 1121-1127 ◽  
Author(s):  
Andrew J. Sheean ◽  
Robert U. Hartzler ◽  
Patrick J. Denard ◽  
Alexandre Lädermann ◽  
Timothy G. Sanders ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rotator Cuff ◽  
Tendon Repair ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears

Intratendinous Strain Variations of the Supraspinatus Tendon Depending on Repair Technique: A Biomechanical Analysis Regarding the Cause of Medial Cuff Failure

2021 ◽  
pp. 036354652110061
Author(s):  
Michael Hackl ◽  
Julia Nacov ◽  
Sandra Kammerlohr ◽  
Manfred Staat ◽  
Eduard Buess ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Tendon Repair ◽  
Supraspinatus Tendon ◽  
Biomechanical Analysis ◽  
Double Row ◽  
Camera System ◽  
Musculotendinous Junction ◽  
Repair Technique ◽  
Medial Cuff Failure ◽  
Tendon Strain

Background: Double-row (DR) and transosseous-equivalent (TOE) techniques for rotator cuff repair offer more stability and promote better tendon healing compared with single-row (SR) repairs and are preferred by many surgeons. However, they can lead to more disastrous retear patterns with failure at the medial anchor row or the musculotendinous junction. The biomechanics of medial cuff failure have not been thoroughly investigated thus far. Purpose: To investigate the intratendinous strain distribution within the supraspinatus tendon depending on repair technique. Study Design: Controlled laboratory study. Methods: Twelve fresh-frozen cadaveric shoulders were used. The intratendinous strain within the supraspinatus tendon was analyzed in 2 regions—(1) at the footprint at the greater tuberosity and (2) medial to the footprint up to the musculotendinous junction—using a high-resolution 3-dimensional camera system. Testing was performed at submaximal loads of 40 N, 60 N, and 80 N for intact tendons, after SR repair, after DR repair, and after TOE repair. Results: The tendon strain of the SR group differed significantly in both regions from that of the intact tendons and the TOE group at 40 N ( P≤ .043) and from the intact tendons, the DR group, and the TOE group at 60 N and 80 N ( P≤ .048). SR repairs showed more tendon elongation at the footprint and less elongation medial to the footprint. DR and TOE repairs did not provide significant differences in tendon strain when compared with the intact tendons. However, the increase in tendon strain medial to the footprint from 40 N to 80 N was significantly more pronounced in the DR and TOE group ( P≤ .029). Conclusion: While DR and TOE repair techniques more closely reproduced the strains of the supraspinatus tendon than did SR repair in a cadaveric model, they showed a significantly increased tendon strain at the musculotendinous junction with higher loads in comparison with the intact tendon. Clinical Relevance: DR and TOE rotator cuff reconstructions lead to a more anatomic tendon repair. However, their use has to be carefully evaluated whenever tendon quality is diminished, as they lead to a more drastic increase in tendon strain medial to the footprint, putting these repairs at risk of medial cuff failure.

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