A Novel Ultrasound-Guided Interventional Procedure for the Combined Treatment of Rotator Cuff Calcific Tendinopathy Complicated with Adhesive Capsulitis: The 'Rizzoli' Technique.

Calcific tendinopathy (CT) is a common condition that usually affects rotator cuff tendons; rarely other tendons are involved ( 1 Speed C.A. Hazleman B.L. Calcific tendinitis of the shoulder. N Engl J Med. 1999; 340: 1582-1584https://doi.org/10.1056/NEJM199905203402011 Crossref PubMed Scopus (135) Google Scholar , 2 Hayes C.W. Conway W.F. Calcium hydroxyapatite deposition disease. Radiographics. 1990; 10: 1031-1048https://doi.org/10.1148/radiographics.10.6.2175444 Crossref PubMed Scopus (162) Google Scholar , 3 Ponti F. Parmeggiani A. Martella C. et al. Imaging of calcific tendinopathy in atypical sites by ultrasound and conventional radiography: a pictorial essay. Med Ultrason. 2022; 24: 235-241https://doi.org/10.11152/mu-3101 Crossref Scopus (2) Google Scholar ). The disease can be extremely painful, and several treatments have been proposed over the last decades. Currently, ultrasound-guided irrigation is considered the gold standard treatment for CT, both in the common rotator cuff location as well as in different atypical sites ( 4 Papalexis N. Ponti F. Rinaldi R. et al. Ultrasound-guided treatments for the painful shoulder. Curr Med Imaging. 2022; 18: 693-700https://doi.org/10.2174/1573405617666211206112752 Crossref Scopus (3) Google Scholar , 5 Spinnato P. Safety and effectiveness of ultrasound-guided irrigation for painful calcific tendinopathy located outside the rotator cuff. Acad Radiol. 2022; 29: 172https://doi.org/10.1016/j.acra.2021.10.016 Abstract Full Text Full Text PDF Scopus (1) Google Scholar , 6 Spinnato P. Ponti F. D'Agostino V. et al. Ultrasound-guided percutaneous irrigation of calcific tendinopathy outside the rotator cuff: short-term evaluation. Skeletal Radiol. 2022; 51: 2039-2044https://doi.org/10.1007/s00256-022-04035-3 Crossref Scopus (0) Google Scholar ). Moreover, it is well known that CT of the rotator’s cuff may lead to adhesive capsulitis (AC) of the glenohumeral joint ( 7 Merolla G. Bhat M.G. Paladini P. et al. Complications of calcific tendinitis of the shoulder: a concise review. J Orthop Traumatol. 2015; 16: 175-183https://doi.org/10.1007/s10195-015-0339-x Crossref PubMed Scopus (39) Google Scholar ), increasing the pain and worsening the functional impairment. Indeed, ‘frozen shoulder’ can complicate CT, usually when prolonged pain is followed by limited range of motion resulting in secondary AC ( 7 Merolla G. Bhat M.G. Paladini P. et al. Complications of calcific tendinitis of the shoulder: a concise review. J Orthop Traumatol. 2015; 16: 175-183https://doi.org/10.1007/s10195-015-0339-x Crossref PubMed Scopus (39) Google Scholar ). In the recent years, several radiological signs of AC have been recognized to confirm the diagnosis, and several minimally invasive image-guided treatments have been proposed. Among those new treatments, ultrasound-guided percutaneous hydrodistension has proven to be safe, effective, and easy to perform ( 8 Papalexis N. Parmeggiani A. Facchini G. et al. Current concepts in the diagnosis and treatment of adhesive capsulitis: role of diagnostic imaging and ultrasound-guided interventional procedures. Radiol Med. 2022; 127: 1390-1399https://doi.org/10.1007/s11547-022-01566-6 Crossref Scopus (1) Google Scholar ).