钙化性肌腱炎资料

您的感受

您可能因肩袖肌腱内钙化沉积物周围的炎症而感到急性或慢性肩部疼痛。这种磨损性疾病会严重影响您的生活质量，并导致您需要请假休息。疼痛通常感觉深在且持续，使日常活动变得困难。

简单的任务，如在背后扣文胸或把衬衫塞进裤子里，可能会变得具有挑战性。您可能会发现难以将物体举过头顶，或在患侧舒适地睡觉。夜间疼痛很常见，往往会干扰您的休息，使您在第二天感到疲劳。醒来时感到僵硬也是一个常见的抱怨，尤其是如果这种情况已经存在了一段时间。

在某些情况下，疼痛可能表现得不典型。您可能会感到肩后部不适，或者注意到将手臂举过头顶时特别疼痛，这是因为较小的肌肉（如小圆肌）受累所致。虽然这些症状可能令人困扰，但症状性钙化性肌腱炎在长期内完全缓解的可能性很大。大多数患者通过保守治疗找到缓解，这通常是首选方案，尤其是在早期阶段。

如果您正在经历这些症状，您的外科医生将评估您的具体情况以确定最佳的治疗方案。无论疼痛是新发的还是长期的，都有有效的治疗方法可以帮助恢复您的功能并减轻不适。您不必接受这种疼痛是永久性的。通过适当的治疗，您可以期望随着时间的推移，肩部疼痛和功能得到显著改善。

实际发生了什么

钙化性肌腱炎是由于钙沉积物在肩部肌腱内积聚所致。这些肌腱是连接肌肉与骨骼的强韧组织带。您可以将其想象为悬索桥上的缆绳。当钙结晶在这些“缆绳”内形成时，会产生坚硬的肿块。该肿块会刺激周围组织，导致剧烈疼痛和僵硬。

肩袖是由一组肌肉和肌腱组成的结构，用于将肩关节固定在位。它就像包裹在上臂骨头球体周围的一层稳定套筒。在许多情况下，这些钙沉积物会形成于肩袖肌腱内。身体有时会尝试通过分解这些沉积物来自我修复，但这一过程可能伴随疼痛。分解过程中产生的炎症会导致您感受到的锐痛。

您的肩关节是一个复杂的球窝关节。肱二头肌长头肌腱穿过该关节，有助于维持其稳定性。当您患有钙化性肌腱炎时，疼痛可能会影响这些结构的协同工作。沉积物本身并不总是引起症状，但当其处于活动期时，会干扰肩关节的平滑运动。

我们常观察到，肩关节骨骼的形状或肌腱的厚度可能会影响这一过程。然而，主要问题在于钙沉积物本身。它会产生机械性阻塞和炎症反应。这就是为什么即使在没有大幅度活动手臂时，您仍可能感到疼痛的原因。沉积物在狭小空间内压迫敏感的神经和组织。

理解这一点有助于解释为何仅靠休息可能不足以解决问题。身体需要时间来重新吸收钙质，或者我们可能需要协助将其移除。对于大多数人来说，物理治疗或冲击波治疗等保守治疗方法有助于缓解疼痛并恢复功能。这些治疗支持身体的自然愈合过程。如果沉积物较大或持续存在，我们可能会讨论手术切除。这涉及仔细清除钙质，以减轻对肌腱的压力。

我们能做什么

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 博士在处理此病症时，首先采用侵入性最小的治疗方案。大多数患者无需手术即可改善。我们从自我管理和物理治疗开始。您可以尝试调整活动方式，以避免引发疼痛的动作。物理治疗旨在恢复您肩关节的活动范围和力量。我们通常建议先充分尝试这种方法，再考虑其他步骤。

如果疼痛持续，我们会转向药物治疗。口服抗炎药物有助于减轻肿胀和疼痛。皮质类固醇注射可为许多患者提供显著的缓解。体外冲击波疗法是另一种安全、非侵入性的选择。它利用声波分解钙化沉积物并改善功能。该治疗在缓解疼痛方面成功率很高，且并发症几乎可以忽略不计。超声引导下针刀松解术和冲击波疗法均已被证明可以消除钙化沉积物并改善临床结果。

