Calcific Tendinitis Impormasyon

Ano ang nararamdaman mo

Maaari kang maranasan ang akutong o kronikong sakit sa iyong balikat na dulot ng pamamaga sa paligid ng mga deposito ng kalsyo sa mga tendon ng rotator cuff. Ang kondisyong ito na sanhi ng pagkasira dahil sa paggamit ay maaaring makaimpluwensya nang malaki sa iyong kalidad ng buhay at magdulot ng pagkakataon ng pagkawala sa trabaho. Ang sakit ay madalas na tila malalim at patuloy, na nagpapatigil sa mga pang-araw-araw na galaw.

Ang mga simpleng gawain tulad ng pag-abot sa likod ng iyong likod upang isara ang bra o pagtupi ng isama ay maaaring maging hamon. Maaari mong makita na mahirap itong itaas ang mga bagay sa itaas ng iyong ulo o matulog nang komportable sa apektadong gilid. Karaniwan ang sakit sa gabi, madalas na nagdudulot ng pagkagulo sa iyong pahinga at nag-iwan sa iyo na pagod sa susunod na araw. Ang paggising na may katigasan ay isang karaniwang reklamo, lalo na kung ang kondisyon ay nariyan na sa loob ng ilang panahon.

Sa ilang kaso, maaaring magpakita ang sakit sa hindi karaniwang paraan. Maaari mong maranasan ang hindi komportableng pakiramdam sa likod ng iyong balikat o mapansin na ang paggalaw ng iyong braso sa itaas ay partikular na nakakairita dahil sa pagliban ng mas maliliit na kalamnan tulad ng teres minor. Habang ang mga sintomas na ito ay maaaring nakakairita, ang symptomatic calcific tendinitis ay may magandang pagkakataon na ganap na matanggal sa pangmatagalang panahon. Karamihan sa mga pasyente ay nakakahanap ng ginhawa sa pamamagitan ng mga konserbatibong paggamot, na madalas na ang pangunahing pagpipilian, lalo na sa mga maagang yugto.

Kung ikaw ay karanasan ang mga sintomas na ito, ang iyong doktor ay susuriin ang iyong partikular na sitwasyon upang matukoy ang pinakamahusay na landas. Kung ang sakit ay bago o matagal nang nararamdaman, may mga epektibong paggamot na available upang tulungan ang pagbawi ng iyong function at pagbawas ng hindi komportableng pakiramdam. Hindi mo kailangang tanggapin ang sakit na ito bilang permanenteng. Sa angkop na alaga, maaari kang mag-anticipate ng malalaking pagpapabuti sa sakit sa balikat at function sa loob ng panahon.

Ano ang nangyayari talaga

Ang calcific tendinitis ay nangyayari kapag nagtipon-tipon ang mga deposito ng kalsiyum sa loob ng mga tendon ng iyong balikat. Ang mga tendon na ito ay matibay na banda ng tisyu na nag-uugnay ng iyong mga kalamnan sa iyong mga buto. Isipin mo silang mga lubid sa isang suspension bridge. Kapag bumubuo ang mga kristal ng kalsiyum sa loob ng mga lubid na ito, nabubuo ang isang matigas na bulto. Ang bultong ito ay nakaka-irita sa nakapaligid na tisyu, na nagdudulot ng malaking sakit at stiffness.

Ang rotator cuff ay isang grupo ng mga kalamnan at tendon na nagpapanatili ng iyong shoulder joint sa tamang posisyon. Ito ay gumagana tulad ng isang stabilizing sleeve sa paligid ng ulo ng iyong upper arm bone. Sa maraming kaso, ang mga deposito ng kalsiyum ay bumubuo sa loob ng mga tendon ng rotator cuff. Minsan, sinusubukan ng katawan na magpagaling sa sarili sa pamamagitan ng pagbabawas ng mga deposito na ito, ngunit maaaring masakit ang prosesong ito. Ang pamamaga mula sa pagbabawas na ito ang nagdudulot ng matulis na sakit na nararamdaman mo.

