Shoulder
Calcific tendonitis of the shoulder: is subacromial decompression in combination with removal of the calcific deposit beneficial?

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Hypothesis

We postulated that treatment of patients with calcific tendonitis of the supraspinatus tendon by debridement of the calcific deposit alone was comparable to treatment by debridement and concomitant subacromial decompression.

Materials and methods

During a 10-year period, 50 consecutive patients with calcific tendonitis refractory to nonoperative measures were surgically treated by debridement (D) as an isolated procedure (25 patients) or by debridement and concomitant subacromial decompression (D+SAD; 25 patients), and the surgical groups were retrospectively compared. The main outcome of interest was the time to resumption of unrestricted activity without pain. An abbreviated version of disabilities of the Disabilities of Arm, Shoulder and Hand (QuickDASH) score and University of California-Los Angeles (UCLA) shoulder summary scores were compiled at a mean follow-up of 5 years (range, 2-10 years).

Results

Average time to return to activity without pain was significantly shorter for the D group compared with the D+SAD group (11 vs 18 weeks; P < .006). At the final evaluation, QuickDASH scores were equally low (group D, 6; group D + SAD, 11; P = .191), indicating that both treatment groups had high levels of function. The mean UCLA shoulder scores at final evaluation were 33 for both groups (P = .678).

Discussion

Patients treated by debridement of the calcific deposit and concomitant subacromial decompression required a longer time to return to unrestricted activity without pain.

Conclusions

Debridement of a calcific deposit alone is a better surgical option to treat calcific tendonitis.

Section snippets

Materials and methods

This retrospective study included 50 consecutive patients with symptomatic calcification of the supraspinatus tendon who underwent surgical treatment in our institution between 1996 and 2006.

Imaging analysis

Calcium deposition was characterized as discrete or fragmented and dense or fluffy using the classification scheme developed by Mole et al21 (Table II). Approximately 76% of the calcifications were dense (type A or B) and 24% were fluffy (type C). The small sample size of this study did not permit a comparison of outcomes related to the pattern of calcification. Complete removal of calcium was achieved in 44 patients (88%) after surgery, with faint specks apparent in 6 (12%). Outlet view

Discussion

This study documented 2 major findings: (1) patients undergoing debridement alone of a calcific deposit of the supraspinatus tendon had earlier relief of pain and return to activity than patients undergoing combined debridement and arthroscopic subacromial decompression, and (2) no long-term differences between the 2 groups were measured. Our overall treatment outcomes compared favorably with other studies that found good to excellent results approaching 90%.2, 11, 16, 17, 27

The rationale for

Conclusion

This study found that the concomitant use of acromioplasty significantly delayed the time to return to normal activity without the benefit of any long-term improvement in patient outcome. Therefore, we concluded that subacromial decompression as an added procedure in the removal of a calcific deposit was not beneficial. We believe that debridement of a calcific deposit alone is a better surgical option to treat calcific tendonitis.

Disclaimer

The authors received no funding in support of this study.

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (33)

  • D.E. Beaton et al.

    Development of the QuickDASH: comparison of three item-reduction approaches

    J Bone Joint Surg Am

    (2005)
  • L. Bigliani et al.

    The morphology of the acromion and its relationship to rotator cuff tears

    Orthop Trans

    (1986)
  • B.M. Bosworth

    Calcium deposits in the shoulder and subacromial bursitis: a survey of 12,122 shoulders

    JAMA

    (1941)
  • E.A. Codman

    Calcified deposits in the supraspinatus tendon

  • T.H. Comfort et al.

    Barbotage of the shoulder with image-intensified fluoroscopic control of needle placement for calcific tendinitis

    Clin Orthop Relat Res

    (1978)
  • G.R. Ebenbichler et al.

    Ultrasound therapy for calcific tendinitis of the shoulder

    N Engl J Med

    (1999)
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    The institutional review board of University of California-Davis reviewed and approved this study (IRB approval number: 200816629-1; October 13, 2008).

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