Needling Procedures for Calcific Tendinitis Performed by Orthopedic Surgeons

BACKGROUND: Common and effective treatments for calcific tendinitis involve needling procedures. However, it has been widespread practice to refer patients with calcific tendinitis, which is a predominantly orthopedic condition, to radiology department. The purpose of this study was to compare clinical and radiological outcomes after ultrasound-guided needling for calcific tendinitis between the orthopedics and radiology department. METHODS: Seventy-seven shoulders (Group 1) and 38 shoulders (Group 2) treated in the radiology and orthopedic department, respectively. A fellowship-trained orthopedic surgeon and a musculoskeletal radiologist each performed the procedure of ultrasound-guided needle decompression with subacromial steroid injection. Clinical outcomes was evaluated using the visual analogue scale for pain (pVAS) and the American Shoulder and Elbow Surgeons (ASES) shoulder score before treatment and at each follow-up. The pre- and post-needling size and shape of the calcific deposits were compared between the two groups. RESULTS: We analyzed a total of 56 shoulders for Group 1 and 32 shoulders for Group 2. The mean age and sex ratio of the patients no significantly different. We found that the mean decrease in the diameter of calcification between pre- and post-needling was 9.0 mm for Group 1 and 13.1 mm for Group 2; the difference was significantly larger in Group 2 than in Group 1. Both groups showed improved pVAS and ASES scores after needling but the extent of these improvements did not differ with the type of operator. CONCLUSIONS: Needling decompression performed by orthopedic surgeons could a viable option for the treatment of calcific tendinitis.

Acromion Index in Korean Population and Its Relationship with Rotator Cuff Tears

BACKGROUND: Among the many causes of rotator cuff tears, scapular morphology is associated with the accelerating degenerative process of the rotator cuff. Acromion index (AI) was previously introduced and compared in two populations. METHODS: We enrolled 100 Korean patients diagnosed with full-thickness rotator cuff tears by magnetic resonance imaging and intraoperative arthroscopic findings between January and December 2013. Another 100 Korean patients with an intact rotator cuff tendon identified on magnetic resonance imaging and other shoulder diseases, such as frozen shoulder and instability, were enrolled as controls. We retrospectively compared these 100 rotator cuff tear patients (mean age, 63 years) and 100 controls (mean age, 51 years) in this study. Two independent orthopedic surgeons assessed the AI on radiographs. We performed an interobserver reliability test of the AI assessment, and then compared the AI between two groups. RESULTS: The measurement of the AI showed excellent reliability (intraclass correlation coefficient, 0.82). The mean AI in the rotator cuff tear group was 0.68 and it was significantly different between groups (p<0.001, 95% confidence interval). The AI was not related to tear size. CONCLUSIONS: Our study showed that the AI was an effective predictive factor for rotator cuff tears in a Korean population.

Needling Procedures for Calcific Tendinitis Performed by Orthopedic Surgeons

BACKGROUND: Common and effective treatments for calcific tendinitis involve needling procedures. However, it has been widespread practice to refer patients with calcific tendinitis, which is a predominantly orthopedic condition, to radiology department. The purpose of this study was to compare clinical and radiological outcomes after ultrasound-guided needling for calcific tendinitis between the orthopedics and radiology department. METHODS: Seventy-seven shoulders (Group 1) and 38 shoulders (Group 2) treated in the radiology and orthopedic department, respectively. A fellowship-trained orthopedic surgeon and a musculoskeletal radiologist each performed the procedure of ultrasound-guided needle decompression with subacromial steroid injection. Clinical outcomes was evaluated using the visual analogue scale for pain (pVAS) and the American Shoulder and Elbow Surgeons (ASES) shoulder score before treatment and at each follow-up. The pre- and post-needling size and shape of the calcific deposits were compared between the two groups. RESULTS: We analyzed a total of 56 shoulders for Group 1 and 32 shoulders for Group 2. The mean age and sex ratio of the patients no significantly different. We found that the mean decrease in the diameter of calcification between pre- and post-needling was 9.0 mm for Group 1 and 13.1 mm for Group 2; the difference was significantly larger in Group 2 than in Group 1. Both groups showed improved pVAS and ASES scores after needling but the extent of these improvements did not differ with the type of operator. CONCLUSIONS: Needling decompression performed by orthopedic surgeons could a viable option for the treatment of calcific tendinitis.

Clavicle Nonunion: Matchstick Bone-grafting and Osteosynthesis

BACKGROUND: This study was conducted to evaluate the surgical outcomes of plate fixation using autologous iliac bone graft shaped in the form of a matchstick in clavicle nonunion resulting from prior surgical or non-surgical management. METHODS: From May 2005 to February 2013, 17 patients underwent surgery for clavicle nonunion. The mean age at the time of surgery was 48.8 years. The iliac bone was harvested and shaped into slivers approximately 3 cm long, which resembled matchsticks. After opening of the medullary canal, the plate and screws were applied and cancellous bone was placed at the nonunion site. Matchstick bone grafts which were longitudinally placed and encircled on the nonunion site were tied with periosteum using 3–4 stitches. Union was determined via postoperative plane X-ray. Clinical status was evaluated using the visual analogue scale score for pain, and Constant and American Shoulder Elbow Surgeon score. RESULTS: All patients had a stable radiological union at the follow-up. The mean duration from index operation to nonunion operation was 13.2 months (7–32 months). The mean follow-up period was 20.1 months (8–56 months), and the mean duration until union was 11.2 weeks (8–16 weeks). All clinical scores were improved at the final follow-up (p<0.001). The mean segmental defect was 3.3 ± 2.6 mm (1–18 mm); and the difference in clavicular length between operative and non-operative site was 5.9 ± 6.9 mm. CONCLUSIONS: Matchstick shaped autologous iliac bone grafting technique in clavicle nonunion is acceptable with a high union rate.

Clavicle Nonunion: Matchstick Bone-grafting and Osteosynthesis

BACKGROUND: This study was conducted to evaluate the surgical outcomes of plate fixation using autologous iliac bone graft shaped in the form of a matchstick in clavicle nonunion resulting from prior surgical or non-surgical management. METHODS: From May 2005 to February 2013, 17 patients underwent surgery for clavicle nonunion. The mean age at the time of surgery was 48.8 years. The iliac bone was harvested and shaped into slivers approximately 3 cm long, which resembled matchsticks. After opening of the medullary canal, the plate and screws were applied and cancellous bone was placed at the nonunion site. Matchstick bone grafts which were longitudinally placed and encircled on the nonunion site were tied with periosteum using 3–4 stitches. Union was determined via postoperative plane X-ray. Clinical status was evaluated using the visual analogue scale score for pain, and Constant and American Shoulder Elbow Surgeon score. RESULTS: All patients had a stable radiological union at the follow-up. The mean duration from index operation to nonunion operation was 13.2 months (7–32 months). The mean follow-up period was 20.1 months (8–56 months), and the mean duration until union was 11.2 weeks (8–16 weeks). All clinical scores were improved at the final follow-up (p<0.001). The mean segmental defect was 3.3 ± 2.6 mm (1–18 mm); and the difference in clavicular length between operative and non-operative site was 5.9 ± 6.9 mm. CONCLUSIONS: Matchstick shaped autologous iliac bone grafting technique in clavicle nonunion is acceptable with a high union rate.