Ang iyong shoulder joint ay isang kompleks na ball-and-socket na koneksyon. Ang long head ng biceps tendon ay dumadaan sa loob ng joint na ito at tumutulong upang panatilihin ang katatagan nito. Kapag mayroon kang calcific tendinitis, ang sakit ay maaaring makaapekto sa paraan ng pagtutulungan ng mga estrukturang ito. Hindi laging nagdudulot ng sintomas ang deposito mismo, ngunit kapag ito ay aktibo, ito ay nagdudulot ng pagkagulo sa makinis na galaw ng iyong balikat.

Madalas naming nakikita na ang hugis ng iyong mga buto ng balikat o kapal ng iyong mga tendon ay maaaring makaapekto sa prosesong ito. Gayunpaman, ang pangunahing isyu ay ang deposito ng kalsiyum mismo. Ito ay lumilikha ng mechanical block at inflammatory response. Ito ang dahilan kung bakit maaaring makaramdam ka ng sakit kahit hindi ka sobrang gumagalaw ng iyong braso. Ang deposito ay pumipindot sa sensitibong mga nerbiyo at tisyu sa isang makitid na espasyo.

Ang pag-unawa sa mga ito ay tumutulong upang maipaliwanag kung bakit maaaring hindi sapat ang pahinga lamang. Kailangan ng katawan ng oras upang muling sumipsip ng kalsiyum, o maaari naming tulungan itong alisin. Para sa karamihan ng mga tao, ang mga conservative na paggamot tulad ng physical therapy o shock wave therapy ay maaaring tumulong sa pamamahala ng sakit at pagpapanumbalik ng function. Sinusuportahan ng mga paggamot na ito ang natural na proseso ng pagpagaling ng iyong katawan. Kung malaki o matagal ang deposito, maaaring talakayin namin ang surgical removal. Ito ay kinabibilangan ng maingat na paglilinis ng kalsiyum upang bawasan ang pressure sa iyong mga tendon.

Ano ang maaari naming gawin dito

Si Dr. Kieran Hirpara, isang surgeon sa upper-limb sa Mater Private Hospital Rockhampton, ay pinagsisimulan ang paggamot sa kondisyong ito sa pinakamababang antas ng invasiveness. Ang karamihan sa mga pasyente ay gumagaling nang walang operasyon. Sinisimulan namin sa pamamahala ng sarili at pisikal na terapiya. Maaari mong subukan ang pagbabago sa mga gawain upang maiwasan ang mga masakit na galaw. Layunin ng pisikal na terapiya na ibalik ang saklaw ng galaw at lakas ng iyong balikat. Karaniwang inirerekomenda namin na bigyan ng patas na pagsubok ang pamamaraang ito bago isaalang-alang ang ibang hakbang.

Kung mananatili ang sakit, lumilipat kami sa medikal na pamamahala. Ang mga oral na gamot na anti-inflammatory ay tumutulong upang bawasan ang pamamaga at sakit. Ang mga suntok ng corticosteroid ay maaaring magbigay ng malaking ginhawa sa maraming pasyente. Ang extracorporeal shock wave therapy ay isa pang ligtas na, noninvasive na opsyon. Ginagamit nito ang mga sound wave upang putulin ang mga calcium deposit at mapabuti ang function. Ang paggamot na ito ay may mataas na rate ng tagumpay sa pagpapagaan ng sakit na may napakababa o walang komplikasyon. Parehong ipinakita na ang ultrasound-guided needling at shock wave therapy ay nakakapagwaksi ng mga calcium deposit at nakakapagpapabuti ng mga clinical na resulta.

Ang operasyon ay isaalang-alang lamang kapag ang conservative care ay hindi nagbigay ng sapat na pagpapabuti. Hinahanap namin ang mga partikular na senyales na nagpapahiwatig na maaaring tumulong ang operasyon. Halimbawa, ang mga pasyente na may mga calcific lesion na mas malaki sa 1 cm ay may 2.8 beses na mas mataas na pagkakataon na kailanganin ang operatibong paggamot. Ang arthroscopic pag-alis ng calcification ay nagdudulot ng pagpapabuti sa mga clinical na resulta sa mga chronic na kaso. Ang mga functional na score sa mga pasyenteng ito ay dahan-dahang umaayos, na nakararating sa higit sa 75 porsyento sa anim na buwan pagkatapos ng operasyon. Ang karamihan sa mga pasyenteng dumaraan sa surgical na pamamahala para sa pag-alis ng calcific deposit ay nangangailangan ng kasamang rotator cuff repair. Ang operasyong ito ay nagdudulot ng malaking pagpapabuti sa sakit sa balikat at function. Ipinag-uusapan namin ang mga opsyong ito sa iyo upang desidihin ang pinakamainam na landas patungo sa hinaharap.

