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Shoulder supraspinatus calcific tendinitis dr.sandeep agrawal agrasen hospital gondia maharashtra india

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SHOULDER- SUPRASPINATUS CALCIFIC TENDINITIS DR.SANDEEP AGRAWAL Agrasen Hospital Gondia Maharashtra INDIA
A common cause of Shoulder pain.

Published in: Health & Medicine
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Shoulder supraspinatus calcific tendinitis dr.sandeep agrawal agrasen hospital gondia maharashtra india

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  2. 2. Calcific tendinitis ► Presence of macroscopic deposits of calcium hydroxyapatite crystal in any tendon of the rotator cuff ► Self-limited disease
  3. 3. Incidence  7.5 to 20 percent of adults with no symptoms  6.8 percent of those with shoulder pain  most common among people between 30 - 60 years of age  Women > Men  sedentary work > manual work  Bilateral involved:13-47%
  4. 4. Etiology ► Still unknow  Decreased local oxygen tension and hypoxia  Non degeneration  Non trauma ► Bursal side > articular site ► Usual involved Supraspinatus tendon  1-2 cm proximal to the tendon insertion on the greater tuberosity (critical Zone)
  5. 5. Clinical Symptom ► shoulder pain ► restricted motion ► tenderness on greater tuberosity
  6. 6. Stage ► Stage I  precalcific phase ► Stage II  formative phase ► Stage III  resorptive phase ► Stage IV  postcalcific phase
  7. 7. Diagnosis ► History ► Physical Examination ► Radiography  Plain X-ray  CT  MRI ► Ultrasonography
  8. 8. DePalma and Kruper Classification ► Type I  Fluffy and amorphous ► Acute stages of the disease, ► calcific material may be liquid to semiliquid ► Type II  Defined and homogenous ► subacute or chronic disease ► calcific material forming a dry dense powder
  9. 9. Treatment ► Medical treatment NSAID Corticosteroid subacrominal injection ► Physical therapy ► Surgical treatment Open Arthroscopy ► Ultrasound ► ESW (Extracorporeal shock wave) ► Needle aspiration Blind aspiration Sonographic guide Fluoroscopic guide
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  13. 13. Ultrasound ► Ebenbichler N Engl J Med 1999  Double blind control study ► Ultrasound vs control  Pain relief and function result are better in ultrasound group  The result was no different after 9 months follow-up
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  15. 15. Extracorporeal Shock Wave ► Loew M, J Bone Joint Surg [Br] 1999;81  30-70% of patients obtained pain relief  20-77% of cases, the calcific deposit disappeared or disintegrated. ► Rompe JD, J Shoulder Elbow Surg 1998  Good result ►High energy group 68% ►Low energy group 52%  Partial or complete disintegration of calcific deposit ►High energy group 64% ►Low energy group 50%
  16. 16. Extracorporeal Shock Wave ► Results of ECSW depend on the energy of the waves and on the number of pulses ► The optimal dose has not yet been established. ► Advantage  Non invasive  Low complication ►hematomas develop in most patients (80% ) ► Disadvantage  Pain  May need anesthesia for high energy
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  18. 18. Sonographic Guidance Aspiration
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  20. 20. 20 Happiness is not something you postpone for the future; it is something you design for the present. It is also like a butterfly; the more you chase it, the more it will elude you, but if you turn your attention to other things, it will come and sit softly on your shoulder. Happiness comes when your work and words are of benefit to yourself and others.

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