[Shoulder calcifying tendinitis].
Calcifying tendinitis is a frequent shoulder disease but the surgical treatment is still debatable. The authors of this symposium reviewed retrospectively 450 patients treated by arthroscopal excision for calcifying tendinitis. Imaging were used to assess the cuff status in every case. The minimum follow-up was five years except for subscapularis and infraspinatus calcification (minimum two years). At the same time, we led a prospective study evaluating the prevalence of the calcifications on 1276 asymptomatic shoulders. The prevalence of rotator cuff calcification was 7.3%, with a female predominance specially in the operated group. Calcifications have been found as well in patients more than 70 years old. The inter- and intraobserver agreement for the A-B-C classification was poor, specially to differentiate the type A and B calcifications. The long-term follow-up allows to prove that the calcifying tendinitis is temporary without any relation with rotator cuff rupture. Recurrence of the calcific deposit after complete disappearance was never observed and the rate of full thickness tears was 3.9% at an average of nine years follow-up (mean age 56 years). These findings allowed to conclude than cuff suture after removing the deposit is not mandatory. However, the preoperative cuff status had a significant influence on the functional results at follow-up. Preoperative associated partial tear of the cuff or a preoperative positive Jobe test affected significantly the results and increased the rate of full thickness tear at follow-up. The subscapularis calcifications were rare (6% of the calcifications) and were associated with further deposit on the cuff. Infraspinatus calcifications were more frequent (20%), mostly associated to over tendons calcifications. The arthroscopic treatment obtained good results independently from the calcification location but the surgical approach should be adapted. Functional results were lower after removing a type C calcification. Acromioplasty improved the results when the calcification was associated with an aggressive acromion or a partial cuff tear.
Clavert
P
P
Centre de chirurgie orthopédique et de la main, avenue Baumann, 67400 Illkirch-Graffenstaden, France.
Sirveaux
F
F
D000174:Acromion / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D002114:Calcinosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000473:pathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012782:Shoulder / Q000473:pathology / Q000601:surgery*; D013536:Suture Techniques; D052256:Tendinopathy / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*