Calcifications in the cuff: take it or leave it?

Abstract

Objectives: The aim of this study was to evaluate whether removing the calcifications in the rotator cuff tendons during surgical subacromial decompression improves outcome in patients with calcific tendonitis. Methods: Two groups of 20 patients with a subacromial impingement syndrome and cuff calcifications were operated on. In group A, patients had an anterolateral acromioplasty according to Neer with excision of calcifications. In group B, the same procedure was performed without additional excision of calcifications. After a minimum follow-up of 3 years the patients were assessed with the disabilities of arm, shoulder and hand score (DASH), the visual analogue scale (VAS) for pain, measurements of range of motion (ROM) in all planes, and satisfaction with treatment. Results: The results for the DASH score, ROM, VAS and satisfaction with treatement showed no significant difference between the two groups. Conclusion:The results of our study suggest that removal of calcific deposits with anterolateral acromioplasty does not influence patient outcome. Further prospective studies are needed to determine the optimal surgical treatment for calcific tendonitis. C alcific tendonitis of the shoulder is a common and painful disorder and is characterised by calcifications in the tendons of the rotator cuff (fig 1). The incidence in the healthy population is 2.7%, rising to 6.8% in patients with shoulder pain.1 2 The predominant age is 30-60 years and women are affected slightly more often than men. The calcifications are most often seen in the tendon of the supraspinatus muscle.1 Risk factors for shoulder pain due to problems of the rotator cuff include overhead activities and sports.3 4 The treatment of choice is primarily conservative. This includes rest, physiotherapy, non-steroidal anti-inflammatory drugs and at a later stage a subacromial infiltration with corticosteroids. When conservative treatment fails, surgery can be recommended. In most studies on surgical treatment of calcific tendonitis, removal of the calcifications in combination with a subacromial decompression is only recommended when there are signs of subacromial irritation. [5][6][7][8][9][10][11] However, it has also been advocated that a subacromial decompression alone might be sufficient, stating that the calcifications will dissolve as a matter of natural course. 12 The aim of this study was to evaluate whether it is beneficial for patient outcome to remove the calcifications of the tendons of the rotator cuff when performing a subacromial decompression. MATERIALS AND METHODS PatientsA total of 40 patients (27 women and 13 men) with calcific tendonitis were selected for this retrospective cohort study performed at the St. Elisabeth Hospital in Tilburg, the Netherlands. Two treatment groups (A and B) were defined and treated accordingly. In group A, an open acromioplasty was performed with removal of the calcifications of the rotator cuff. In group B, an open acromioplasty was performed without removal of the calcifications. Four orthopaedic surge...

Evaluating the long-term effect of ultrasound-guided needle puncture without aspiration on calcifying supraspinatus tendinitis

“…This result is similar to results obtained through surgical therapy for calcifying tendonitis. 7,8 The mechanism of calcium deposit dissolution is unknown. Ultrasoundguided needle puncture of calcified deposits may result in inflammation and a hyperemic reaction.…”

“…Some calcified plaques are difficult to aspirate, 6 but certain studies suggest that it may not be essential to completely remove the calcified deposit to obtain substantial clinical improvement. [7][8][9] The aim of this study was to evaluate whether an aspirating procedure would affect patient outcome during ultrasound-guided needle puncture for calcifying supraspinatus tendinitis. February 2000 and June 2005, 81 consecutive patients with pain and calcifying supraspinatus tendinitis (identified with conventional radiographs and ultrasound) were treated with an ultrasound-guided percutaneous needle puncture at the Affiliated Sixth People's Hospital, Shanghai, China.…”

Calcifying tendinitis of the shoulder: Advances in imaging and management

“…Most studies on surgical treatment discuss calcifi cation removal with a subacromial decompression only when there are signs of subacromial irritation [10,24,[35][36][37][38][39]. Other studies, however, advocate subacromial decompression alone, with the hope that calcifi cations will dissolve [40,41]. With either approach, results of subacromial decompression do not have good track records: usually the success percentage is around 75%, higher in the more acute phases with perhaps calcifi cations in the resorptive phases.…”

High-energy Versus Low-energy Extracorporeal Shock Wave Therapy for Calcifying Tendinitis of the Shoulder: Which is Superior? A Meta-analysis

“…However, when this fails, extracorporeal shock wave therapy (ESWT) can be a good and less-invasive treatment option before surgery [10,12]. The exact mechanisms of action of the ESWT are largely unknown; Loew et al [17] postulated that the shock waves lead to a three-way mechanism of action: (1) mechanical effect resulting in deposit fragmentation; (2) molecular effect resulting in deposit phagocytosis; and (3) analgesic effect resulting in denervation of pain receptors.…”