الفهرس 
Anatomy of the shoulderOnly 14 pages are availabe for public view
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Abstract
The shoulder is a complex joint due to its anatomy and wide range of movement, and consequently it is frequently affected by diseases of complex etiology. Calcific shoulder tendinitis is a relatively common disease of unknown cause, characterized by the presence of calcium hydroxyapatite crystals deposition in the tendons. Extracorporeal shock wave therapy has emerged as an alternative treatment for RC calcific tendinopathy when conservative treatment fails and prior to invasive procedures. ESWT treatment avoids potential complications and costs of surgery, and reduces the time for rehabilitation. The aim of this study was to evaluate the role of MSK US in the diagnosis and assessment of treatment of calcific shoulder tendinitis and to compare the therapeutic effects of focused, radial, and combined shock wave therapy in the treatment of resistant cases of calcific shoulder tendinitis. This study was carried on 45 patients with resistant calcific shoulder tendinitis, their age ranged from (30 - 68) years, 28 patients were females and 17 were males. They were diagnosed according to the diagnostic criteria for upper limb disorders proposed by the United Kingdom Health and Safety Executive Workshop (189) and confirmed by diagnostic MSK US. Patients were divided into 3 groups, each group included 15 patients. group I received F-SW (1500 shocks, 0.3 mj/mm2, 4 Hz) group II received R-SW (2000 shocks, 2.5 bars, 4 Hz) and group III received combined shockwaves with the same previous parameters. The following assessment was done before treatment, at 1 week after treatment, and after 3 months follow up: I – Clinical assessment by: 1 – Complete history taking. 2 – Complete clinical examination. A - Assessment of degree of shoulder pain during movement by (VAS). B - Assessment of degree of shoulder tenderness. C - Goniometric assessment of active ranges of shoulder movement. D - Special tests for shoulder tendinitis. II - Functional assessment of the shoulder by (SDQ). III - Ultrasonographic assessment by MSK US. The results of this study showed that: Before treatment, the three studied groups were matched as regards age, sex, occupation, disease duration, affected side, clinical parameters (pain, tenderness, ROM), shoulder function (SDQ), and ultrasonographic findings. As regards shoulder pain assessed by VAS and the degree of tenderness, there was better significant improvement of (VAS) and tenderness degree at 1 week after treatment and after 3 months follow up when compared with before treatment and also at 3 months follow up when compared with 1 week after treatment in the three studied groups. Comparison of improvement of VAS in the three studied groups showed that the best improvement at 1 week after treatment and after 3 months follow up was obtained in group III when compared with group I and group II, whereas the differences of improvement of VAS between group I and group II were non-significant. At the end of this study, the best complete relief of shoulder pain was obtained in group III (60 %) and it was significantly better than group II and group I (20 % and 13.3 %) respectively. Comparison of improvement of shoulder tenderness degree in the three studied groups revealed that, the best improvement of tenderness degree was obtained in group III, but the difference was statistically significant between group III and group I. As regards active ROM of the shoulder, there was better significant improvement of the shoulder (flexion, extension, abduction, external, and internal rotation) at 1 week after treatment and after 3 months follow up when compared with before treatment in the three studied groups. In group I, there was better significant improvement of shoulder abduction at 3 months follow up when compared with 1 week after treatment. In group II and group III, there was better significant improvement of shoulder flexion, abduction, and internal rotation at 3 months follow up when compared with 1 week after treatment. Comparison between the three studied groups as regards improvement of active shoulder ROM at 1 week after treatment and after 3 months follow up revealed that, the best improvement of active shoulder abduction and internal rotation was obtained in group III when compared with group I and group II.