Background A preferable surgical treatment for patients with conservative therapy-resistant calcifying tendinitis of the shoulder is still a matter of debate. Therefore, the purpose of this study was to evaluate and compare short-term clinical and radiological results of three surgical treatment options for these patients. Methods A multicenter randomized trial was conducted. Sixty-nine patients were randomly assigned to receive 1. subacromial decompression (Group SAD), 2. debridement of calcifications (Group D), or 3. debridement of calcifications with SAD (Group D + SAD). Stringent inclusion and exclusion criteria were used. The primary outcome was an improvement in VAS for pain (pVAS) 6 months postoperatively. Secondary outcomes were an improvement in pVAS 6 weeks postoperatively, functional outcomes (CMS, DASH, ASES), radiological outcome, additional treatments, and complications. Results The improvement in pVAS was significant in all groups (p < 0.001) and did not differ between the groups after 6 months. Six weeks postoperatively, the improvement in pVAS was significantly (p = 0.03) less in Group SAD compared to Group D + SAD (16.5 mm, SD 19.3 mm vs 33.1 mm, SD 19.7 mm, respectively). The mean size of calcifications decreased significantly in all groups (p < 0.0001). In Group SAD, the size of the calcifications decreased less (p = 0.04) compared to Group D and Group D + SAD after 6 weeks. Group SAD received more additional treatments (p = 0.003) compared to Group D + SAD (9 vs 1), which were mainly subacromial cortisone injections. Conclusions All patient groups showed significant pain relief and an improvement in shoulder function 6 months after surgery. However, patients in Group SAD showed inferior pain relief and less improvement in DASH score after 6 weeks. Furthermore, this group required more postoperative additional treatments. No significant differences in clinical and radiological outcomes were observed between patients in Group D compared to Group D + SAD. Therefore, an arthroscopic debridement without subacromial decompression seems to be advisable for patients with therapy-resistant calcifying tendinitis of the shoulder. Level of evidence 2, Open-Label Randomized Clinical Trial. IRB METC Zuyderland MC. Number: 14-T-112. Registered at trialregister.nl NL 4947.

Background Shoulder complaints arise from a single pathology or a combination of different underlying pathologies that are hard to differentiate in general practice. Subgroups of pathologies have been identified on the basis of ultrasound imaging that might affect treatment outcomes. Objective Our aim was to validate the existence of different subgroups of patients with shoulder complaints, based on ultrasound-detected pathology, and compare clinical features among them. Profiling shoulder patients into distinct shoulder pathology phenotypes could help designing tailored treatment trials. Methods This was a cross-sectional study in general practice. Data were extracted from 840 first visit patient records at a single diagnostic centre in the Netherlands. Exclusion criteria were age &lt;18 years and previous shoulder surgery. Latent class analysis was used to uncover cross-combinations of ultrasound detected pathologies, yielding subgroups of shoulder patients. The uncovered subgroups were compared for demographic and clinical characteristics. Results We uncovered four distinct subgroups of patients with shoulder complaints: (i) Frozen shoulder group (11%), (ii) Limited pathology group (44%), (iii) Degenerative pathology group (31%) and (iv) Calcifying tendinopathy group (15%). Group comparisons showed significant differences in demographic and clinical characteristics among subgroups, consistent with the literature. Conclusion In a general practice population, we uncovered four different phenotypes of shoulder patients on the basis of ultrasound detected pathology. These phenotypes can be used designing tailored treatment trials in patients with shoulder complaints.

Background: A preferable surgical treatment for patients with conservative therapy resistant calcifying tendinitis of the shoulder is still a matter of debate. Therefore, the purpose of this study was to evaluate and compare short-term clinical and radiological results of three surgical treatment options for these patients. Methods: A multicenter randomized trial was conducted. 69 patients were randomly assigned to receive 1. subacromial decompression (Group SAD), 2. debridement of calcifications (Group D), or 3. debridement of calcifications with SAD (Group D+SAD). Stringent inclusion and exclusion criteria were used. Primary outcome was improvement in VAS for pain (pVAS) six months postoperatively. Secondary outcomes were improvement in pVAS six weeks postoperatively, functional outcome (CMS, DASH, ASES), radiological outcome, side treatments and complications. Results: The improvement in pVAS was significant in all groups (p<0.001) and did not differ between the groups after six months. Six weeks postoperatively, the improvement in pVAS was significantly (p=0.03) less in Group SAD compared to Group D+SAD (16.5mm, SD 19.3mm vs 33.1mm, SD 19.7mm, respectively). The mean size of calcifications decreased significantly in all groups (p<0.0001). In Group SAD the size of the calcifications decreased less (p=0.04) compared to Group D and group D+SAD after six weeks. Group SAD received more side treatments (p=0.003) compared to Group D+SAD (9 vs 1), which were mainly subacromial cortisone injections. Conclusions: All patient groups showed significant pain relief and improvement of shoulder function six months after surgery. However, patients in group SAD showed inferior pain relief and improvement in DASH score after six weeks. Furthermore, this group required more postoperative side treatments. No significant differences in clinical and radiological outcomes were observed between patients in group D compared to group D+SAD. Therefore, an arthroscopic debridement without subacromial decompression seems to be advisable for patients with therapy resistant calcifying tendinitis of the shoulder. Level of evidence: 2, Open Label Randomized Clinical Trial. IRB: METC Zuyderland MC. Number: 14-T-112. Registered at trialregister.nl: NL 4947