Ano ang inaasahan

Ang calcific tendinitis ay isang kondisyon kung saan nag-iipon ng calcium sa mga tendon ng balikat. Ang pag-iipon na ito ay nagdudulot ng pamamaga at sakit. Ang pag-unlad ng kondisyong ito ay nag-iiba-iba mula sa isang tao patungo sa isa. Para sa marami, ang mga sintomas ay gumagaling nang buo sa mahabang panahon. Gayunpaman, ang proseso ay maaaring magtagal. Maaaring maranasan mo ang sakit na pumapasok at lumalabas sa loob ng ilang buwan. Ang pagtitiyaga nito ay maaaring magdulot ng pagkawala ng oras sa trabaho at pagbaba ng kalidad ng buhay.

Kung pipili ka ng pamamahala na hindi nangangailangan ng operasyon, maaaring mag-ayos ang iyong balikat nang mag-isa. Ang konservatibong paggamot ay madalas na pangunahing pagpipilian, lalo na sa mga maagang yugto. May ilang pasyente ang nakakahanap ng ginhawa sa pamamagitan ng shock wave therapy o mga pamamaraan ng karayom. Layunin ng mga paggamot na ito na sirain ang mga deposito ng calcium o hugasan ang mga ito. Nag-aalok ang mga ito ng mataas na antas ng tagumpay sa pagpapagaan ng sakit na may napakababang komplikasyon. Kung maliit ang iyong deposito ng calcium o kung ito ay umiiral na nang mas mababa sa sampung buwan, mas malamang na makikita mong gumagaling ito sa pamamagitan ng mga paraang ito.

Kung hindi magpapabuti ang mga sintomas, ang pagsingil sa operasyon ng deposito ng calcium ay isang pagpipilian. Ang arthroscopic surgery ay nagbibigay-daan sa iyong surgeon na alisin ang calcification sa pamamagitan ng maliliit na hiwa. Karamihan sa mga pasyente na dumadaan sa pamamaraang ito ay nangangailangan din ng rotator cuff repair sa parehong oras. Ito ay dahil madalas na mahina ang tendon dahil sa pag-iipon ng calcium. Maaari kang mag-anticipate ng malaking pagpapabuti sa sakit ng balikat at pag-andar pagkatapos ng operasyon.

Ang paggaling ay isang unti-unting proseso. Mabagal na umuunlad ang mga functional scores sa paglipas ng panahon. Karaniwang kailangan ng hindi bababa sa anim na buwan upang maging ganap na kitang-kita ang mga pagpapabuting ito. Sa anim na buwan pagkatapos ng operasyon, higit sa 75 porsyento ng mga pasyente ay nag-ulat ng magandang functional outcomes. Ang karamihan sa mga pasyente ay nakakamit ng sapat na resulta sa kanilang huling follow-up. Habang ang ilang tao ay mabilis gumaling, ang iba ay nangangailangan ng mas maraming oras. Gabay ng iyong surgeon ang iyong timeline batay sa iyong partikular na progreso.

Kailan pumunta sa doktor

Pumunta sa iyong GP kung mayroon kang sakit sa balikat na hindi gumagaling kahit pahinga. Humingi ng pagsusuri ng espesyalista kung ang mga sintomas ay nakakaapekto sa iyong pagtulog o trabaho. Ang calcific tendinitis ay isang akutong o kronikong kondisyon na dulot ng pamamaga sa paligid ng mga deposito ng kalsyo sa mga tendon ng rotator cuff. Maaaring tumagal nang matagal ang mga sintomas. Humingi ng pag-aalaga kung mapapansin mo ang kahinaan, kawalan ng katatagan, o pagkakasara. Ang biglaang paglala ng sakit ay dahilan din upang mag-book ng appointment. Ang maagang pagsusuri ay tumutulong na maiwasan ang hindi kinakailangang mga pagsusuri. Karamihan sa mga pasyente ay nakakakita ng malaking pagpapabuti sa pamamagitan ng konservatibong paggamot. Ang iyong surgeon ay magbibigay-daan sa iyo sa tamang mga hakbang upang ibalik ang function at bawasan ang sakit.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Calcific tendon deposits of the shoulder are a frequent occurrence in the general population [1].
Only one third of calcific tendon deposits are painful [1].
The primary choice of treatment for calcific tendinitis is conservative, especially in patients with acute calcific tendinitis [7].
Conservative treatment for calcific tendinitis of the shoulder showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits [3].
Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment in the setting of calcific tendinitis of the shoulder [2].
Extracorporeal shock wave therapy (ESWT) can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder due to its good tolerance, safety, and clinical radiological response [6].
Patients with calcific tendinitis of the shoulder who have factors identified for a poor outcome after ESWT should undergo a different procedure [38].
Utilization of barbotage as a treatment for calcific tendonitis of the shoulder appears to produce notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation [9].
The incidence of rotator cuff tears in cases of calcific tendonitis is higher than previously reported [10].
Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of calcific tendinitis due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment [8].
The short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression [14].

