Original article
Arthroscopic Treatment of Chronically Painful Calcifying Tendinitis of the Supraspinatus Tendon

https://doi.org/10.1016/j.arthro.2006.01.012Get rights and content

Purpose: The purpose of this study was to analyze the outcome of arthroscopic removal of calcifying tendinitis of the rotator cuff, to document the postoperative pain evolution, and to analyze structural changes of the supraspinatus tendon by use of ultrasonography. Methods: Fifty-four of 58 patients with a mean age of 45.4 years (±8 years) enrolled in the study were available for follow-up. The calcific deposits were exclusively located in the supraspinatus tendon. Shoulder function was evaluated by using the Constant score. Radiographs were obtained preoperatively, immediately postoperatively, and at 3, 6, 12, and 24 months. The integrity of the rotator cuff was assessed by using ultrasonography. Results: Shoulder function according to the Constant score improved from 32.8 points (±19.8) preoperatively to 90.9 (±13.0) at 24 months (P < 0.001). The evolution of postoperative pain was very irregular; 31% of the patients were pain free or reached their minimum pain level after 3 months, 17% after 6 months, 20% after 9 months, and 28% after 12 months; 78% of the patients returned to work within 6 weeks, irrespective of their profession. At the final follow-up 92% of the patients were very satisfied with the outcome. Ultrasonography revealed minor structural changes of the supraspinatus tendon in 66% of the patients. Conclusions: The study confirmed previously reported successful results of arthroscopic treatment of calcifying tendinitis of the rotator cuff. Complete intraoperative removal of the deposit did not appear to be essential. Even if most of the patients were able to return to work within 6 weeks, postoperative recovery was prolonged over several months in most of the patients. The clinical relevance of the ultrasonographic changes of the supraspinatus tendon has not yet been determined. Level of Evidence: Level IV, therapeutic case series.

Section snippets

Methods

There were 58 consecutive patients who underwent surgery over a 3-year period (January 1998 to December 2000) enrolled in the study (26 women, 32 men) with a mean age of 45.4 years (range, 29 to 62 years); 54 patients (93%) were available at follow-up. The dominant arm was affected in 29 patients (54%). In 28 patients (52%), the calcification was located in the right shoulder. Preoperative pain had lasted for 4.4 (±3.3) years on average.

Clinical Results

Intraoperatively, an intra-articular synovitis of the rotator interval could be found in 7 patients (12%) and an articular sided tear of the supraspinatus tendon in 5 patients (9%). A hypertrophic bursitis was present in 28 patients (52%).

The Constant score improved from 32.8 points (±19.8) preoperatively to 90.9 points (±13.0) at 24 months (P < .001). There was no change in shoulder function between 12 and 24 months. Shoulder function was not related to the length of preoperative pain, the

Discussion

Shoulder function and patient satisfaction were excellent in more than 90% of the patients, with an average Constant score of 91. This confirmed the results of previously published studies of arthroscopic deposit removal7, 10, 14, 15, 16, 17 (Table 1). The reported results of open procedures were similar. Gazielly et al.18 reported a Constant score of 85 after open excision of the calcification and acromioplasty; 82% of their patients graded the result as excellent. Rubenthaler and Wittenberg19

Conclusions

This study confirmed that if conservative treatment fails, arthroscopic treatment of chronically painful calcific tendinitis of the rotator cuff promises to be successful in more than 90% of the patients. Pain relief after surgery is often slowly progressive and may extend over a period of 1 year. Despite this prolonged recovery period, most of the patients are able to return to work within 6 weeks. Ultrasonographic changes of the supraspinatus tendon are still visible in more than half of the

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