Clinical and Structural Results of Rotator Cuff Repair Compared With Rotator Cuff Debridement in Arthroscopic Treatment of Calcifying Tendinitis of the Shoulder

Background: Arthroscopic treatment of calcifying tendinitis of the shoulder reveals good to excellent results. However, whether the tendon needs to be repaired after removal of the calcific deposit or simply debrided remains unclear. Purpose: To evaluate the structural and clinical results after arthroscopic calcific deposit removal with additional rotator cuff repair or rotator cuff debridement. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 44 patients (46 shoulders) were enrolled in this retrospective cohort study with a mean follow-up of 58.4 months. Patients underwent arthroscopic removal of a calcific deposit and bursectomy after failed nonoperative treatment. A total of 22 patients received additional rotator cuff repair irrespective of the degree of debridement (the repair group), whereas 22 patients received a simple rotator cuff debridement without additional repair (the debridement group). Groups were comparable in sex, age, and size and consistency of the deposits according to the Gärtner and Bosworth classifications. Clinical evaluation was performed by the Constant score, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, and numerical rating scales for pain, function, and satisfaction. In 29 patients (14 in the debridement group and 15 in the repair group), additional magnetic resonance imaging at follow-up was performed to evaluate the structural results using the Sugaya classification. Results: All patients were satisfied with the results of surgery; 100% of the repair group and 95.7% of the debridement group reported they would undergo the surgical procedure again. Comparison of the clinical results showed significantly better results in the repair group versus the debridement group for the Constant score (86.2 vs 80.6, respectively; P = .04), the ASES score (98.3 vs 88.9; P = .004), the Simple Shoulder Test (11.6 vs 10; P = .005), and the numerical rating scales for pain (0.1 vs 0.8; P = .007), function (9.6 vs 8.8; P = .008), and satisfaction (9.8 vs 9.1; P = .036). Comparison of the postoperative tendon integrity showed 80% Sugaya grade I in the rotator cuff repair group and 64% Sugaya grade II in the debridement group, with a statistically significant difference in favor of the repair group ( P = .004). Postoperative clinical evaluation revealed no positive O’Brien tests in the repair group, whereas approximately one-third of the debridement group showed a positive O’Brien test during examination. Conclusion: Arthroscopic removal of calcific deposits with rotator cuff debridement or cuff repair showed good to excellent clinical and structural midterm results. However, patients who underwent additional repair of the tendon defect had significantly better clinical results as well as better structural results in terms of tendon integrity.

Current treatment concepts of calcifying tendinitis of the shoulder

Calcifying tendinitis is a very common pathology in the shoulder region, which may be acute or chronic. The rotator cuff, particularly the supraspinatus tendon, is most frequently affected. The tendons of the rotator cuff undergo a natural cycle of destruction and regeneration. The development of calcifying tendinitis is caused by defective tendon repair. Typical is a chronic course with acute pain exacerbation, which leads to medical presentation. Treatment options range from conservative therapy including rest, physical therapy, nonsteroidal anti-inflammatory drugs, and shock wave therapy, to surgical therapy with arthroscopic removal of the calcific focus. This article discusses the current stage-dependent therapeutic concepts and provides a treatment recommendation.

Conservative Treatment in Calcifying Tendinitis of Shoulder

"ABSTRACT. Introduction: Calcium tendinopathy of the shoulder is a familiar, unpleasant situation distinguished by calcium buildups in rotating tendons. Current assumptions suggest that these calcifications might originate from a cellular-involved procedure in whom, following a calcium sedimentation phase, calcifications are suddenly re-orbited. Objectives: This paper aims to establish non-surgical therapeutic conduct of maximum efficiency in the case of calcified Tendinitis in the shoulder by combining methods of physiokinetotherapy. Methods: The research methods used by us were: bibliographic method, experimental method, case study method, observation method, test method, statistical-mathematical methods of data processing, graphic method of presentation of results, Shapiro-Wilk test, t-Student test, parametric test for unpaired data, respectively Mann-Whitney test, non-parametric test for unpaired data. Results: As a result, statistically, using the t-Student test, p<0.05, we found a statistically significant difference between the averages of the abstraction values in weeks 8 and 12 in the two lots. Conclusions: Kinetic treatment ensures improvement of the algal component and functional parameters, thus ensuring the patient's quality of life by combating muscle contractions and increasing joint mobility."

The Rotator Cuff and Biceps Tendon

Rotator cuff disease is the most common condition responsible for shoulder pain worldwide. The understanding and treatment of rotator cuff disease has advanced tremendously over the last few years, mostly due to both technological advances (magnetic resonance imaging, ultrasonography, arthroscopic surgery, and reverse arthroplasty) and a better understanding of the biology of healing and of muscle changes over time. Not uncommonly, the long head of the biceps tendon presents structural pathology in patients with cuff disease; however, determining the contribution of biceps pathology to patients’ symptoms is not always straightforward. This chapter discusses these issues and covers aspects of assessment and treatment of rotator cuff disease such as anatomy and function, basic science, rotator cuff tears, calcifying tendinitis, neuropathies and the rotator cuff, and biceps tendon pathology.