[Tendinosis calcarea of the rotator cuff].
Calcifying tendinitis of the rotator cuff is a common disorder of the shoulder which affects mainly individuals between 30 and 50 years of age. The etiology is still a matter of speculation. The calcification is a reactive process actively mediated by cells in a viable environment. The deposit undergoes an evolution (precalcific stage--calcific stage with formative phase, resting period and resorption--postcalcific stage), which ultimately remodels normal tendon tissue. However, the evolutionary stages of the disease do not always follow the typical sequence. A symptomatic deposit may persist or postcalcific tendinitis develop. The treatment should be based on the knowledge of the natural history of the disease, which shows a strong tendency towards self-healing by spontaneous resorption of the deposit. The stage of evolution of the disease should be judged, combining pain history, morphology of the deposit on plain X-rays, and ultrasound findings. The therapeutic approach depends on the evolution of the disease. During the resorption phase we favor a conservative approach. For deposits which are not under resorption we propose a concept which consists of three steps: a conservative approach, extracorporal shock wave therapy (ESWT) or needling, and arthroscopic surgery. The efficacy of ESWT and needling has still to be proven. Patients with persisting pain after steps 1 and 2 are candidates for surgical removal of the deposit. We prefer the arthroscopic approach. In some cases an additional arthroscopic subacromial decompression (ASD) is indicated.
Rupp
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S
Orthopädische Klinik und Poliklinik, Universitätskliniken des Saarlandes, 66421 Homburg/Saar.
Seil
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R
Kohn
D
D
D000328:Adult; D002114:Calcinosis / Q000175:diagnosis* / Q000628:therapy; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012075:Remission, Spontaneous; D017006:Rotator Cuff / Q000473:pathology; D052256:Tendinopathy / Q000175:diagnosis* / Q000628:therapy