Rupp S, Seil R, Kohn D
Orthopädische Klinik und Poliklinik, Universitätskliniken des Saarlandes, 66421 Homburg/Saar.
Orthopade. 2000 Oct;29(10):852-67.
Calcifying tendinitis of the rotator cuff is a common disorder of the shoulder which affects mainly individuals between 30 and 50 years of age. The etiology is still a matter of speculation. The calcification is a reactive process actively mediated by cells in a viable environment. The deposit undergoes an evolution (precalcific stage--calcific stage with formative phase, resting period and resorption--postcalcific stage), which ultimately remodels normal tendon tissue. However, the evolutionary stages of the disease do not always follow the typical sequence. A symptomatic deposit may persist or postcalcific tendinitis develop. The treatment should be based on the knowledge of the natural history of the disease, which shows a strong tendency towards self-healing by spontaneous resorption of the deposit. The stage of evolution of the disease should be judged, combining pain history, morphology of the deposit on plain X-rays, and ultrasound findings. The therapeutic approach depends on the evolution of the disease. During the resorption phase we favor a conservative approach. For deposits which are not under resorption we propose a concept which consists of three steps: a conservative approach, extracorporal shock wave therapy (ESWT) or needling, and arthroscopic surgery. The efficacy of ESWT and needling has still to be proven. Patients with persisting pain after steps 1 and 2 are candidates for surgical removal of the deposit. We prefer the arthroscopic approach. In some cases an additional arthroscopic subacromial decompression (ASD) is indicated.
肩袖钙化性肌腱炎是一种常见的肩部疾病，主要影响30至50岁的人群。其病因仍存在争议。钙化是一个在存活环境中由细胞积极介导的反应过程。沉积物会经历一个演变过程（钙化前期——钙化期，包括形成期、静止期和吸收期——钙化后期），最终重塑正常的肌腱组织。然而，疾病的演变阶段并不总是遵循典型的顺序。有症状的沉积物可能持续存在，或者发展为钙化后期肌腱炎。治疗应基于对疾病自然史的了解，疾病表现出通过沉积物的自发吸收而自我愈合的强烈趋势。应结合疼痛史、X线平片上沉积物的形态以及超声检查结果来判断疾病的演变阶段。治疗方法取决于疾病的演变情况。在吸收期，我们倾向于采用保守治疗方法。对于未处于吸收阶段的沉积物，我们提出一种包含三个步骤的治疗方案：保守治疗、体外冲击波疗法（ESWT）或针刺治疗，以及关节镜手术。ESWT和针刺治疗的疗效仍有待证实。在第1步和第2步治疗后仍持续疼痛的患者是沉积物手术切除的候选对象。我们更倾向于关节镜手术方法。在某些情况下，还需要进行额外的关节镜下肩峰下减压术（ASD）。
