Image Quiz
Progressive Shoulder Pain in a Forty-nine-Year-Old Woman Following Extracorporeal Shock-Wave Treatment for Rotator Cuff Tendinopathy1
A forty-nine-year-old woman underwent serial magnetic resonance imaging examinations of the left shoulder over a period of ten months to evaluate pain, which had begun after she pulled a heavy object. The imaging was performed with a phased-array shoulder coil and a standard 1.5-T whole-body imager (Sonata; Siemens Medical Solutions, Erlangen, Germany). The protocol included coronal and axial T1-weighted imaging, coronal and sagittal turbo spin-echo T2-weighted imaging, coronal T1-weighted imaging with fat saturation, and axial T1-weighted imaging without fat saturation after intravenous injection of a gadolinium-based contrast agent (Omniscan; Amersham/GE Healthcare, Milwaukee, Wisconsin). The serial magnetic resonance examinations were performed before (Figs. 1-A and 1-D), three months after (Figs. 1-B and 1-E), and seven months after (Figs. 1-C and 1-F) extracorporeal shock-wave treatment. The first magnetic resonance examination revealed shoulder impingement with a partial tear of the supraspinatus tendon on the humeral side, subacromial and subdeltoid bursitis, and biceps tenosynovitis (Figs. 1-A and 1-D).
The patient then received one extracorporeal shock-wave treatment each week with a piezoelectric system (Piezoson 100; Richard Wolf, Knittlingen, Germany) for three consecutive weeks. The impulse rate was 3000 shocks per session with an energy of 0.78 mJ/mm2. The total energy given (2340 mJ/mm2) was within the range recommended by the manufacturer (300 to 5850 mJ/mm2).
Three months after the extracorporeal shock-wave treatment, the follow-up magnetic resonance examination was performed (Figs. 1-B and 1-E). No specific treatment was given. Seven months after the extracorporeal shock-wave treatment, another follow-up magnetic resonance examination was performed (Figs. 1-C and 1-F).
| For larger view, click on image |
Fig. 1-A |
Fig. 1-B |
Fig. 1-C |
Fig. 1-D |
Fig. 1-E |
Fig. 1-F |
|
