Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Conservative and Arthroscopic Treatment of Calcific Tendinitis

석회화 건염의 보존적 및 수술적 치료 결과

  • Choi, Chang-Hyuk (Department of orthopaedic surgery, School of Medicine, Catholic University of Daegu) ;
  • Kim, Shin-Kun (Department of orthopaedic surgery, School of Medicine, Catholic University of Daegu) ;
  • Lee, Ho-Hyoung (Department of orthopaedic surgery, School of Medicine, Catholic University of Daegu)
  • 최창혁 (대구가톨릭대학교의과대학 정형외과학교실) ;
  • 김신근 (대구가톨릭대학교의과대학 정형외과학교실) ;
  • 이호형 (대구가톨릭대학교의과대학 정형외과학교실)
  • Published : 2007.12.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: We evaluated calcium resolution and clinical improvement of calcific tendinitis after conservative and arthroscopic treatment. Materials and Methods: We reviewed 126 patients of calcific tendinitis treated from January, 2002 to April, 2005. Average age was 53 and female dominant in 77% of the cases. Calcium deposits were involved in supraspinatus tendon in 84% of the cases. We compared clinical changes for 64 cases treated with injection, and 12 cases treated by arthroscopic decompression with 6 month follow-up. Results: 77%(49/64) of the cases with steroid injection showed symptom improvement. Even though complete resolution of calcific deposit occurred in 36%(23/64), incomplete resolution in 17%(11/64) and no change in 47%(30/64), Pain was relieved in 87%(20/23), 82%(9/11) and 67%(20/30), respectively. With arthroscopic treatment, calcium deposit completely resolved in 83%(10/12), and all cases showed pain free motion after 6 months. Conclusion: Conservative treatment with steroid injection was effective for acute pain in resorptive phase. In cases of arthroscopic treatment, there was no need for complete removal of calcium deposit during the procedure, but clinical symptoms improved with resolution of the deposit.

목적: 석회화 건염에 대하여 보존적 치료 및 관절경을 이용한 수술적 치료 후 석회질 소실정도와 임상경과를 비교 관찰하였다. 대상 및 방법: 2002년 1월부터 2005년 4월까지 석회화 건염으로 진단받은 126예 중 6개월 이상 추시관찰이 가능하였던 주사치료 64예 및 수술 치료 12예를 대상으로 하여 석회질의 소실정도와 임상증상의 호전을 비교 관찰하였다. 126예의 평균연령은 53세, 여성이 77%였으며, 극상 건에 침범한 경우가 84%였다. 결과: 주사 치료의 경우 77%(49/64)에서 증상의 호전을 볼 수 있었다. 방사선적으로 석회질의 완전소실을 볼 수 있었던 경우는 36%(23/64)였고 불완전 소실은 17%(11/64)였으며, 석회질 크기에 변화가 없었던 경우가 47%(30/64)였다. 관절경적 치료를 시행한 석회질은 83%(10/12)에서 평균 3.9개월에 완전 소실되었다. 결론: 용해기의 급성통증은 스테로이드주사로 증상의 호전을 볼 수 있었다. 형성기의 석회화건염에 대한 관절경하 수술적 치료 시 완전제거를 시행할 필요는 없으나, 완전한 증상완화를 위해서는 석회침착물의 완전 소실을 확인하는 것이 중요한 것으로 생각되었다.

