CALCIFYING TENDINITIS OF THE SHOULDER JOI NT

Degenerative ossification is formed directly at the major tubercle. Li ke in any other gliding tendon, fibrocartilage cells lie on the articu lar side of the rotator tendon at the pivot of the humerus head. Typic ally, the calcific deposits of calcifying tendinitis are found between these two areas. At this site, hydroxyapatite is usually formed by fi brocartilage cells through an unknown stimulus. There is no ossificati on. This is a two-phase disease. During the chronic initial phase, a c alcific deposit is formed in the tendon of the rotator cuff. In the X- ray, it is clearly circumscribed and has a dense appearance (type I). Pain is inconsistent and may exist for years. In the acute phase, the deposit undergoes spontaneous resolution. Now it takes on a translucen t and cloudy appearance without clear circumscription (type III). Pati ents experience severe pain for 2-3 weeks. Finally, a normally functio ning shoulder joint will result. The X-ray therefore allows a prognost ic conclusion. In a study including 235 calcific deposits, it became c lear that there are some cases where it is not possible to designate t he specific X-ray morphology to a given deposit (type II). Irrespectiv e of the phase of disease, the so-called calcific deposit is composed of poorly mineralized hydroxyapatite. For a diagnosis, we require: a t ypical history, clinical findings consistent with tendinitis of the ro tator cuff, calcific deposits in the tendon associated with signs and symptoms of tendinitis. It is recommendet that radiographs be taken at least in AP projections with the shoulder in internal and external ro tation to demonstrate the deposits without superimposition. Ultrasound shows concomitant bursitis and is useful for the differential diagnos is of rupture of the rotator cuff. Radiographic diagnosis is most diff icult when there are small opacifications near the rotator attachment. In this case, allocation may become possible only later in the course of disease. Initial treatment should always be non-operative. Almost all therapeutic modalities are said to be quite successful. Needles un der local anesthesia is recommended only for patients with marked pain who lack any signs of resolution in the X-ray. According to a prospec tive study, the success rates of needles depend on the roentgenologic findings: in type I deposits, resolution occurs in 33%, in type II dep osits in 71%. Freedom from pain is seen in about 50% of the patients. Type III deposits undergo resolution with and without therapy in about 2-3 weeks. Postoperative results are reported to lie between 77% and 96% irrespective of the method used. This holds true for removal of ca lcific deposits by open surgery and by arthroscopy with and without ac romioplasty as well as for acromioplasty alone.