Anatomy & Pathophysiology

Only one third of calcific tendon deposits in the general population are painful [1].
Calcific tendinitis of the shoulder in the Korean population has demographic, radiographic, and clinical features that are not different from those of Western populations [5].
Imaging and functional data indicate that calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis [11].
The acromion index is not different between shoulders with calcifying tendinitis, partial-thickness rotator cuff tears, or full-thickness rotator cuff tears [17].
The acromion index of shoulders with calcific tendinitis is comparable to that of shoulders with subacromial impingement [27].
The theoretical concept that a high acromion index results in increased upward force against the subacromial space, influencing pain and function in calcifying tendinitis, was not supported [40].
A rotator cuff tear was the only factor affecting the complete recovery of shoulder function in patients treated for calcific tendinitis [35].

Classification

Symptoms of calcific tendinitis can be protracted, resulting in time off work and impaired quality of life [4].
The demographic, radiographic, and clinical features of calcific tendinitis in the Korean population are not different from those of Western populations [5].
The acromion index is not different between shoulders with calcifying tendinitis, partial- or full-thickness rotator cuff tears [17].
Calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis [11].
Calcification in medial epicondylitis was more commonly identified than previously reported and was distributed over a relatively broad area [13].
Conservative treatment for calcific tendinitis showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits [3].
Shock wave therapy is a heterogeneous but effective treatment for calcifying tendinitis of the shoulder [18].

Clinical Presentation

Only one third of calcific tendon deposits in the shoulder are painful [1].
The prevalence of calcific deposits within the rotator cuff tendons is 7.8% in asymptomatic patients [21].
The prevalence of calcific deposits within the rotator cuff tendons is 42.5% in patients with subacromial pain syndrome [21].
Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment [2].
The demographic, radiographic, and clinical features of calcific tendinitis in the Korean population were not different from those of Western populations [5].
Acute calcific deposition of the hand and wrist is a benign self-limiting disease [15].
Clinical criteria predictive for shoulder rotator cuff calcific tendinopathy can help clinicians suspect this musculoskeletal disease early and with certainty [22].

Investigations

Calcific tendinitis symptoms can be protracted, resulting in time off work and impaired quality of life [4].
Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis [16].
Sonographic or MRI evaluation has accuracy limitations when assessing for rotator cuff tears in the context of calcific tendinitis [16].
The condition of articular chondrocalcinosis is characterized by multiple calcific deposits in the articular cartilage, primarily in the deeper and mid-portions of the cartilage above the tidemark [41].
The dynamic pathological process of calcific tendinopathy includes migration patterns of calcium deposits [12].

Treatment

Calcific tendon deposits are a frequent occurrence in the general population, although only one third are painful [1].
Nonsurgical management remains the mainstay of treatment for calcific tendinitis of the rotator cuff, with most patients improving with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections [19].
Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain, and thus it is reasonable to trial ultrasound-guided needling (barbotage) and extracorporeal shock wave therapy (ESWT) as first-line treatment [36].
ESWT can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder due to its good tolerance, safety, and clinical radiological response [6].
ESWT in calcific tendinitis of the shoulder is very effective [20].
ESWT has a therapeutic effect on tendinosis calcarea [29].
Radial extracorporeal shock wave therapy (rESWT) showed a 14.28% reduction in pain, a 43% improvement in shoulder functional status, and significant increases in shoulder flexion, abduction, extension, and external rotation compared to traditional physiotherapy [26].
Needle aspiration of calcific deposits (NACD) is safe and effective for calcific tendinitis of the rotator cuff [30].
Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement [31].

