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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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Happiness is not something you postpone for the future; it is something

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.

Happiness comes when your work and words

are of benefit to yourself and others.