Background Generally, early mobilization in patients with subacromial shoulder tendinitis has shown a benefit in terms of recovery of function. By their nature, subacromial acute calcifying tendinitis might be an exception, however there are no studies that have compared the mobilization with rest or sling use in such patients.
Objectives To compare benefits of early movement and rest with sling in patients diagnosed by acute subacromial calcifying tendinitis.
Methods We reviewed the clinical chart of patients with acute subacromial calcifying tendinitis of three different centers that carry on a similar management of this patology. This protocol includes radiological, ultrasound diagnosis and eventually the realization of infiltration of glucocorticoid assisted real-time ultrasound. Patients were classified in cases (patients without symptomatic improvement) and controls (patients with satisfactory symptoms control defined by its reincorporation to normal activity). We used as cutoff time: 30 days after diagnosis ±10 days. We evaluated the exposure to immobilization with a sling at least 12 hours per day. No patient had been infiltrated with glucocorticoids. All patients were diagnosed with ultrasound or radiology of shoulder and all were treated with NSAIDs and/or opioids.
Results One hundred twenty subacromial acute calcifying tendinitis diagnosis were established between 2011 and 2013, of which 77 were included for presenting baseline data and control at one month. Their corresponding medical records were reviewed and grouped according to clinical outcome once made the corresponding review. Thirty patients (38.9%) were considered as cases (no improvement) and 47 (61.1%) were considered controls (return to normal activity). The gender ratio and mean age of the two groups was similar. The proportion of patients receiving NSAIDs, NSAIDs and opioids or opioids alone was similar in the two groups. Twenty-four cases had used the sling according to indication (51.06%) while 23 had not used or had used less than half the time indicated (48.94%). Furthermore, 24 controls had used the sling (80.0%) while 6 (20.0%), no (p value =0.0154 bilateral, Fisher).
Conclusions Immobilization with sling appears to be associated with better clinical response in the acute management of subacromial calcifying tendinitis. Although early mobilization in other forms of tendinitis of the shoulder is fairly widespread, inflammatory pathophysiology of calcifying tendinitis, secondary to a mechanical phenomenon of subacromial entrapment, could justify that early mobilization play a deleterious role in the rehabilitation of these patients and it would therefore be inadvisable.
Disclosure of Interest : None declared
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