Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulder

Abstract

Objective. To define prognostic factors in chronically symptomatic patients with calcific tendinitis of the shoulder.Methods. We evaluated 420 patients (488 shoulders) in the context of a prospective cohort study. Epidemiologic data were assessed. The radiographic and sonographic appearance of the calcific deposits was classified. The mean period of nonoperative therapy was 4.4 years (range 0.5-13.7 years). After referral to our institution, standardized nonoperative therapy was continued for a minimum of 3 months. Failure of nonoperative therapy was defined as the persistence of symptomatic calcific tendinitis of the shoulder after a minimum of 6 months. Prognostic factors (determined at P < 0.05 by chi-square test) were analyzed by logistic regression.Results. Of the 420 patients, 269 (64%) were women, 151 (36%) were men. The mean age of the patients was 51.3 years (range 28-84 years). Occurrence of calcific tendinitis of the shoulder was unilateral in 84% and bilateral in 16%. Gärtner type I calcific deposits were found in 37%, type II in 32%, and type III in 31%. Failure of nonoperative therapy was observed in 114 patients (27%). Negative prognostic factors were bilateral occurrence of calcific tendinitis of the shoulder, localization to the anterior portion of the acromion, medial (subacromial) extension, and high volume of the calcific deposit. Positive prognostic factors were a Gärt-ner type III deposit and a lack of sonographic sound extinction of the calcific deposit.Conclusion. Our findings demonstrate the existence of prognostic factors in the nonoperative treatment of chronic symptomatic calcific tendinitis of the shoulder. Guidelines for optimal treatment can be implemented according to these factors to avoid a longterm symptomatic disease course.

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

“…Ogon et al 32 investigated prognostic factors in non-operative therapy for chronic symptomatic RCCT (420 patients). Failure of non-operative treatment was observed in 27% of patients.…”

“…Negative prognostic elements were found in bilateral occurrence, anterior acromion localization, subacromial extension and size (large calcifications), while Gärtner Type 3 deposits and the absence of acoustic barrier were found to be positive factors. 32 Several techniques were proposed to treat and to solve RCCT, and ultrasound-guided percutaneous procedures represent a valid mini-invasive solution. Different methods were developed, and DNL is a well-established option, although different approaches are available and preferred from authors to authors within the same technique.…”

“…[30][31][32] First, radiologic course of the calcific deposits in RCCT: does the initial radiologic aspect affect the final results? Excellent or good results (72%) in terms of clinically significant improvement were obtained with conservative treatment regardless of location, size, symptoms and radiologic type of calcifications.…”

Calcifying Tendonitis of the Shoulder: Risk Factors and Effectiveness of Acetic Acid Iontophoresis and Ultrasound

“…Electro shock wave therapy and arthroscopy are two advanced therapeutic options in CT treatment (16). They are as effective as iontophoresis; however, they are painful, expensive and not free of risks or complications (1).…”

Clinical Outcome after Ultrasound-Guided Needling in the Treat-ment of Chronic Calcifying Rotator Cuff Tendinopathy

“…These non-operative therapies are effective in approximately 70% of individuals with calcifying tendinopathy [9]. Ultrasound (US) guided needling and extracorporeal shockwave therapy (ESWT) have been proven to be successful minimally invasive treatment modalities when conservative treatment fails [10,11].…”