[Radiotherapy for shoulder impingement].
OBJECTIVE
Up to now, degenerative shoulder diseases were summarized by the term "periarthritis humeroscapularis". Actual shoulder diseases can be differentiated etiopathologically according to a primary and secondary impingement syndrome. Narrowing of the subacromial space, which is caused by an osseous shape variant, leads to primary impingement. Secondary impingement develops, when the subacromial space is reduced by swelling tissue below the osseous shoulder roof. This study aimed for the exact diagnosis to indicate therapy and to classify the results according to the Constant score.


METHODS
From August 1999 to September 2002, 102 patients with 115 shoulder joint conditions underwent radiation therapy (RT). All joints received two RT series (6 x 0.5 Gy/series) applied in two to three weekly fractions, totaling a dosage of 6.0 Gy (250 kV, 15 mAs, 1-mm Cu filter). The second RT course started 6 weeks after the end of the first. 115 shoulders were examined before RT, 6 weeks after the second RT course and, finally, during the follow-up from January to May 2003.


RESULTS
Pain relief was achieved in 94/115 shoulder joints (82%) after 18-month follow-up (median). A significant difference existed between secondary impingement and primary/non-impingement according to response. Tendinosis calcarea, bursitis subdeltoidea, tendovaginitis of the long biceps tendon, and capsulitis adhaesiva responded well to therapy.


CONCLUSIONS
Shoulder diseases of secondary impingement demonstrate a good response to RT. Less or no benefit was found in primary impingement syndrome or complete rotator cuff disruption and acute shoulder injuries, respectively.
Adamietz
Boris
B
Institut für Radiologie, Universitätsklinikum Erlangen, Erlangen.
Sauer
Rolf
R
Keilholz
Ludwig
L
D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging / Q000528:radiation effects; D000328:Adult; D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010489:Periarthritis / Q000000981:diagnostic imaging / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000528:radiation effects; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000532:radiotherapy*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000528:radiation effects; D016896:Treatment Outcome; D014463:Ultrasonography