Dept of Athletic Training, Duquesne University, Pittsburgh, PA, USA.
J Sport Rehabil. 2012 Nov;21(4):334-42. doi: 10.1123/jsr.21.4.334. Epub 2012 Mar 2.
The efficacy of a variety of noninvasive, conservative management techniques for calcific tendinopathy has been investigated and established for improving pain and function and/or facilitating a decrease in the size or presence of calcium deposits. Surprisingly, few have reported on the use of traditional therapeutic exercise and rehabilitation alone in the management of this condition, given the often spontaneous resorptive nature of calcium deposits. The purpose of this case is to present the results of a conservative approach, including therapeutic exercise, for the management of calcific tendinopathy of the supraspinatus, with an emphasis on patient outcomes.
The patient was a self-referred 41-y-old man with complaints of acute right-shoulder pain and difficulty sleeping. Imaging studies revealed liquefied calcium deposits in the right supraspinatus. The patient reported constant pain at rest (9/10) and tenderness in the area of the greater tuberosity. He exhibited a decrease in all shoulder motions and had reduced strength. The simple shoulder test (SST) revealed limited function (0/12). Conservative management included superficial modalities and medication for pain and a regimen of scapulothoracic and glenohumeral range-of-motion (ROM) and strengthening exercises.
At discharge, pain levels decreased to 0/10 and SST scores increased to 12/12. ROM was full in all planes, and resisted motion was strong and pain free. The patient was able to engage in endurance activities and continue practicing as a health care provider.
The outcomes with respect to pain, function, and patient satisfaction provide evidence to support the use of conservative therapeutic interventions when managing patients with acute cases of calcific tendinopathy. Successful management of calcific tendinopathy requires attention to outcomes and an understanding of the pathophysiology, prognostic factors, and physical interventions based on the current stage of the calcium deposits and the patient's status in the healing continuum.
多种非侵入性、保守治疗技术治疗钙化性肌腱病的疗效已得到证实，可改善疼痛和功能，或促进钙沉积的大小或存在减少。令人惊讶的是，鉴于钙沉积通常具有自发吸收的性质，很少有报道仅使用传统的治疗性运动和康复来治疗这种疾病。本病例的目的是介绍一种保守治疗方法（包括治疗性运动）治疗肩袖上的钙化性肌腱病的结果，重点是患者的结局。
患者为一名 41 岁的自我转诊男性，主诉急性右肩疼痛和难以入睡。影像学检查显示右肩袖中有液化钙沉积。患者报告静息时持续疼痛（9/10），大结节处触痛。他表现出所有肩部运动受限，力量减弱。简单肩部测试（SST）显示功能受限（0/12）。保守治疗包括浅表治疗和止痛药物治疗，以及肩胛胸和盂肱关节活动度（ROM）和强化运动的方案。
出院时，疼痛程度降至 0/10，SST 评分增至 12/12。所有平面的 ROM 均完全，阻力运动有力且无痛。患者能够进行耐力活动并继续作为医疗保健提供者进行练习。
在疼痛、功能和患者满意度方面的结果为急性钙化性肌腱病患者管理中使用保守治疗干预措施提供了证据支持。钙化性肌腱病的成功管理需要关注结局，并了解基于钙沉积的当前阶段和患者在愈合连续体中的状况的病理生理学、预后因素和物理干预措施。
