shoulder supraspinatus calcific tendinitis dr.sandeep agrawal agrasen hospital gondia maharashtra...

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Calcific tendinitis

► Presence of macroscopic deposits of calcium hydroxyapatite crystal in any

tendon of the rotator cuff

► Self-limited disease

Incidence

7.5 to 20 percent of adults with no symptoms

6.8 percent of those with shoulder pain

most common among people between 30 - 60 years of age

Women > Men

sedentary work > manual work

Bilateral involved:13-47%

Etiology

► Still unknow Decreased local oxygen tension and hypoxia

Non degeneration

Non trauma

► Bursal side > articular site

► Usual involved Supraspinatus tendon 1-2 cm proximal to the tendon insertion on the

greater tuberosity (critical Zone)

Clinical Symptom

► shoulder pain

► restricted motion

► tenderness on greater tuberosity

Stage

► Stage I

precalcific phase

► Stage II

formative phase

► Stage III

resorptive phase

► Stage IV

postcalcific phase

Diagnosis

► History

► Physical Examination

► Radiography

Plain X-ray

CT

MRI

► Ultrasonography

DePalma and Kruper Classification

► Type I

Fluffy and amorphous

► Acute stages of the disease,

► calcific material may be liquid to semiliquid

► Type II

Defined and homogenous

► subacute or chronic disease

► calcific material forming a dry dense powder

Treatment

►Medical treatmentNSAIDCorticosteroid subacrominal injection

►Physical therapy

►Surgical treatmentOpenArthroscopy

►Ultrasound►ESW (Extracorporeal shock wave)►Needle aspiration

Blind aspirationSonographic guideFluoroscopic guide

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Ultrasound

► Ebenbichler N Engl J Med 1999

Double blind control study

► Ultrasound vs control

Pain relief and function result are better in ultrasound group

The result was no different after 9 months follow-up

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Extracorporeal Shock Wave

► Loew M, J Bone Joint Surg [Br] 1999;81 30-70% of patients obtained pain relief 20-77% of cases, the calcific deposit disappeared or

disintegrated.

► Rompe JD, J Shoulder Elbow Surg 1998 Good result

►High energy group 68%►Low energy group 52%

Partial or complete disintegration of calcific deposit►High energy group 64%►Low energy group 50%

Extracorporeal Shock Wave

► Results of ECSW depend on the energy of the waves and on the number of pulses

► The optimal dose has not yet been established.

► AdvantageNon invasive Low complication

►hematomas develop in most patients (80% )

► Disadvantage PainMay need anesthesia for high energy

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Sonographic Guidance Aspiration

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you design for the present. It is also like a butterfly; the more you chase

it, the more it will elude you, but if you turn your attention to other

things, it will come and sit softly on your shoulder.

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are of benefit to yourself and others.