Remoción artroscópica y reparación del manguito rotador sin acromioplastía para el tratamiento de las calcificaciones sintomáticas del supraespinoso / Arthroscopic removal and rotator cuff repair without acromioplasty for the treatment of calcified tendinitis of the supraspinatus tendon

Introducción: Las calcificaciones del manguito rotador son una causa frecuente de dolor crónico de hombro y pueden provocar a una limitación funcional importante del mismo. Si bien la mayoría de los pacientes responden favorablemente al tratamiento conservador algunos requieren cirugía. La cirugía artroscópica es una alternativa con baja morbilidad y ventajas cosméticas. Objetivos: Evaluar los resultados clínicos luego de la remoción artroscópica de calcificaciones del supraespinoso y reparación del manguito rotador sin acromioplastía. Materiales y Métodos: Realizamos una evaluación retrospectiva de los resultados clínicos de la remoción artroscópica de los depósitos de calcio y posterior reparación del manguito rotador sin acromioplastía. Se evaluaron 30 pacientes consecutivos con una edad media de 49.2 años. El seguimiento promedio fue 35 meses (12 a 88 meses). EL dolor se evaluó subjetivamente con la escala visual análoga EVA pre y postoperatorio. La evaluación funcional se realizó con el score de Constant, UCLA y Quick DASH. Se realizaron radiografías postoperatorias y RNM para evaluar las calcificaciones remanentes y la indemnidad de la reparación del supraespinoso. Resultados: La EVA mejoró significativamente desde un promedio de 8.7 antes de la cirugía a 0.8 luego de la operación (p<0.001). El Constant promedio aumentó de un promedio de 23.9 antes de la cirugía a 85.3 en el postoperatorio (p< 0.001), el Quick DASH disminuyó de un promedio de 47.3 preoperatorio a 8.97 en el postoperatorio (p< 0.001) y el escore de UCLA aumentó de un promedio de 15.8 en el preoperatorio a 32.2 en el postoperatorio (p< 0.001). Conclusiones: La remoción artroscópica y la reparación del manguito rotador sin acromioplastía disminuye significativamente el dolor y mejora la función del hombro en pacientes con calcificaciones del supraespinoso. Nivel de Evidencia: IV. Tipo de Estudio: Serie de Casos...

Background: Calcified rotator cuff tendinitis is a common cause of chronic shoulder pain that leads to significant pain and functional limitations. Although most patients respond well to conservative treatment, some eventually require surgical treatment. Arthroscopic surgery is a valid option due to lower morbidity and better cosmetics. Purposes: Evaluate the clinical outcome after calcific deposit arthroscopic removal and rotator cuff repair without acromioplasty for the treatment of calcified tendinitis of the supraspinatus tendon. Methods: We retrospectively evaluated the clinical outcomes of the arthroscopic removal of calcium deposits and rotator cuff repair without acromioplasty of 30 consecutive patients with a mean age of 49.2 years. The mean follow up was 35 months (range 24-88 months). Preoperative and postoperative functional assessment was performed using the Constant score, UCLA score, and Quick DASH. Pain was subjectively measured by with a visual analog scale (VAS). Radiographs and magnetic resonance (MRI) were performed to evaluate the recurrence of calcifications and the indemnity of the supraspinatus tendon repair. Results: The VAS improved significantly from a mean of 8.7 before surgery to 0.8 after the operation (p< 0.001). The mean Constant score increased from 23.9 preoperatively to 85.3 postoperatively (p<0.001) the mean Quick DASH score decreased from 47.3 preoperatively to 8.97 postoperatively (p< 0.001) and the UCLA score increased from 15.8 preoperatively to 32.2 postoperatively (p< 0.001). MRI examination at last follow-up (70 % of patients) showed no tendon tears and 96.2% of patients was satisfied with their results. Conclusions: Arthroscopic removal and rotator cuff repair without acromioplasty can lead to good results in patients with symptomatic calcifying tendonitis of the supraspinatus tendon. Level of Evidence: IV. Study Design: Cases Series...

Extracorporeal Shockwave Therapy for Calcifying Tendinitis of Hands: Two Cases Report

Calcifying tendinitis of the hand is rare, and known to be self-limited or to show improvement with conservative therapy. However, poor response to treatment has been observed in cases of chronic conditions. The authors have performed extracorporeal shock wave therapy on a 19-year-old woman with chronic calcifying tendinitis of the extensor carpi ulnaris tendon, and a 45-year-old female with the condition involving the 4th finger flexor tendon, who showed no response to conservative treatment. Pain relief and radiological improvements were observed in the both patients.

Shoulder Operation

Although shoulder pain is a very common problem and compromised shoulder movement due to pain, stiffness, or weakness can cause substantial disability, many patients fail to recognize a need for a proper treatment. The diagnosis and treatment of the shoulder should be specified for each of the disease entity. Most of shoulder pain can be managed non-operatively with a well-organized rehabilitation program. However, the surgery should always remain as an option in case of failure of conservative managements, which can be seen from a definite indication of a patient's condition. The article presents four representative disease entities other than shoulder trauma occurring in old age which doctors see most often at outpatient's clinics. Impingement syndrome, rotator cuff tear, calcifying tendonitis, and arthritis are described in this article, introducing each diseases and surgical indications and descriptions, and their results.

Extracorporeal Shock Wave Therapy for Calcific Tendinitis of the Shoulder / 대한정형외과학회잡지

PURPOSE: To evaluate whether Extracorporeal Shock Wave Therapy (ESWT) is an effective treatment without side effects for chronically painful calcifying tendinitis. MATERIALS AND METHODS: Study subjects were 72 patients (17 males and 55 females) aged 37-64 years, with a mean of 48, showing chronic, symptomatic, calcifying tendinitis of the shoulder refractory to other conventional conservative therapies. Calcifications were type I or type II according to the classification of Gartner, and with a minimum diameter of 10 mm. Patients with type 3 calcific tendinitis were excluded, because this type has a strong tendency to spontaneous resolution. Extracorporeal shock wave therapy comprised one or two treatments, each consisting of 800 shocks, with a frequency of 120 impulse per minute and the energy density of 0.14 mJ/mm2. We assessed the presence and size of calcified deposits at 1, 3, 6 and 12 months by conventional radiography. All patients also underwent clinical examination, and the Constant (and Murley) score and pain were calculated. The intensity of pain was measured with the visual analogue scale (VAS) from 0 to 10 points, where 0 represents the absence of pain and 10 unbearable pain. RESULTS: One month after the treatment, complete resorption of the calcium deposits was observed in 19 patients (26%), partial resorption was observed in 26 patients (36%), and no modification in the calcium deposits was observed in 27 patients (38%). At six months the complete disappearance of the calcium deposits was noted in 42 patients (68%), but in the 10 patients (14%), calcium deposit appeared unchanged. This result is remained unvaried after 6 month follow-up. Using the Constant and Murley score, this study showed a significant decrease in pain and a significant increase in shoulder function (p<0.001). At six months, 76% of the patients presented satisfactory functional result. About 15% reported a subjective and objective recovery, and only 6 patients (8%), classified as poor result but in our series no differences were found between results at 6 month and 12 month follow-up. At 12 month follow-up there were differences in the Constant score between treated shoulder and contralateral side, respectively 77.6 (59-91) and 87.2 (74-96), but not significant. There were no side effects. CONCLUSION: ESWT is an effective treatment without side effects and an alternative therapy for chronically painful calcifying tendinitis of the shoulder refractory to conventional therapies.