Calcified tendinosis represents a clinical challenge to both patient and treat. For large Scale formation in the subacromial space so the patient will in many cases end up with a acromionreseksjon to create more space.
A method that is constantly evolving but now sailing up as a good option, lime chicken. The method is that you under sonographic guidance and local anesthesia, enters shoulder tendon with an injection needle. It is then pumped into numbing agent (fast-acting local anesthetic). The air flow from inside the chalk formation ensures that the cup that dissolves flushed into the syringe and the level of calcium in the tendon reduced.
The treatment is concluded by conducting a dry needling of residual calcium remaining in the tendon for the body to break this down even, should it be necessary. In order to avoid a sharp inflammation of the subacromial bursa after the procedure so inserted 1 ml kenacort (cortisone). This ensures that the patient does not get severe pain after the procedure, and since it goes into slime bag so it does not prevent macrophage task of eating the chalk formation after surgery or healing, the tendon tissue after dry needlingen.
The patient comes to the control after 4-6 weeks, considering the need to repeat the treatment.
Lime Chicken is a method that is increasingly well documents in research. There are described several methods, both with one and two injection needles. If one uses the technique with one needle so it is important to place the needle correctly in classification. It is also essential for the result that the calcifications are of such type that it can be dissolve. This can in some cases decide in advance in connection with the ultrasound scan. Chalice indeed appear as a by this time, structure in otherwise normal tendon tissue, and it provides some "shadow" in the picture that indicates that it has a harder consistency than the rest of the tendon tissue.
Calcifications that have stood for a long time can provide a powerful shadow on the ultrasound images. These calcifications are often impossible to resolve with rinsing, and you must change the technique to dry needling as described later in this article.
Method with 1 needle:
Pull up about 4 ml numbing agent in a 10-20 ml large syringe. Select a gross injection needle of sufficient length to reach the chalk formation under sonographic guidance. Needles of 50 mm is suitable often. The thickness of the needles should be 19-21G. Less serious injection needles tend to clog with lime enters the calcifications and the method will not work as intended. Make sure you start to inject some numbing agent on the way in when you pass bursae and controls the needle into the chalice. This way you avoid clog the needle and the patient will be sedated enough so that the interference is not experienced pain. There is no need for anesthesia before surgery.
Once you have placed the needle in the cup so it is important not to lead the needle too far. If one causes the needle through the cup and into the tendon tissue on the other side, so you create an output of the solution. It will make it impossible to create enough pressure in chalk formation to get this to flow into the needle and into your syringe.
Do not be impatient if it does not come any scale back the syringe immediately. Pump gently and rhythmically the sprayer. Tap and release immediately. Slowly but surely, they will loosen calcium crystals from tendon tissue and follow the solution back into the syringe. It is crucial that you now hold the rear end of the syringe below naletuppen so that gravity can do prevails.
Keep on with the technique until you notice that it comes out more lime. Then you can gently try to change the position of the needle and continue. When you can no longer get out more calcium you need to do an evaluation if you have removed enough to end the procedure. If you are successful then optimally remove the needle, and ends the procedure of putting 1 ml kenacort (cortisone) mixed with 2 mL Marcaine (local anesthetic) into the subacromial bursa. This is also under sonographic guidance to ensure proper placement. Due to the procedure ends with a cortisone injection in the slime bag because it will leak some lime into this during the procedure, and this creates a powerful bursitis. To prevent the patient is in pain after treatment, so you set the quick-acting cortisone. This does not appear to damage the healing, the injury or the body's ability to absorb the rest of the cup.
If you closed the lime chicken not feel that you have gotten out enough calcium, or parts of it are hard to wash out, so you can stop the procedure by performing a sonographic guided dry needling of residual calcium in the tendon. This causes the cup to fragment so that the body can break down the rest.
Method with 2 needles:
Method with two needles are relatively similar with one needle. The only difference is that one uses one injection needle for pumping the liquid to loosen the lime, and build up the required pressure inside it, and a second needle end of the cup. Method with two needles requires that you bring a colleague who can keep one syringe during surgery.
Dry needling of soner classification
There are a variety of different shapes and phases of calcified tendinosis. Some are like a lot of toothpaste inside a restricted area of the tendon tissue. Other shapes may be hard as bone tissue, while a third form appears scattered lime deposits over a larger area of the tendon tissue without forming a common structure. The first form is often suitable for lime chicken as mentioned earlier in the article. The second and third form of hard Scale formation or scattered deposits suited to dry needling.
The method is that you go in with a needle attached to a 5.2 ml syringe. The needle may be 40mm-50mm long and thick 21-23G. When the needle passes into the tendon tissue as you carefully inject about 2-3 ml of numbing agent around limestone formation. One lets the needle stand patient and wait about 5 min before gently leads needle into and out of limestone deposit the tendon so that this fragment sufficient for the body to absorb it. The trauma caused to the tendon tissue by this method appears to create a reaction that causes the body to break down the calcium tissue and absorb this.
The procedure is concluded by injecting 1 ml kenacort (cortisone) were mixed with 2 ml of Marcaine (local anesthetic) in the subacromial bursa. Use a new needle and syringe for this so as to avoid spraying lime from the needle into the bursae.
Control or 4-6 weeks
All patients who have undergone a dry needling or lime chicken must come to the control after 4-6 weeks. They will then undergo ultrasound examination to identify the need for further treatment. Some need 2-3 treatments to get rid of all the cup, while some patients need only the first procedure to get satisfactory results.
Why must the cup away?
It is a controversial issue of the chalice in a shoulder tendon needs to be removed to obtain satisfactory results. One can see that research has shown that ESWT treatment of calcified tendinosis is an effective treatment compared with placebo treatment rarely leads to the cup is gone.
A general rule for assessing lime importance for the clinical outcome, whether it creates a thickening of the tendon tissue or not. The cup is that a deposition in the tendon, but does not create any lack of space under the acromion as it is not necessary to remove it.
But if the cup gets the tendon to bulge considerably and secondary creates a structural impingement, so it is easier to argue for taking this away.
As an alternative to the acromion resection
One justification for operation with acromion resection is failure to respond to conservative treatment. Included in the conservative treatment is considered here MTT, Redcord, ESWT and / or injection therapy. If acromion also has a type 2 or 3 form that creates a lack of space, then surgery may be the only solution for the patient. But there are many patients who have developed a lack of space due to a calcified tendinosis. These patients do not necessarily need surgery to be good. If one can use simple methods as mentioned above in this article as with the need to remove the acromion roof away.
One can also argue that it is worth a try to take away the cup before choosing surgery. The interference with lime chicken or dry needling is little invasive and provides a shorter rehabilitation. It is also considerably cheaper treatment and relief specialist health / hospitals that have already blasted capacity.
Rehabilitation is vital for performance
After successful treatment where lime is removed from skuldersenene, so expect further action from a physiotherapist. This group of patients often have had long-term pain and impaired function, and the function will not automatically back by the loss of the structural cause of impingement in the shoulder.
The patient must be referred to a physiotherapist for rehabilitation of shoulder function and treating additional concerns already that one often finds in chronic shoulder pain. Since the space under the acromion is now improved so you will now have a greater chance for successful rehabilitation of these patients.
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