Keywords

References

  1. Ark JW, Flock Ti Flatow EL, Biglinani LU: Arthroscopic treatment of calcific tendinitis of the shoulder. Arthroscopy, 8:183-188, 1992. https://doi.org/10.1016/0749-8063(92)90034-9
  2. Bosworth BM: Calcium deposits in the shoulder and subacromial bursitis: a survey of 12,122 shoulders. JAMA, 116:2477-2482, 1941. https://doi.org/10.1001/jama.1941.02820220019004
  3. Depalma AF, Kruper JS: Long term study of shoulder joints afflicted with and treated for calcific tendinitis. Clin Orthop Relat Res, 20:61-72, 1961.
  4. Dhuly RG, Lauler DP, Thorn GW: Pharmacology and chemistry of adrenal glucocorticosteroids. Med Clin North Am, 57:1155-1165, 1973. https://doi.org/10.1016/S0025-7125(16)32218-0
  5. Harmon HP: Methods and results in the treatment of 2,580 painful shoulders with special reference to calcific tendinitis and the frozen shoulder. Ann J Surg, 95:527-544, 1958. https://doi.org/10.1016/0002-9610(58)90436-7
  6. Hsu HC, Wu JJ, Jim YF, et al: Calcific tendinitis and rotator cuff tearing: a clinical and radiographic study. J Shoulder Elbow Surg, 3:159-164, 1994. https://doi.org/10.1016/S1058-2746(09)80095-5
  7. Jerosch J, Strauss JM, Schmiel S: Arthroscopic treatment of calcific tendinitis of the shoulder. J Shoulder Elbow Surg, 7:30-37, 1998. https://doi.org/10.1016/S1058-2746(98)90180-X
  8. Jiang CY, Geng XS, Wang MY, Rong GW, Flatow EL: Close needling for the treatment of calcifying tendinitis. Zhonghua Wai Ke Za Zhi, 41:346-350, 2003.
  9. Kim JS, Yoo JH, Yoo SO: Arthroscopic treatment of chronic calcific tendinitis of the shoulder. J Korean Shoulder Elbow Surg Society, 1:6-11, 1998.
  10. Lasar Y, Azzolin J: Puncture-lavage-infiltration of calcifying tendinitis of the rotator cuff. Bull Soc Sci Med Grand Duche Luxemb, 1: 17-22, 2003.
  11. Lippman RK: Observations concerning the calcific cuff deposit. Clin Orthop Relat Res, 20:49-60, 1961.
  12. Maier M, Krauter T, Pellengahr C, et al: Open surgical procedures in calcifying tendinitis of the shoulder-concomitant pathologies affect clinical outcome. Z Orthop Ihre Grenzgeb, 140:656-661, 2002. https://doi.org/10.1055/s-2002-36033
  13. Mole D, Kempf JF, Gleyze P, et al: Resultats du traitement arthroscopique des tendinopathies non-rompues de la coiffe. Rev Chir Orthop Reparative Appat Mot 79:532-541, 1993.
  14. Neer CS: Shoulder reconstruction. Philadelphia, WB Saunders Co: 427-433, 1990.
  15. Ogon P, Ogon M, Jager A: The quadrant technique for arthroscopic treatment of rotator cuff calcifications. Arthroscopy, 17:1-3, 2001.
  16. Ozkoc G, Akpinar S, Hersekli MA, Ozalay M, Tandogan RN: Arthroscopic treatment of rotator cuff calcifying tendinitis. Acta Orthop Traumatol Turc, 36:413-416, 2002.
  17. Plenk HP: Calcifying tendinitis of the shoulder. Radiology, 59:384-389, 1952. https://doi.org/10.1148/59.3.384
  18. Porcellini G, Paladini P, Campi F, Paganelli M: Arthroscopic treatment of calcifying tendinitis of the shoulder-clinical and ultrasonographic follow-up findings at two to five years. J Shoulder Elbow Surg, 13:503-508, 2004. https://doi.org/10.1016/j.jse.2004.04.001
  19. Re LP Jr, Karzel RP: Management of rotator cuff calcifications. Ortho Clin North Am, 24:125-132, 1993.
  20. Rhee YG, Kim YH, Park MS: Arthroscopic treatment in calcific tendinitis of the shoulder. J Korean Shoulder Elbow Surg Society, 3:68-74, 2000.
  21. Rubenthaler F, Ludwig J, Wiese M, Wittenberg RH: Prospective randomized surgical treatments for calcifying tendinopathy. Clin Orthop Relat Res, 410:278-284, 2003. https://doi.org/10.1097/01.blo.0000063786.32430.22
  22. Uhthoff HK, Sarkar K: The shoulder. lst ed., Philadelphia, WB Saunders Co: 774-790, 1990.
  23. Vebostad A: Calcific tendinitis in the shoulder region: a review of 43 operated shoulders. Acta Orthop Scand, 46:205-210, 1975. https://doi.org/10.3109/17453677508989209
  24. Welfling J, Kahn MF, Destroy M: Les calcifications delepaule. II. La maladie des calcifications tendineuses multiples. Rev Rheum, 32:325-334, 1965.

Cited by

  1. Calcific Tendinitis of Shoulder Associated with Intraosseous Involvement -A Case Report- vol.14, pp.2, 2011, https://doi.org/10.5397/CiSE.2011.14.2.242
  2. The effects of therapeutic exercise using PNF on the size of calcium deposits, pain self-awareness, and shoulder joint function in a calcific tendinitis patient: a case study vol.29, pp.1, 2017, https://doi.org/10.1589/jpts.29.163