Rotator Cuff Preservation in Arthroscopic Treatment of Calcific Tendinitis

Maier, Dirk; Jaeger, Martin; Izadpanah, Kaywan; Bornebusch, L.; Suedkamp, Norbert P.; Ogon, Peter

doi:10.1016/j.arthro.2013.01.031

Cited by 46 publications

(45 citation statements)

References 21 publications

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“…More "radical" treatment options include shock wave therapy, 13 image-guided procedures 14 and surgery. [15][16][17] In the 1990s, ultrasound-guided techniques were developed to address this issue. 18,19 Today, ultrasound-guided percutaneous treatment is pivotal.…”

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confidence: 99%

Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome

Bazzocchi

Pelotti

Serraino

et al. 2016

BJR

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Objective: Rotator cuff calcific tendinitis (RCCT) is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. Between non-surgical and surgical treatment options, today a few minimal invasive techniques are available to remove the calcific deposit, and they represent a cornerstone in the management of this painful clinical condition. The aim of the work was a retrospective evaluation of double-needle ultrasoundguided percutaneous fragmentation and lavage (DNL), focused on understanding the factors which are of major importance in determining a quick and good response at 1 month. Methods: A series of 147 patients affected by RCCT and suitable for DNL were evaluated. A systematic review of anamnestic, clinical and imaging data was performed in 144 shoulders treated in a single-centre setting. Clinical reports and imaging examinations were revisited. The inclusion criteria were submission to DNL, therefore fitness for the percutaneous procedure, and following 1-month follow-up. There was no exclusion owing to risk of bias. The treatment was defined as successful for constant shoulder modified score (CSS) improvement of .50% at 1 month. Results: In 70% of shoulders, the treatment resulted in a quick and significant reduction of symptoms (successful). On the whole, CSS increase at 1 month was estimated at 91.5 6 69.1%. CSS variations were significantly related to age of patients (better results between 30 and 40 years old), calcification size (more relevant improvement for middle-sized calcifications, 12-17 mm), sonographic and radiographic features of calcific deposits (softer calcifications) and thickening of subacromial/subdeltoid bursa walls. In the final model of stepwise regression for CSS variation, ultrasound score pre-treatment and posttreatment, the distance between bursa and calcification before treatment and the size of post-treatment calcification area were shown to be independently correlated to success. Numeric rating scale score for pain showed similar results. Pain at admission was also related to age, calcification size, ultrasound and Gärtner score, power Doppler positivity, bursal wall thickening and biceps tenosynovitis. Conclusion: The success of the procedure with quick improvement in function and symptoms is warranted in soft and middle-sized calcifications, in young adults. Advances in knowledge: Ultrasound-guided percutaneous procedures for RCCT must be safe, effective and with prompt pain relief and function restoration. This study shows which clinical picture is more favourable to this purpose and actual prognostic factors for DNL (soft and middle-sized calcifications, in young adults, are more favourable). INTRODUCTIONRotator cuff calcific tendinitis (RCCT) is a common condition, occurring in up to 20% of painful shoulders and even present in up to 7.5% of asymptomatic shoulders.

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confidence: 99%

Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome

Bazzocchi

Pelotti

Serraino

et al. 2016

BJR

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“…10 However, a recent study looked at a series of patients with calcific tendonitis whose resection was focused on preserving the integrity of the rotator cuff. 11 A complete deposit removal was achieved in 82 of 99 patients, and 17 of 99 had some minor residual calcium remaining. Preserving the integrity of the rotator cuff while removing as much of the calcium deposit as possible yielded good to excellent results in 90% of both groups of patients and avoided iatrogenic tendon defects.…”

Section: Discussionmentioning

confidence: 99%

“…The minor residual deposits did not impair clinical outcomes and spontaneously resolved at follow-up. 11 In contrast, Tillander and Norlin 4 reported 2 matched-pair groups with 25 patients each with and without radiographic calcium undergoing arthroscopic subacromial decompression while the calcium deposit was left untouched. At 2 years, radiographs showed the disappearance or decrease in size of the calcific deposits in 79%.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Treatment of Calcific Tendonitis

