Ultrasound-guided percutaneous irrigation of rotator cuff calcific tendinosis. What radiologist should know.

Rotator cuff calcific tendinopathy is a common condition caused by the presence of calcification into the rotator cuff or in the subacromial-subdeltoid bursa. The pathogenetic mechanism of this pathology is still debated. Calcific tendinitis frequently affects the rotator cuff and may cause shoulder pain and reduction of range of motion. It can be diagnosed with conventional radiography, ultrasound, or magnetic resonance imaging. The first therapeutic option includes conservative management based on rest, physical therapy, and oral non-steroid anti-inflammatory administration. Extracorporeal shock wave therapy is a noninvasive technique that can be useful for the fragmentation of calcific deposits. Imaging-guided percutaneous irrigation is currently considered the gold standard technique for the treatment of calcific tendinitis due to its minimal invasiveness and its success rate of about 80%.

Clavicular Osteochondroma: Extremely Rare Cause of Impingement Syndrome.

INTRODUCTION: Impingement syndrome is one of the most common pain disorders of the shoulder; it may be due by structural alteration of acromion, coracoacromial ligament, acromioclavicular joint, biceps tendon, or coracoid process; however, in rare cases, impingement syndrome may be due also by benign tumors such as osteochondroma. CASE REPORT: We presented a case of 27-year-old male with clavicular impingement syndrome secondary to osteochondroma. He received conservative treatment before the diagnosis of the osteochondroma. Radiograph, computed tomography, and magnetic resonance imaging of the shoulder were performed. As the failure of non-operative treatment, the patient underwent to open surgical procedure with the excision of the osteochondroma. CONCLUSION: Clavicular osteochondroma is a very rare cause of impingement syndrome, and it may cause severe shoulder impingement with reduction of the range of movements. Osteochondroma may be complicated by a number of secondary abnormalities, including inflammatory changes of the bursa exostotica ("exostosis bursata") covering the cartilaginous cap, pressure on nerves, blood vessels, and the adjacent bone. The least common complication seen in <1% of cases of solitary lesions is malignant transformation to chondrosarcoma. The diagnosis of clavicular osteochondroma should be considered in any patient with shoulder impingement syndrome, and good functional results can be expected following total excision.