Department of Orthopaedics, Liuzhou Workers' Hospital/The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Am J Sports Med. 2024 Feb;52(2):461-473. doi: 10.1177/03635465231217733.
Treatment options for calcific tendinitis (CT) of the shoulder remain controversial. A consensus for an operative indication for this condition is lacking.
To compare nonoperative versus operative treatment for shoulder CT and analyze factors affecting the prognosis after treatment.
Cohort study; Level of evidence, 3.
A total of 180 patients diagnosed with symptomatic CT between January 2017 and September 2021 were evaluated in this retrospective cohort study. There were 103 patients treated nonoperatively at our institution, which included the use of nonsteroidal anti-inflammatory drugs, acupuncture, steroid injections, extracorporeal shock wave therapy, and ultrasound-guided needle aspiration/percutaneous irrigation. However, 77 patients were treated with arthroscopic surgery after 6 months of failed nonoperative treatment. The visual analog scale (VAS) for pain, the Constant-Murley score, and imaging were used to assess and evaluate outcomes. Descriptive data, functional outcomes, and imaging findings were compared between the operative and nonoperative groups before and after propensity score matching. Additionally, prognostic factors including calcium deposit size, tendon infiltration by calcium deposits, involvement of single or multiple tendons, and occurrence of rotator cuff tears were analyzed by comparing the groups to determine their effect on treatment options and recovery.
Magnetic resonance imaging showed that the supraspinatus tendon (66.7%) was most commonly involved, followed by the infraspinatus (42.8%) and subscapularis (21.1%) tendons. Tendon infiltration by calcium deposits was observed in 84.4% of the patients, and rotator cuff tears occurred in 30.0% of the patients. After propensity score matching, there was no significant difference in changes in the Constant-Murley score (48.1 ± 25.4 vs 49.0 ± 22.8, respectively; = .950) and VAS score (4.9 ± 2.3 vs 4.5 ± 1.9, respectively; = .860) between the operative and nonoperative groups at the final follow-up. However, for patients with shoulder CT and without rotator cuff tears, there was a significant difference in changes in the Constant-Murley score (52.93 ± 25.18 vs 42.13 ± 22.35, respectively; = .012) and VAS score (5.21 ± 2.06 vs 3.81 ± 1.98, respectively; < .001) between the operative and nonoperative groups, but the recovery time in the operative group was longer than that in the nonoperative group (86.92 ± 138.56 vs 30.42 ± 54.97 days, respectively; = .016). The results also showed that calcium deposit size, involvement of multiple tendons, and tendon infiltration by calcium deposits did not affect the recovery time after treatment. The survival analysis showed that rotator cuff tears affected the complete recovery of shoulder function.
This study demonstrated no significant difference between nonoperative and operative treatment for patients with shoulder CT, on the whole. However, for patients with shoulder CT and without rotator cuff tears, the effect of operative treatment was better than that of nonoperative treatment; yet, operative treatment was shown to prolong the recovery time. Calcium deposit size, tendon infiltration by calcium deposits, and involvement of multiple tendons did not correlate with recovery time or the recovery of function. A rotator cuff tear was the only factor affecting the complete recovery of shoulder function.
肩袖钙化性肌腱炎（CT）的治疗方案仍存在争议。对于这种情况，缺乏手术指征的共识。
比较肩袖 CT 的非手术与手术治疗，并分析治疗后影响预后的因素。
队列研究；证据水平，3 级。
本回顾性队列研究共评估了 2017 年 1 月至 2021 年 9 月期间我院确诊的 180 例有症状的 CT 患者。103 例患者在我院接受非手术治疗，包括使用非甾体抗炎药、针灸、类固醇注射、体外冲击波治疗和超声引导下的针吸/经皮灌洗。然而，77 例患者在非手术治疗 6 个月后失败，接受了关节镜手术。使用视觉模拟评分（VAS）评估疼痛、Constant-Murley 评分和影像学结果，以评估和评估结果。在进行倾向评分匹配前后，比较手术组和非手术组的描述性数据、功能结果和影像学发现。此外，通过比较各组来分析钙沉积大小、钙沉积对肌腱的浸润、单根或多根肌腱受累以及肩袖撕裂的发生等预测因素，以确定它们对治疗方案和恢复的影响。
磁共振成像显示，肩袖的冈上肌腱（66.7%）最常受累，其次是冈下肌腱（42.8%）和肩胛下肌腱（21.1%）。84.4%的患者有钙沉积对肌腱的浸润，30.0%的患者有肩袖撕裂。在进行倾向评分匹配后，手术组和非手术组在最终随访时的 Constant-Murley 评分（分别为 48.1 ± 25.4 与 49.0 ± 22.8， =.950）和 VAS 评分（分别为 4.9 ± 2.3 与 4.5 ± 1.9， =.860）的变化均无显著差异。然而，对于无肩袖撕裂的肩袖 CT 患者，手术组和非手术组的 Constant-Murley 评分（分别为 52.93 ± 25.18 与 42.13 ± 22.35， =.012）和 VAS 评分（分别为 5.21 ± 2.06 与 3.81 ± 1.98， <.001）的变化有显著差异，但手术组的恢复时间长于非手术组（分别为 86.92 ± 138.56 与 30.42 ± 54.97 天， =.016）。结果还表明，钙沉积大小、多根肌腱受累和钙沉积对肌腱的浸润并不影响治疗后恢复时间。生存分析表明肩袖撕裂影响肩功能的完全恢复。
本研究表明，肩袖 CT 患者的非手术与手术治疗整体上无显著差异。然而，对于无肩袖撕裂的肩袖 CT 患者，手术治疗的效果优于非手术治疗；然而，手术治疗会延长恢复时间。钙沉积大小、钙沉积对肌腱的浸润以及多根肌腱受累与恢复时间或功能恢复无关。肩袖撕裂是影响肩功能完全恢复的唯一因素。
