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Other Soft Tissue Pain Syndromes

The authors treated calcifying tendonitis of the shoulder joint with low-dose radiotherapy while taking note of the calcification[s] present. In particular, they used the Farin classification and sought to determine if patients with certain Farin classification types fared better than other patients with different Farin classification types. The Farin (1) classification depends on ultrasonographic examination. Type I consists of a hyper-reflexive lesion with a well-circumscribed dorsal acoustic shadow. This lesion is smaller in Type II and not detectable in Type III. In addition to using the Farin classification, the Gartner score (2) was also used. Over a three-year period, a total of 102 patients [115 painful shoulder joints] underwent low-dose radiotherapy. There were 42 males and 60 females, mean age 57 years [range 40–79 years]. Sixty-one patients had therapy to the right shoulder, 28 to the left shoulder, and 13 to both shoulders. Ultrasound was performed using a 7.5 MHz linear transducer. A single dose of 0.5 Gy was given in increments for a total dose of 3.0 Gy. There was a six-week break from treatment, and a second series with a second cumulative dose of 3.0 Gy was administered. Of the 115 shoulders, 29 [26 percent] had calcifying tendonitis with a variety of other diagnoses represented, including tendovaginitis, partial tear of rotator cuff, and adhesive capsulitis. A total of 82 percent of all shoulders [94 of 115] responded well to radiotherapy with pain relief after a follow-up of 18 months. In Type I calcifying tendonitis, of 11 cases, five responded very well, three patients had a good response, and three patients did not respond at all. Eighteen patients with Type III Farin tendinosis, however, had complete pain relief with improvement and mobility of the shoulder joint after completion of therapy. This result continued during the observation period after six weeks and 18 months. The authors concluded that sonographic classification of calcific tendonitis has a good outcome after radiotherapy. They noted that the patients with Farin Type III calcification benefited the most from low-dose radiotherapy. The authors also noted that there was no significant correlation between the Gartner classification score and treatment outcome.