Complications

Calcific tendon deposits of the shoulder are a frequent occurrence in the general population, although only one third are painful [1].
Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis and aware of the accuracy limitations of sonographic or MRI evaluation [16].
The prevalence rate of calcific deposits in the rotator cuff is 7.8% in asymptomatic patients and 42.5% in patients with subacromial pain syndrome [21].

Recovery

The dynamic pathological process of calcific tendinopathy includes migration patterns of calcium deposits, which are relevant to functional recovery [12].
Arthroscopic bursectomy and debridement of the calcific deposit provides short-term functional outcomes that are not influenced by whether subacromial decompression is performed in combination [14].
Outcome after arthroscopic treatment seems to correlate strongly only with the presence of residual calcium deposits in the tendon, with complete removal recommended [48].
Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques [23].
There was no significant difference in short- and long-term clinical outcomes between single- and double-needle US-guided percutaneous irrigation of calcific tendinopathy [24].
Utilization of barbotage produces notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation [9].
Only with one-time needling, radiologic changes in size and/or density were seen in 76.6% of the calcific tendinitis patients at 4 weeks after the index procedure [28].
A symptom duration of ≤10 months or calcification size of ≤10.82 mm represented the clinical scenarios most likely to show resorption after ESWT [44].
In ESWT studies, Type III calcifications and shorter symptom duration were associated with better outcomes [46].
The onset of calcium resorption in acute calcific tendinitis occurs most frequently in the summer in Japan [47].
The minimal and substantial clinical benefit (MCID, SCB) and responsiveness for patients with long-lasting rotator cuff calcific tendinitis treated with minimally invasive treatment options have been established for the Constant-Murley score and Disabilities of the Arm, Shoulder and Hand score [32].