仅在保守治疗未能带来足够改善时，才会考虑手术。我们会寻找提示手术可能有益的特定指征。例如，钙化病灶大于 1 厘米的患者，需要接受手术治疗的可能性增加 2.8 倍。在慢性病例中，关节镜下清除钙化灶可改善临床结果。这些患者的功能评分改善较慢，在术后六个月时超过 75%。接受手术清除钙化沉积物的患者中，大多数需要同时进行肩袖修复术。该手术可显著改善肩痛和功能。我们会与您讨论这些选项，以决定最佳的治疗路径。

预期情况

钙化性肌腱炎是指钙质在肩关节肌腱中积聚的疾病。这种积聚会导致炎症和疼痛。该病程因人而异。对许多人来说，症状在长期内会完全缓解。然而，这一过程可能迁延不愈。您可能会经历持续数月的间歇性疼痛。这种持续性可能导致无法工作并降低生活质量。

如果您选择非手术治疗，您的肩关节可能会自行好转。保守治疗通常是首选方案，尤其是在早期阶段。一些患者通过冲击波治疗或穿刺手术获得缓解。这些治疗旨在分解钙沉积物或将其冲洗出来。它们在缓解疼痛方面成功率很高，且并发症极少。如果您的钙沉积物较小或存在时间不足十个月，您更有可能通过这些方法使其消退。

如果症状没有改善，可以考虑手术移除钙沉积物。关节镜手术允许您的外科医生通过小切口去除钙化灶。大多数接受此手术的患者同时还需要进行肩袖修复。这是因为肌腱通常因钙质积聚而变得薄弱。您可以预期术后肩关节疼痛和功能有显著改善。

恢复是一个渐进的过程。功能评分会随时间缓慢提高。通常需要至少六个月，这些改善才会完全显现。术后六个月，超过 75% 的患者报告良好的功能结果。大多数患者在最终随访时达到满意的结果。虽然有些人恢复迅速，但其他人需要更多时间。您的外科医生将根据您的具体进展指导您度过这一恢复期。

何时就诊

如果肩部疼痛在休息后未改善，请咨询您的全科医生。如果症状影响睡眠或工作，请要求专科医生进行评估。钙化性肌腱炎是一种急性或慢性疾病，由肩袖肌腱周围钙质沉积引起的炎症所致。症状可能持续很长时间。如果出现无力、不稳定或关节卡锁，请及时就医。疼痛突然加重也是预约就诊的原因。早期评估有助于避免不必要的检查。大多数患者通过保守治疗可获得显著改善。您的外科医生可以指导您采取正确的步骤以恢复功能并减轻疼痛。

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

[1] Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders. Skeletal Radiology. 2015. DOI: 10.1007/s00256-015-2240-3

[2] Predictive factors for failure of conservative management in the treatment of calcific tendinitis of the shoulder. JSES International. 2021. DOI: 10.1016/j.jseint.2021.01.013

[3] Radiologic course of the calcific deposits in calcific tendinitis of the shoulder: Does the initial radiologic aspect affect the final results?. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.07.008

[4] Calcific tendinitis: Natural history and association with endocrine disorders. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.06.007

[5] Calcific tendinitis of the shoulder in the Korean population: demographics and its relation with coexisting rotator cuff tear. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2020.00010

[6] Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study. Annals of the Rheumatic Diseases. 2003. DOI: 10.1136/ard.62.3.248

[7] Diagnosis and treatment of calcific tendinitis of the shoulder. Clinics in Shoulder and Elbow. 2020. DOI: 10.5397/cise.2020.00318

[8] Examination of concomitant glenohumeral pathologies in patients treated arthroscopically for calcific tendinitis of the shoulder and implications for routine diagnostic joint exploration. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1839-z

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[10] Calcific Tendonitis of the Shoulder: Protector or Predictor of Cuff Pathology? A Magnetic Resonance Imaging–Based Study. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.127

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