Intra-operative ultrasound facilitates the localization of the calcific deposit during arthroscopic treatment of calcifying tendinitis.
OBJECTIVE
Calcifying tendinitis is a common condition of the shoulder. In many cases, arthroscopic reduction in the deposit is indicated. The localization of the deposit is sometimes challenging and time-consuming. Pre-operative ultrasound (US)-guided needle placement in the deposit and pre-operative US marking of the deposit at the skin with a ballpoint are described and recommended methods to alleviate the procedure without using ionizing radiation by fluoroscopy.


METHODS
Intra-operative sonography of the shoulder is introduced as a new method to localize the calcific deposit with high accuracy. After standard arthroscopic buresectomy, the surgeon performs an ultrasound examination under sterile conditions to localize the deposits. A ventral longitudinal US section is recommended, and the upper arm is rotated until the deposit is visible. Subsequently, perpendicular to the skin at the position of the transducer, a needle is introduced under arthroscopic and ultrasound visualization to puncture the deposit.


RESULTS
The presence of snow-white crystals at the tip of the needle proves the exact localization. Consecutively, the curettage can be accomplished. Another intra-operative sonography evaluates possible calcific remnants and the tendon structure.


CONCLUSIONS
This new technique may alleviate arthroscopic calcific deposit curettage by visualizing the deposit without using ionizing radiation. Additionally, soft tissue damage due to decreased number of punctures to detect the deposit may be achieved. Both factors may contribute to reduced operation time.
Sabeti-Aschraf
M
M
Department for Orthopaedics and Orthopaedic Surgery, General Hospital of Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. manuel.sabeti-aschraf@meduniwien.ac.at
Gonano
C
C
Nemecek
E
E
Cichocki
L
L
Schueller-Weidekamm
C
C
D001182:Arthroscopy; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D003475:Curettage; D006801:Humans; D007430:Intraoperative Care; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000601:surgery*; D018084:Ultrasonography, Interventional