Key Evidence

[L3] Calcific tendon deposits of the shoulder are a frequent occurrence in the general population, although only one third are painful. [1] (10.1007/s00256-015-2240-3)
[L3] Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment in the setting of calcific tendinitis of the shoulder. [2] (10.1016/j.jseint.2021.01.013)
[L2] Conservative treatment for calcific tendinitis of the shoulder showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits. [3] (10.1016/j.jse.2009.07.008)
[L3] Calcific tendinitis is a poorly understood condition in which symptoms can be protracted, resulting in time off work and impaired quality of life. [4] (10.1016/j.jse.2006.06.007)
[L4] This study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in the Korean population, which were not different from those of Western populations. [5] (10.5397/cise.2020.00010)
[L2] Because of its good tolerance, safety, and clinical radiological response, ESWT can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder. [6] (10.1136/ard.62.3.248)
[L5] The primary choice of treatment for calcific tendinitis is conservative, especially in patients with acute calcific tendinitis. [7] (10.5397/cise.2020.00318)
[L3] Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of calcific tendinitis due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment. [8] (10.1186/s12891-017-1839-z)
[L4] Utilization of barbotage as a treatment for calcific tendonitis of the shoulder appears to produce notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation. [9] (10.1016/j.jseint.2024.06.005)
[L4] The incidence of rotator cuff tears in cases of calcific tendonitis in this cohort of patients who underwent MRI is higher than previously reported. [10] (10.1016/j.arthro.2019.11.127)
[L2] Imaging and functional data indicate that calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis that should be considered in clinical and surgical practice. [11] (10.1016/j.jse.2008.09.016)
[L5] The paper illustrates the dynamic pathological process of calcific tendinopathy, including migration patterns of calcium deposits, and discusses clinical and sonographic assessment to optimize diagnosis, rehabilitation, and interventional management for functional recovery. [12] (10.3390/diagnostics12123097)
[L3] Calcification in medial epicondylitis was more commonly identified than previously reported and was distributed over a relatively broad area. [13] (10.1016/j.jse.2021.08.031)
[L1] This study has demonstrated that the short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression. [14] (10.1016/j.arthro.2015.05.015)
[L5] Acute calcific deposition of the hand and wrist is a benign self-limiting disease. [15] (10.1016/j.jhsa.2014.06.011)
[L3] Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis and aware of the accuracy limitations of sonographic or MRI evaluation. [16] (10.5397/cise.2021.00094)
[L3] The acromion index is not different between shoulders with calcifying tendinitis, partial- or full-thickness rotator cuff tears. [17] (10.1007/s00402-011-1263-z)
[L1] Shock wave therapy is a heterogeneous but effective treatment for calcifying tendinitis of the shoulder. [18] (10.1177/1941738108331197)
[L5] Nonsurgical management remains the mainstay of treatment for calcific tendinitis of the rotator cuff, with most patients improving with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. [19] (10.5435/jaaos-22-11-707)
[L1] ESWT in calcific tendinitis of the shoulder is very effective. [20] (10.1007/s00256-004-0849-8)
[L3] The prevalence rates of 7.8% in asymptomatic patients and 42.5% in patients with subacromial pain syndrome provide a current view on the epidemiology of calcific deposits in the rotator cuff. [21] (10.1016/j.jse.2015.02.024)
[L3] These clinical criteria, predictive for shoulder RCCT, can be crucial to help all clinicians suspect this musculoskeletal disease early and with certainty, thus allowing for an appropriate and prompt diagnosis path. [22] (10.1177/17585732241244515)
[L4] Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques, and it is only slightly invasive and painful. [23] (10.2214/ajr.07.2254)
[L1] There was no significant difference in short- and long-term clinical outcomes between single- and double-needle US-guided percutaneous irrigation of calcific tendinopathy. [24] (10.1148/radiol.2017162888)
[L2] Specifically, the rESWT group showed a 14.28% reduction in pain, a 43% improvement in shoulder functional status, and significant increases in shoulder flexion, abduction, extension, and external rotation. [26] (10.5606/archrheumatol.2019.7081)
[L4] The AI of shoulders with calcific tendinitis is comparable to that of shoulders with subacromial impingement. [27] (10.1007/s00167-012-2327-5)
[L4] Only with one-time needling, radiologic changes in size and/or density were seen in 76.6% of the calcific tendinitis patients at 4 weeks after the index procedure. [28] (10.1016/j.arthro.2013.03.033)
[L2] ESWT has a therapeutic effect on tendinosis calcarea. [29] (10.1007/s00776-003-0720-0)
[L4] Needle aspiration of calcific deposits (NACD) is safe and effective for calcific tendinitis of the rotator cuff. [30] (10.1016/j.ejrad.2016.01.018)
[L3] Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement. [31] (10.1007/s00167-022-06870-2)
[L2] This study established the MCID, SCB, and responsiveness for patients with long-lasting rotator cuff calci fi c tendinitis who were treated with minimally invasive treatment options. [32] (10.1016/j.jseint.2020.05.001)
[L3] A rotator cuff tear was the only factor affecting the complete recovery of shoulder function. [35] (10.1177/03635465231217733)
[L1] Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain, and thus it is reasonable to trial UGN and ESWT as first-line treatment. [36] (10.1016/j.jse.2023.03.017)
[L3] Patients with calcific tendinitis of the shoulder who have the factors identified for a poor outcome after ESWT should undergo a different procedure. [38] (10.1302/0301-620x.99b12.bjj-2016-1178.r1)
[L2] The theoretical concept of a high acromion index resulting in an increased upward force against the subacromial space, which influences pain and function in calcifying tendinitis of the shoulder, was not supported. [40] (10.1007/s00167-011-1563-4)
[L5] The condition is characterized by multiple calcific deposits in the articular cartilage, primarily in the deeper and mid-portions of the cartilage above the tidemark. [41] (10.2106/00004623-197254040-00015)
[L3] A symptom duration of ≤10 months or calcification size of ≤10.82 mm represented the clinical scenarios most likely to show resorption after ESWT. [44] (10.1177/23259671241231609)
[L3] In SWT studies, Type III calcifications and shorter symptom duration were associated with better outcomes. [46] (10.1177/17585732251414964)
[L3] The onset of calcium resorption in acute calcific tendinitis occurs most frequently in the summer in Japan; however, the reasons for seasonal variation remain unclear, and further studies will be needed. [47] (10.1186/s12891-020-03773-6)
[L4] Outcome seems to correlate strongly only with the presence of residual calcium deposits in the tendon; complete removal is recommended. [48] (10.1016/j.jse.2004.04.001)

References

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