[Radiotherapy for shoulder impingement]. / Bestrahlung beim Impingementsyndrom des Schultergelenks.

BACKGROUND AND PURPOSE: Up to now, degenerative shoulder diseases were summarized by the term "periarthritis humeroscapularis". Actual shoulder diseases can be differentiated etiopathologically according to a primary and secondary impingement syndrome. Narrowing of the subacromial space, which is caused by an osseous shape variant, leads to primary impingement. Secondary impingement develops, when the subacromial space is reduced by swelling tissue below the osseous shoulder roof. This study aimed for the exact diagnosis to indicate therapy and to classify the results according to the Constant score. PATIENTS AND METHODS: From August 1999 to September 2002, 102 patients with 115 shoulder joint conditions underwent radiation therapy (RT). All joints received two RT series (6 x 0.5 Gy/series) applied in two to three weekly fractions, totaling a dosage of 6.0 Gy (250 kV, 15 mAs, 1-mm Cu filter). The second RT course started 6 weeks after the end of the first. 115 shoulders were examined before RT, 6 weeks after the second RT course and, finally, during the follow-up from January to May 2003. RESULTS: Pain relief was achieved in 94/115 shoulder joints (82%) after 18-month follow-up (median). A significant difference existed between secondary impingement and primary/non-impingement according to response. Tendinosis calcarea, bursitis subdeltoidea, tendovaginitis of the long biceps tendon, and capsulitis adhaesiva responded well to therapy. CONCLUSION: Shoulder diseases of secondary impingement demonstrate a good response to RT. Less or no benefit was found in primary impingement syndrome or complete rotator cuff disruption and acute shoulder injuries, respectively.

Long-term results of radiotherapy for periarthritis of the shoulder: a retrospective evaluation.

BACKGROUND: To evaluate retrospectively the results of radiotherapy for periarthritis of the shoulder METHODS: In 1983-2004, 141 patients were treated, all had attended at least one follow-up examination. 19% had had pain for several weeks, 66% for months and 14% for years. Shoulder motility was impaired in 137/140 patients. Nearly all patients had taken oral analgesics, 81% had undergone physiotherapy, five patients had been operated on, and six had been irradiated. Radiotherapy was applied using regular anterior-posterior opposing portals and Co-60 gamma rays or 4 MV photons. 89% of the patients received a total dose of 6 Gy (dose/fraction of 1 Gy twice weekly, the others had total doses ranging from 4 to 8 Gy. The patients and the referring doctors were given written questionnaires in order to obtain long-term results. The mean duration of follow-up was 6.9 years [0-20 years]. RESULTS: During the first follow-up examination at the end of radiotherapy 56% of the patients reported pain relief and improvement of motility. After in median 4.5 months the values were 69 and 89%, after 3.9 years 73% and 73%, respectively. There were virtually no side effects. In the questionnaires, 69% of the patients reported pain relief directly after radiotherapy, 31% up to 12 weeks after radiotherapy. 56% of the patients stated that pain relief had lasted for "years", in further 12% at least for "months". CONCLUSION: Low-dose radiotherapy for periarthropathy of the shoulder was highly effective and yielded long-lasting improvement of pain and motility without side effects.

[Results of radiation therapy in periarthritis humeroscapularis]. / Ergebnisse der Strahlentherapie bei Periarthropathia humeroscapularis.

BACKGROUND: Radiation therapy is applied in painful degenerative shoulder diseases. Aim of this work was to evaluate the contribution of radiation therapy to symptomatic improvement in periarthritis humeroscapularis. METHODS: Ninety-four patients with periarthritis humeroscapularis were treated in two institutions. Mean age was 68 years, sex distribution were 32 men and 62 women. In 58 cases the right side was affected, left in 36 cases. At single doses of 0.75 Gy once a week a total dose of 6 Gy was applied (Fig. 1). The treatment effect was evaluated by the standardized von Pannewitz-score at the end of the treatment up to 6 months thereafter. RESULTS: The treatment results of all the 94 patients were documentated at the end of therapy. Seventy-one patients were followed at least for further 4 months. Radiogenic side-effects were not noticed. The symptoms of 54 patients (57.4%) were improved or vanished, in 40 cases the symptoms were not significantly affected (42.6%) (Table 1). Four months after therapy 42 of 71 patients were improved (59.2%), 29 unchanged (40.8%) (Table 2). The treatment effect occured typically up to 2 months after therapy, there were no age-related differences. Also in recurrent radiation therapies the symptoms improved, in 80 percent after one preceding therapy (Table 3), however only in 31.2 percent after multiple prior radiotherapies (Table 4). CONCLUSION: Radiation therapy is effective in the symptomatic treatment of periarthritis humeroscapularis. Treatment should be performed early after initial conservative treatment prior to any invasive therapy.

[Use of radiotherapy in treatment of painful scapula-humeral periarthritis]. / Zastosowanie radioterapii w leczeniu zespolów bólowych barków.

In 10 cases of painful scapulo-humeral periarthritis radiotherapy was used. In all cases conventional anti-inflammatory treatment was unsuccessful or impossible to deliver. Patients were treated using gamma 60Co radiation and 6 Gy was delivered in 1 Gy fractions over 8 days. The average degree of pain relief and improvement of limb mobility was assessed after radiotherapy completion, 1 week, 7 weeks after treatment and at final-up. The degree of pain relief was respectively 27%, 72%, 85% and 93%. Significant improvement of limb mobility was noted in all cases. Obtained results allow to conclude that anti-inflammatory radiotherapy is an effective treatment of painful scapulo-humeral periarthritis.

[Radiotherapy of humero-scapular periarthritis using ultra-hard photons. Evaluation by MRI findings]. / Strahlentherapie der Periarthritis humeroscapularis mit ultraharten Photonen. Vergleich mit kernspintomographischen Befunden.

