10/20/2023
https://www.facebook.com/100038893911991/posts/1057453018894485/?mibextid=CDWPTG
Calcific tendinopathy📌
👉 Calcific tendinopathy (CT) is an important musculoskeletal condition most commonly seen in the shoulder girdle, accounting for 10–42% of all shoulder pain. https://pubmed.ncbi.nlm.nih.gov/29195923/, https://pubmed.ncbi.nlm.nih.gov/26306389/, https://pubmed.ncbi.nlm.nih.gov/22267694/
👉Calcific tendinopathy (CT) is characterized by the deposition of calcium hydroxyapatite crystals within a pathologically healthy tendon [https://pubmed.ncbi.nlm.nih.gov/8712860/]. This calcification differs from the calcification seen in degenerative tendinopathy, which is composed of a heterogenous mixture of calcium salts diffusely scattered throughout the tendon in areas of collagen degeneration or tear [https://pubmed.ncbi.nlm.nih.gov/8712860/].
👉 Of the shoulder tendons, the supraspinatus tendon of the rotator cuff is most frequently affected, representing 80% of shoulder CT [https://pubmed.ncbi.nlm.nih.gov/2624948/]. CT of the infraspinatus and subscapularis are seen less frequently, in 15 and 5%, respectively [https://pubmed.ncbi.nlm.nih.gov/2624948/].
👉 Hip girdle tendons, including the reflected head of the re**us femoris and gluteus medius, arethe second most commonly affected region, with a reported prevalence of 5.4% [https://pubmed.ncbi.nlm.nih.gov/25159540/].
👱👩Patients between 30 and 60 years of age are most typically affected by calcific tendinitis, slightly more frequently in women [https://pubmed.ncbi.nlm.nih.gov/10332023/, https://pubmed.ncbi.nlm.nih.gov/8817047/].
📊 A prevalence of up to 7.8% in asymptomatic shoulders and up to 42.5% in symptomatic shoulders has been reported. According to current theories, pain is caused by tendon inflammation at the periphery of the deposit, by a rise in intratendinous pressure, or by impingement of the deposit under the acromion [https://pubmed.ncbi.nlm.nih.gov/26842408/].
🤷♂️ The cause of the condition is unknown. Different theories have been proposed, including overuse [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805635/], local ischaemia [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805635/], tenocyte metaplasia [https://pubmed.ncbi.nlm.nih.gov/10797220/], misdifferentiation of stem cells [https://pubmed.ncbi.nlm.nih.gov/21362289/] and genetic predisposition [https://pubmed.ncbi.nlm.nih.gov/4708018/].
📈 The course of the disease is thought to be cyclic and often self-limiting [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559092/] and has been described in four distinct phases of varying length and symptom intensity (the formative, resting, resorptive, and reparative phases), that tend to loosely correlate with clinical presentation [https://pubmed.ncbi.nlm.nih.gov/10797220/].
1⃣ First, the precalcific stage is characterized by the fibrocartilaginous metaplasia of tenocytes into chondrocytes, creating an environment in which calcifications can develop.
2⃣ The second, calcific stage, is subdivided into formative, resting, and resorptive phases.
✖ In the formative phase, calcium crystals are formed and coalesce into large foci of calcification, typically with a chalk-like appearance [https://pubmed.ncbi.nlm.nih.gov/10797220/, https://pubmed.ncbi.nlm.nih.gov/19296885/].
✖ The resting phase is characterized by a stable presence of mature calcifications surrounded by a fibrocartilaginous tissue border or ‘cap’.
✖ Finally, in the resorptive phase, an inflammatory reaction to the calcific deposits occurs and vascularized tissue develops at the calcification periphery or cap [https://pubmed.ncbi.nlm.nih.gov/10797220/, https://pubmed.ncbi.nlm.nih.gov/19296885/]. Resorption is mediated through macrophages and multinuclear giant cells, which infiltrate and phagocytose the calcific deposits. The calcification at this phase resembles toothpaste consistency and can leak into nearby bursae, bone, or muscle, causing severe pain [https://pubmed.ncbi.nlm.nih.gov/10797220/, https://pubmed.ncbi.nlm.nih.gov/19296885/].
3⃣ The last stage is the postcalcific/reparative phase, in which fibroblasts remodel the space previously occupied by calcium with Type III collagen. The Type III collagen is then replaced by Type I collagen, ultimately resulting in complete healing of the affected tendon and the restoration of tendon ar-chitecture [https://pubmed.ncbi.nlm.nih.gov/29853175/].
👉 Over the past few years ultrasound guided lavage together with a steroid injection has gained increasing popularity and has become the preferred method for many orthopaedic surgeons, radiologists, and physical medicine physicians [https://pubmed.ncbi.nlm.nih.gov/25583182/, https://pubmed.ncbi.nlm.nih.gov/27554465/, https://pubmed.ncbi.nlm.nih.gov/31191964/, https://pubmed.ncbi.nlm.nih.gov/31124934/].
☝️ But….a brand-new study in BMJ by Moosmeyer et al. found that the results from ultrasound guided lavage with a steroid injection and from sham lavage with a steroid injection for calcific tendinopathy were not superior to those from sham treatment (all groups performed a post-intervention home based exercise program, . https://www.youtube.com/watch?v=6nRYdqYniUI).
📷Illustration: https://link.springer.com/book/10.1007/978-3-030-91202-4
