Arrigoni Paolo, Brady Paul C, Burkhart Stephen S
The San Antonio Orthopaedic Group and the Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Arthroscopy. 2006 Oct;22(10):1139.e1-3. doi: 10.1016/j.arthro.2005.06.028.
Calcific tendonitis is a common disease of the shoulder which usually responds to conservative treatment. In cases unresponsive to conservative management, arthroscopic treatment is sometimes required. While there are several reports on calcifications within the supraspinatus tendon, documented cases involving the subscapularis tendon are rare. We present a case of a 47 year old farmer with recurrent anterior shoulder pain. An MRI revealed calcium deposits as well as a large subcoracoid cyst. Arthroscopic excision of the multiple calcific deposits left a large defect in the subscapularis tendon which was repaired back to the lesser tuberosity using arthroscopic techniques. A coracoplasty resulted in an increased coracohumeral space. The patient followed a conservative postop rehabilitation protocol and ultimately regained full strength and was pain free at the latest follow-up. We postulate two possible etiologies of subscapularis calcific tendonitis: either an idiopathic calcific tendonitis caused a secondary coracoid impingement or a primary subcoracoid stenosis resulted in an interstitial subscapularis tear which eventually resulted in calcium deposition. This report describes the clinical and technical details of arthroscopic excision of calcific deposits of the subscapularis tendon as well as arthroscopic repair of the resulting subscapularis defect.
钙化性肌腱炎是一种常见的肩部疾病，通常对保守治疗有效。对于保守治疗无反应的病例，有时需要进行关节镜治疗。虽然有几篇关于冈上肌腱内钙化的报道，但涉及肩胛下肌腱的病例记录很少。我们报告一例47岁农民，反复出现肩部前方疼痛。磁共振成像（MRI）显示有钙沉积以及一个巨大的喙突下囊肿。关节镜下切除多处钙化沉积物后，肩胛下肌腱出现一个大的缺损，使用关节镜技术将其修复至小结节。喙突成形术增加了喙肱间隙。患者遵循保守的术后康复方案，最终恢复了全部力量，在最近一次随访时无痛。我们推测肩胛下肌腱钙化性肌腱炎有两种可能的病因：要么是特发性钙化性肌腱炎导致继发性喙突撞击，要么是原发性喙突下狭窄导致肩胛下肌间撕裂，最终导致钙沉积。本报告描述了关节镜下切除肩胛下肌腱钙化沉积物以及对由此产生的肩胛下肌缺损进行关节镜修复的临床和技术细节。
