Brusalis Christopher M, Streepy John T, Williams Tyler, Garelick Sydney, Garrigues Grant E
Hospital for Special Surgery, New York, New York, USA.
Rush University Medical College, Chicago, Illinois, USA.
Video J Sports Med. 2024 May 14;4(3):26350254231220952. doi: 10.1177/26350254231220952. eCollection 2024 May-Jun.
Calcific tendinitis is a common source of shoulder pain and represents pathologic deposition of calcium hydroxyapatite within rotator cuff tendon tissue, most commonly the supraspinatus tendon.
Arthroscopic decompression of calcific tendinitis with possible rotator cuff repair is indicated in patients with persistent, debilitating symptoms of pain and/or dysfunction who are recalcitrant to nonoperative treatments, including corticosteroid administration, ultrasound-guided needle barbotage, and/or extracorporeal shockwave therapy.
With the patient in a beach chair position, a standard diagnostic shoulder arthroscopy is performed to evaluate for concomitant pathologies. Within the subacromial space, a thorough bursectomy is performed and the area of calcium deposition is localized with a spinal needle. A scalpel may be used to create a small incision through the rotator cuff tendon in line with its fibers to promote egress of calcific debris. Surrounding tissue and loose debris are removed with an arthroscopic shaver. Following decompression, the rotator cuff repair is inspected, and if a bursal-sided or full-thickness tear is identified, an arthroscopic repair is performed with a construct individualized to the specific tear pattern.
Surgical treatment conferred greater functional improvement and comparable pain reduction to nonoperative treatments in a systematic review comprised of 27 randomized trials. While the addition of a rotator cuff repair remains controversial, combined excision of calcific tendinitis with concomitant rotator cuff repair led to greater functional outcomes and pain reduction at 2-year minimum follow-up compared with isolated decompression.
Calcific tendinitis within the shoulder may be treated successfully with arthroscopic decompression and subsequent repair of a residual rotator cuff defect, followed by a graduated physical rehabilitation program.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
钙化性肌腱炎是肩部疼痛的常见原因，表现为羟基磷灰石在肩袖肌腱组织内病理性沉积，最常见于冈上肌腱。
对于经非手术治疗（包括皮质类固醇注射、超声引导下针筒冲洗和/或体外冲击波治疗）无效的持续性、使人衰弱的疼痛和/或功能障碍症状患者，建议行钙化性肌腱炎的关节镜减压术并可能进行肩袖修复。
患者取沙滩椅位，进行标准的诊断性肩关节镜检查以评估合并的病变。在肩峰下间隙，彻底切除滑囊，并使用脊椎穿刺针定位钙沉积区域。可使用手术刀沿肩袖肌腱纤维方向做一个小切口，以促进钙化碎片排出。用关节镜刨削器清除周围组织和松散碎片。减压后，检查肩袖修复情况，如果发现滑囊侧或全层撕裂，则根据具体撕裂模式采用个体化的结构进行关节镜修复。
在一项由27项随机试验组成的系统评价中，手术治疗与非手术治疗相比，功能改善更大，疼痛减轻程度相当。虽然增加肩袖修复仍存在争议，但与单纯减压相比，钙化性肌腱炎切除术联合肩袖修复在至少2年的随访中能带来更好的功能结果和疼痛减轻。
肩关节内的钙化性肌腱炎可通过关节镜减压及随后修复残留的肩袖缺损，再配合逐步的物理康复计划成功治疗。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可识别，作者已随本提交的出版物包含患者的豁免声明或其他书面批准形式。