Barber

Cowden

2014

Arthroscopy Techniques

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Calcific tendonitis, or calcifying tendonitis, is a common disorder characterized by the multifocal accumulation of basic calcium phosphate crystals within the rotator cuff tendons. In most cases, the multifocal calcifications are located 1 to 2 cm from the insertion of the supraspinatus tendon on the greater tuberosity. The initial treatment should be nonoperative including oral anti-inflammatory medication and physical therapy. If this is unsuccessful, arthroscopic debridement of the deposit is effective. The technique used is an arthroscopic localization and debridement without associated subacromial decompression. The rotator cuff should be evaluated for partial-and full-thickness tears before and after the debridement of calcifications. If a partial-or full-thickness rotator cuff tendon tear is identified, it should be treated in a fashion consistent with those without associated calcium deposits. In our hands, tears 5 mm or greater in depth are repaired using a tendon-to-tendon or tendon-to-bone technique. Tears with less depth are debrided and then left alone. Arthroscopic debridement of calcific tendonitis can yield excellent functional results and high patient satisfaction.

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“…However, techniques intended for preserving tendons or involving a small tendon incision have been associated with a higher rate of residual calcific deposit (17% 56%) 10,15 , as well as concern about symptomatic relapse. Subacromial decompression alone is also likely to be followed by recurrence, as it has been shown to result in residual calcific deposit in all the patients at the final follow-up examination 14 .…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Removal and Tendon Repair for Refractory Rotator Cuff Calcific Tendinitis of the Shoulder

et al. 2017

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Background:The purpose of this study was to evaluate clinical and radiological outcomes of arthroscopic treatment for refractory rotator cuff calcific tendinitis of the shoulder.Methods: Subjects were 37 patients (35 women and 2 men; mean age, 47.8 years; age range 34 61 years) who had undergone arthroscopic treatment for calcific tendinitis of the shoulder. Despite sufficient nonsurgical treatments, all patients had residual calcific deposit with persistent or recurrent pain. Before surgery, all patients underwent 3-directional radiographs of the shoulder and three-dimensional computed tomography to determine the location and size of calcific deposit. Arthroscopic surgery was performed with the patient under general anesthesia in the lateral decubitus position. A 2-cm single longitudinal incision was made with a radiofrequency hook blade on the tendon surface above calcific deposit. Calcific deposit was removed as much as possible with a curette and a motorized shaver. The incised tendon was repaired with a side-to-side suture with strong sutures. The Japanese Orthopaedic Association shoulder score was used to evaluate clinical outcomes. The extent of calcific deposit removal was evaluated with radiographs obtained before surgery, 1 week after the surgery and at the final follow-up examination. Results:The mean follow-up duration was 30.4 (range, 13 72) months. The mean shoulder score significantly improved from 69.7 (range, 58 80) points before surgery to 97.8 (range, 89 100) points at the final follow-up examination. Postoperative radiographs in all patients, showed that the calcific deposit was resolved or reduced and those from 1 week after surgery to the final examination showed no evidence of recurrence or enlargement of calcific deposit. The calcific deposit had completely resolved in 34 patients but remained in 3 patients. Conclusion:When treating calcific tendinitis of the shoulder, it is important to accurately determine the size and location of calcific deposit by radiographs and 3-dimensional computed tomography. Satisfactory clinical and radiological outcomes can be expected after reliable removal of calcific deposit through a single longitudinal incision and side-to-side repair with strong sutures, in association with an appropriate rehabilitation program. (J Nippon Med Sch 2017; 84: 19 24)

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Rotator Cuff Preservation in Arthroscopic Treatment of Calcific Tendinitis

Cited by 46 publications

References 21 publications

Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome

Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome

Arthroscopic Treatment of Calcific Tendonitis

Arthroscopic Removal and Tendon Repair for Refractory Rotator Cuff Calcific Tendinitis of the Shoulder

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