Calcifying tendinitis of the shoulder: arthroscopic needling versus complete calcium removal and rotator cuff repair. A prospective comparative study

Surgical approaches of shoulder calcific tendonitis: a systematic review and meta-analysis

Background

Calcific tendonitis is a painful shoulder disorder characterized by calcium deposits (CDs) in the rotator cuff tendon. This systematic review and meta-analysis examined the most efficient surgical procedure for calcific tendonitis. This includes the comparison between the three main surgical techniques: CD removal, CD removal with subacromial decompression (SAD) and CD removal with tendon repair with respect to functional outcomes and pain control scores.

Methods

Four electronic databases (MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials) were searched in February 2023. Studies were eligible for inclusion if they were peer-reviewed, and participants were patients diagnosed with calcific tendonitis of one or more rotator cuff tendon based on diagnostic imaging who underwent shoulder calcific tendonitis surgery. Other shoulder pathology diagnoses were excluded. Meta-analyses were conducted for results that were sufficiently homogeneous in terms of statistical, clinical, and methodological characteristics. Subgroup analyses were performed to determine if effect sizes differed based on the patient's position during the surgery, physiotherapy, and follow-up time.

Results

All surgical interventions resulted in significant improvements in shoulder function and pain control. There were no significant differences between CD removal vs. CD removal with SAD or CD removal vs. CD removal with tendon repair. However, there was a trend in favor of CD removal alone or CD removal with SAD approaches, as they provided better outcome scores than CD removal with tendon repair in terms of shoulder function and pain control.

Conclusions

All surgical interventions provide substantial improvement in shoulder functions and pain control scores with no significant difference between these surgical techniques.

Long-term evolution of calcific tendinitis of the rotator cuff: clinical and radiological evaluation 10 years after diagnosis

BACKGROUND

Calcific tendinitis of the shoulder has a tendon involvement that could evolve to rotator cuff tear and shoulder osteoarthritis. This study aimed to evaluate the prevalence of glenohumeral osteoarthritis and rotator cuff tears in patients affected by calcific tendinitis at a minimum follow-up of 10 years after diagnosis.

METHODS

Patients diagnosed with calcific tendinitis of the shoulder with a minimum follow-up of 10 years were contacted and invited for a clinical and radiological evaluation. Information on the demographics, affected and dominant side, bilateral shoulder pain, type of treatment, habits, systemic or musculoskeletal diseases, reoperation of the index shoulder, and subjective satisfaction was collected. The clinical evaluation was performed using Constant-Murley score (CMS), American Shoulder and Elbow Surgeons Score (ASES), and numerical rating scale (NRS); isometric strength in forwarding flexion and abduction was also measured. Each patient also underwent an ultrasound examination to evaluate rotator cuff tendon integrity and a shoulder radiograph to evaluate osteoarthritis.

RESULTS

Seventy-nine patients were available for a phone interview, and 35 agreed to be examined. The mean age was 58.89 (± 7.9) years at follow-up. The prevalence of glenohumeral osteoarthritis was 17.14% in the study population, with significant progression in 14.29% of the cases, without rotator cuff full-thickness tears. x-Ray examination showed residual calcifications in 31 patients, with a mean diameter of 5.54 mm. In 30 cases, there was a reduction of the diameter; in 4 cases, the calcification increased in size; and in 1 case, the size did not change. The mean ASES score was 74.1 (± 22.7) in the group with calcifications larger than 2 mm and 89.4 (± 8.2) in patients with smaller calcifications (p = 0.08) without correlation with the type of treatment performed.

CONCLUSIONS

Calcific tendinitis is a self-resolving disease without rotator cuff tears at long-term follow-up or degenerative glenohumeral progression.

LEVEL OF EVIDENCE

3, cohort study.

Calcifying Tendinitis of Shoulder: A Concise Review

Calcifying Tendinitis (CT) shoulder a self limiting disorder characterized by deposition of calcium salts in rotator cuff muscles. The main symptom being pain followed by activity restriction resolving on its own in most cases. Symptomatic patients are initially managed by NSAIDs, Physiotherapy, Corticosteroid injections. ESWT involves acoustic waves causing fragmentation of deposits with pain releif. Ultrasound guided needling barbotage have shown promising results. Arthroscopic excision remains the definitive management for patients associated with complications as cuff tear and for uncomplicated patients. In calcifying tendinitis the initial evaluation, maintenance of function and appropriate choice of treatment modalities determines the prognosis.

Arthroscopic Removal of Rotator Cuff Calcifications: Operative Technique

Introduction

In this article, we present our operative technique for the removal of rotator cuff calcifications.

Indications & Contraindications

Step 1 Setup and Patient Positioning

Perform the shoulder arthroscopy with the patient in the beach-chair position with a shoulder positioner.

Step 2 Glenohumeral Inspection

Perform an arthroscopic inspection of the glenohumeral joint to exclude concomitant lesions.

Step 3 Subacromial Inspection and Identification of Subacromial Landmarks

Ensure that subacromial placement of the arthroscope and identification of the subacromial landmarks are correct as they are necessary for localization of the rotator cuff calcification.

Step 4 Identification and Removal of Rotator Cuff Calcification

With a spinal needle, localize and needle the rotator cuff calcification.

Results

In our series, all patients undergoing arthroscopic calcification removal exhibited significant improvement in the Constant score (p = 0.003), Quick DASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) (p < 0.001), and Simple Shoulder Test (p < 0.001) at 1 year after the operation⁸.

Pitfalls & Challenges