AB1126 ULTRASOUND CHANGES IN PATIENTS WITH CALCIFICATIONS IN THE SUPERSPINATUS TENDON BEFORE AND AFTER THE DEVELOPMENT OF A SUBACROMIAL PAINFUL SYNDROME
Authors: Carlos Guillén-Astete, Andrea Briones-Figueroa
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The relationship between subacromial syndrome (SS) and the presence of calcifications in the thickness of the superspinatus tendon is complex. It is undeniable that the presence of a solid body hinders the movement of the rotator cuff through the subacromial space and to some extent contributes to the trapping that conditions pain and functional limitation, but, on the other hand, calcifications in the thickness of the supraspinatus tendon are incidental findings that have no clinical significance or whose presence precedes the painful syndrome in months or years. We understand that in a SS related to calcification, it contributes as an irreducible agent that conditions an inflammatory response of the tendon when it attempts to cross the subacromial space, however, there are no studies available that explain this relationship from a sonoanatomic perspective. <h3>Objectives</h3> To determine the extent to which the disposition and characteristics of a calcification of the supraspinatus tendon, or of the tendon itself, are modified when an SS is triggered. <h3>Methods</h3> A quasi-experimental, "before-after" study was conducted with individuals who presented a SS and in whom incidental calcification in the TSE had been previously diagnosed in an ultrasound study. Demographic data and static images from the ultrasound studies of each patient were compared. The explanatory variable was time (before-after) and the response variables in image were: (1) Increased tendon thickness measured at 30mm from the deep edge of the acromion (GROSORB), (2) Increased tendon thickness measured at the height of the middle of the longitudinal axis of the calcification (GROSORC), (3) Longitudinal axis of the calcification (LONGC), (4) Thickness or height of the calcification, when this was measurable (ALTC), and (5) Distance between the calcification and the deep end of the acromion (DISTC). In addition, two indices were determined: (a) Increased tendon thickness in the calcification zone (GROSORC/GROSORB) and (b) proportion of tendon thickness occupied by calcification (ALTC/GROSORC). The measurements were carried out using the software of the equipment in which the original and subsequent study was made (GE Logiq e; Toshiba Nemio XG). <h3>Results</h3> The "before" ultrasounds were performed between 2012 and 2016 and the "after" ultrasounds between 2015 and 2018. The time fashion between the two ultrasounds for each patient was 2 years. Thirty-three subjects were included, with an average age of 47.5 SD 7.6 years. Proportion of women 66.6%. Proportion of dominant shoulders (51.1%). As shown in table 1, the most significant changes were the thickness of the tendon measured at the height of the middle of the longitudinal axis of calcification and the increase of this measure with respect to the thickness measured at 30mm from the deepest region of acromion (GROSORC/GROSORB). Although the calcification height also showed a statistically significant increase, it could only be measeured in 20 of the 33 subjects. In the correlation tests, the GROSORC/GROSORB index increase correlated strongly with the DISTC (Coef. Pearson 0.686, P&lt;0.01) and with the longitudinal diameter of the calcification (LONGC) (Coef. Pearson 0.797, P&lt;0.01). <h3>Conclusion</h3> The most important factor that explains the development of an SS associated with calcification is the increase in tendon thickness at the height of the calcification itself and, at the same time, this measure increases when the calcification is more lateralized and the more elongated its longitudinal diameter. These modifications could have implications when deciding the therapeutic management of these processes. <h3> Disclosure of Interests</h3> None declared