Comparison of Extracorporeal Shock Wave Therapy and Ultrasound-Guided Shoulder Injection Therapy in Patients with Supraspinatus Tendinitis.

Background: The present study compared the clinical effect of extracorporeal shock wave therapy (ESWT) with that of ultrasound (US)-guided shoulder steroid injection therapy in patients with supraspinatus tendinitis. We hypothesized that the two treatments would show comparable results. Methods: The inclusion criteria were age over 20 years and diagnosis of supraspinatus tendinitis using US. Ultimately, 26 patients were assigned using blocked randomization: 13 in the US-guided shoulder injection group and 13 in the ESWT group. Treatment outcomes were evaluated using the pain visual analog scale (pVAS), the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 1 and 3 months after the procedure. Results: At 1 month after the intervention, pVAS, ASES, and constant score were significantly higher in the US-guided shoulder injection group than in the ESWT group, but not at 3 months after the intervention. Both groups showed clinically significant treatment effects at 3 months after the intervention compared to baseline. No significance was shown using equivalence testing. Conclusions: US-guided shoulder injection therapy was not superior to ESWT therapy. Considering the complications and rebound phenomenon of steroid injections, interventions using ESWT may be a good alternative to treat patients with supraspinatus tendinitis.

Role of shear wave elastography in the evaluation of the treatment and prognosis of supraspinatus tendinitis.

BACKGROUND: Supraspinatus tendinitis recurs easily after treatment. One of the main reasons is the lack of objective tools for the efficacy evaluation. Shear wave elastography (SWE) can quantitatively analyze the tissue elasticity of region of interest by measuring the Young's modulus (YM) value. AIM: To explore the role of SWE in the efficacy and prognostic evaluation of supraspinatus tendinitis. METHODS: Eighty-seven patients with supraspinatus tendinitis treated in Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences were recruited. Another 30 healthy volunteers were enrolled as the control group. The visual analogue scale (VAS) and Constant-Murley Score (CMS) were recorded before treatment. All participants were scanned by SWE scan, and the YM value of the region of interest were recorded. Spearman correlation analysis was performed on YM values with VAS and CMS. Univariate repeated measures analysis of variance was used to calculate the changing trend of VAS, CMS and SWE under different treatment courses. After treatment, the patients were further grouped based on who achieved significantly effective and curative treatment. The patients in the continued treatment group continued to receive treatment according to the YM value, and the remaining patients who stopped receiving treatment were included in the stopped treatment group. All patients were followed up for 1 year, and the difference in recurrence rates between the continued treatment group and the stopped treatment group were compared. RESULTS: The SWE images of supraspinatus muscle in healthy volunteers were mainly blue, while those of patients with supraspinatus tendinitis showed regional red and green areas. The average YM value of the supraspinatus muscle in healthy volunteers was 26.12 ± 4.03 kPa. The average YM value of patients with supraspinatus muscle was greater than that of healthy volunteers (average YM = 60.61 ± 11.53 kPa, t = 26.344, P < 0.001). The YM value was positively correlated with VAS (r = 0.564, P < 0.001) and negatively correlated with CMS (r = -0.411, P < 0.001). The changes of VAS and CMS were the most obvious in course 1 and then decreased gradually. The degree of change in YM values was similar in different courses. After a 1-year follow-up, the cumulative relapse-free rate in the continued treatment group was 91.43%, which was significantly higher than that in the stopped treatment group (64.71%, X 2 = 7.379, P = 0.007). CONCLUSION: SWE can objectively indicate the severity of supraspinatus tendinitis. Using the YM value as a criterion for curative effect may reduce the recurrence rate.

Biomecánica de las lesiones en hombro: Revisión bibliográfica crítica desde la perspectiva médico legal laboral / Biomechanics of shoulder injuries: Critical bibliographic review from the medical-legal-occupational perspective

Resumen La base fundamental de la valoración médico legal de un individuo es establecer la relación de causalidad entre la historia narrada por el mismo y los hallazgos documentados. La biomecánica del trauma es una herramienta que permite dilucidar dicha concordancia, ya que su estudio involucra los mecanismos de trauma implicados en la génesis de las distintas lesiones. Este artículo consiste en una revisión bibliográfica y crítica de la literatura actual en materia de etiopatogenia de las lesiones en hombro por su alta incidencia laboral y capacidad de generar secuelas.

Abstract The basis of the forensic evaluation of an individual is to establish the relationship of causality between the story that has been told by the patient and the documented findings. The study of injury biomechanics is a tool that helps to clarify said concordance, since it involves the trauma mechanisms that are implied in the genesis of the different lesions. This article consists of a bibliographical revision and critique of the current literature about the etiopathogenesis of the shoulder lesions, since they are frequent in the work place and can generate sequels.

Clinical analysis on arthroscopic incomplete removal of calcifications of supraspinatus tendinitis / 局解手术学杂志

Objective To evaluate the treatment effect of the arthroscopic incomplete removal of calcifications of the supraspinatus tendinitis without acromioplasty.Methods The clinical data of 20 patients of calcified supraspinatus tendinitis with Ellman Ⅰ or Ⅱ in general hospital of Shenyang military area command from January 2014 to February 2016 were retrospectively analyzed.Of the 20 patients,4 males and 16 females,the age ranged from 45 to 62 years old,with average age (50.2 ± 6.3) years old.All the patients received removal incomplete of calcification without acromioplasty.Pre-and postoperative 3,6,9 months general situation were evaluated by the VAS score,Constant-Murley score,University of California Los Angeles (UCLA) score,X-Radiographs and CT.Results The shoulder function was evidently improved in all 20 patients.The average VAS pain score was (8.2 ± 1.4) preoperatively and (0.8 ± 0.6) at the 6 months follow-up.The average Constant-Murley score was (44.6 ± 7.4) preoperatively and (95.4± 3.4) at the 6 months follow-up.The average UCLA score was (12.2 ± 3.6) preoperatively and (33.1 ± 1.4) at the 6 months follow-up.Conclusion The arthroscopic incomplete removal of calcifications of the supraspinatus tendon without acromioplasty can lead to good results with less iatrogenic injury.