PURPOSE: Evaluation of MRI in radiotherapy of humeroscapular periarthritis. PATIENTS AND METHODS: Seventy-seven patients with humeroscapular periarthritis prospectively underwent MRI before radiotherapy. RESULTS: Six months after radiotherapy, 34% of the patients had achieved complete pain relief, 35% major pain relief. Twenty percent had only slight improvement and 12% no improvement. Positive correlation of radiotherapy outcome and MRI findings could be shown for acute tendinitis, erosions, and complete and incomplete ruptures of the supraspinatus tendon. CONCLUSIONS: Radiotherapy is highly effective in the treatment of humeroscapular periarthritis. The indication can be improved using MRI.

Laser therapy for fibromyositic rheumatisms.

BACKGROUND AND OBJECTIVES: The objectives of this study is to treat the cases of fibromyositic rheumatisms untreatable with other therapies. The authors chose defocalized laser beams because some experimental studies had showed their analgesic and anti-phlogistic effects on experimental phlogosis. Since 1980 non-surgical laser effects were often noncomparable because of the lack of common treatment protocols. This summarizes fifteen years of clinical observations as to the purpose of identifying some indications on laser treatment of defined pathologies included in fibromyositic rheumatism. STUDY DESIGN/MATERIALS AND METHODS: 846 patients with different types of fibromyositic rheumatisms were submitted to defocalized laser therapy from 1980 to 1995. Criteria for selection included age, sex, and pathological pictures. Control groups were used to compare results with those of traditional methods. Diodes and CO2 lasers were employed, to exploit the photothermic and photochemical effects of the laser radiations to the fullest extent. RESULTS: On the whole, results were positive in comparison with other methods both as regards recovery time and persistence of results. Results were evaluated on the basis of subjective (such as local pain) and objective (hypomotility, phlogosis) criteria. CONCLUSIONS: Results obtained (approximately 2/3 of the patients benefited from the treatment) indicate that there are greater advantages in use of laser over other presently available methods. Standardalization of treatment protocols deserves further studies.

[Periarthritis humeroscapularis (PHS). Indications, technique and outcome of radiotherapy]. / Periarthritis humeroscapularis (PHS). Indikation, Technik und Bestrahlungsergebnisse.

BACKGROUND: Radiation treatment for patients with acute or subacute tendonitis or bursitis of the shoulder once commonplace has been mostly supplanted by antiinflammatory drug treatment. PATIENTS AND METHODS: 106 patients with clinically evident disease of PHS were treated between January 1987 and May 1991. 73/106 patients had a continuous follow-up. 16/73 patients showed typical symptoms on both shoulders: therefore a total of 89 shoulders were examined in this investigation. A daily dose of 0.5 Gy was given for 3 times a week and a total dose of 3.0 Gy. After 8 weeks a second treatment course was performed. In follow-up the subjective (pain) and objective (limitation of abduction) symptoms were classified in 3 grade scales. RESULTS: A marked pain reduction and an improved mobility (abduction of at least 20 degrees more than before radiation) could be observed in 72/89 shoulders (81%). 44/89 shoulders (49%) showed an excellent response and were completely free of pain and impairment of motion. CONCLUSION: Radiotherapy of acute or subacute Periarthritis humeroscapularis is a very effective treatment if radiation starts within the first year of symptoms and if it is supported by physiotherapy.

[Analgetic irradiation of degenerative-inflammatory skeletal diseases. Benefits and risks]. / Analgetische Bestrahlung degenerativentzündlicher Skeletterkrankungen. Nutzen und Risiko.

Between 1980 and 1991, ionizing radiation was applied for analgesic purposes to 181 patients (97 men, 84 women, mean age 54 [29-81] years) with degenerative-inflammatory skeletal disease. The long-term effects were evaluated by questionnaire. Radiation of 2.5 to 6.0 Gy achieved lasting pain relief in 21 of 30 patients (70%) with arthritis of the shoulder or humeroscapular periarthritis, 15 of 21 (71%) with arthritis of the hip, in 12 of 15 (80%) with heel spurs or Achilles tendon bursitis and 10 of 11 (91%) with epicondylitis. Pain relief lasted for longer than two years in 41 of the 77 patients (53%). There were no side effects at the stated dosage. According to dose measurements the theoretical risk of malignant tumour induction is 20-40/million radiated patients and thus four orders of magnitude below the spontaneous malignant tumour incidence rate. The genetic risk is even lower. Ionizing radiation of degenerative-inflammatory diseases is thus an effective form of treatment with few side effects.

[Success and long-term results of radiotherapy of periarthritis humeroscapularis]. / Erfolg und Langzeitergebnisse der Strahlentherapie der Periarthritis humeroscapularis.

The results in 164 patients receiving radiotherapy for humeroscapular periarthritis were evaluated on the basis of questionnaires. In all, 76% of the patients reported an improvement. A long-term study over an average of 5 years showed 61 patients (49%) to have experienced long-lasting freedom from pain. However, 38 patients (24%) noticed no improvement. Criteria affecting the success of therapy seem to include the length of the history of the disease as well as inadequate differential diagnosis. No influence is attributed to age, sex or previous types of treatment.

[Calcified periarthritis. Disappearance of periarticular calcification after laser therapy]. / Periartrite calcifica. Scomparsa di calcificazioni periarticolari dopo laserterapia.

The authors report their results in the laser therapy of 30 calcific shoulder joint periarthritis. In two out of the ten radiographed cases, at the end of therapy, the complete disappearance of calcifications has been shown and in one case a decrease in calcification volume has been demonstrated. In the follow up after 6 months, 80% of clinically checked patients had no painful relapse.