CALCIFYING TENDINITIS - RESULTS AFTER NEE DLING

In a prospective study, 33 patients with calcifying tendinitis had a n eedling in local anaesthesia performed under control of an image conve rter. There was at least a one year follow-up period. Resorption of th e hydroxyapatite deposits was seen in 23 instances; 75% of all patient s were free of symptoms or had considerably improved (Table 3). For be tter assessment of these results we embarked on an additional retrospe ctive study observing the spontaneous evolution of 235 hydroxyapatite deposits for 3 years on average. On the x-ray, these deposits had a ch aracteristic appearance and could be classified into one of three type s: either sharply outlined and densely structured (type I), or with cl oudy limitations and transparent in structure (type III). In addition we saw deposits combining the features of both of the above named type s (type II) (Table 5, Fig. 6). Based on this classification, a clear c orrelation was revealed to exist between initial x-ray findings and th e frequency of resorption after needling: with type I, complete resorp tion was seen in 33% of the cases, with type II in 71%, and with type III in 85% of the cases (Table 6). With type II, however, only half of the patients were free of symptoms. Surgical removal of the hydroxypa tite deposits became necessary in 3 patients because of persisting hea vy pains. As complication we observed intraoperatively an incomplete t ear of the rotator cuff, the relation of which to the needling remaine d unsure. In this context, the question is discussed whether calcifyin g tendinitis and rupture of the rotator cuff may represent two disease entities of identical origin. Based on histological investigations th e rotator cuff rupture is mainly due to degenerative processes whereas in calcifying tendinitis there is active calcification with spontaneo us resorption. To clarify the simultaneous occurrence of calcifying te ndinitis and rupture of the rotator cuff in our own patient population , arthrography was performed in 63 patients with calcifying tendinitis . This revealed only one rupture of the cuff and one incomplete tear j uxta-articular. These two disease entities are therefore unlikely to o ccur simultaneously. In practice, the uncomplicated type of needling d escribed here may be recommended for type II hydroxyapatite deposits w here freedom of symptoms and resorption of the deposit may be expected in about 50% of the cases. In most of the cases, type III deposits ar e already undergoing spontaneous resorption; therefore requiring rathe r lavage than needling. Type I does not present a good indication for needling.