Friday, September 25, 2015

Rotator cuff tendinosis: MRI and prognosis

Medium-term natural history of cuff tendinosis without cuff tear

These authors evaluated 63 patients with rotator cuff tendinosis without rotator cuff tear, defined as those without full thickness tears who responded to a subacromial lidocaine injection.

The MRI results were classified as: 
Type 1 =  increased  signal intensity due to edema and inflammation of the  tendon. 
Type 2a =  findings on the articular surface suggestive of fibrosis and tendinitis on MRI, in addition to the findings described for type 1. 
Type 2b =  findings on the burial surface suggestive of fibrosis and tendinitis on MRI, in addition to the findings described for type 1.

All patients had an identical initial conservative treatment protocol (acute period of treatment consisting of non-steroidal anti-inflammatory drugs, cold compression, and activity modification).

With a mean followup of 8.5 years, patients were grouped as follows: group 1, no recurrence; group 2, relapsing course; and group 3, chronic course. 

The patients in group 1 tended to be younger with lower BMIs and a shorter duration of symptoms

Comment: While not considered by the authors, we were interested in the prognostic value of the pre-treatment MRI. While the numbers in this study were small, we thought this chart created from their data was of interest.

The therapeutic value of these findings is uncertain

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