Die Kalkschulter – Tendinosis calcarea

Abstract

Calcific tendinitis of the shoulder is a process involving crystal calcium deposition in the rotator cuff tendons, which mainly affects patients between 30 and 50 years of age. The etiology is still a matter of dispute. The diagnosis is made by history and physical examination with specific attention to radiologic and sonographic evidence of calcific deposits. Patients usually describe specific radiation of the pain to the lateral proximal forearm, with tenderness even at rest and during the night. Nonoperative management including rest, nonsteroidal anti-inflammatory drugs, subacromial corticosteroid injections, and shock wave therapy is still the treatment of choice. Nonoperative treatment is successful in up to 90% of patients. When nonsurgical measures fail, surgical removal of the calcific deposit may be indicated. Arthroscopic treatment provides excellent results in more than 90% of patients. The recovery process is very time consuming and may take up to several months in some cases.

Guideline for diagnosis and treatment of subacromial pain syndrome

“…There is moderate evidence for fewer re-ruptures in tears larger than 1 cm (measured backward) with a double-row fixation, but any effect on clinical outcome has not been demonstrated. Comparison between ESWT, barbotage (needling of the calcium deposit guided by fluoroscopy or ultrasound), and surgical removal shows no obvious preference for one of these interventions (Diehl et al 2011) in the treatment of tendinosis calcarea. The only difference between a biceps tendon tenotomy and biceps tenodesis is cosmetic (Hsu et al 2011).…”

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

“…The disease mainly affects individuals between 30 and 50 years old, and males and females are equally affected. The calcific material consists of a collection of calcium hydroxyapatite in crystalline or amorphous form [5,8,14]. Approximately 80% the calcium deposits are located in the tendon of the supraspinatus, 15% are in the infraspinatus, and approximately 5% are in the subscapularis tendon.…”

“…Approximately 80% the calcium deposits are located in the tendon of the supraspinatus, 15% are in the infraspinatus, and approximately 5% are in the subscapularis tendon. In the supraspinatus tendon, the most affected location is 1.5 to 2.0 cm away from its insertion at the greater tuberosity [5,8,11,23]. The etiology of the calcium deposits in the rotator cuff is disputed [9,20,23].…”

“…The etiology of the calcium deposits in the rotator cuff is disputed [9,20,23]. It has been suggested that it is related to decreased local oxygen tension or hypoxia [5,8]. The calcifications can be subdivided using the classification of Gärtner and Heyer [8].…”

Surgery for calcifying tendinitis of the shoulder: A systematic review

“…It is one the most frequent causes of non-traumatic shoulder pain and has a high disease burden. In a healthy population the incidence of subacromial calcific deposits is 2.7%[1]. In patients with shoulder complaints this number rises to 6.8%.…”