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Intra-articular findings in shoulder joints affected by calcific tendinitis

Intraoperative Begleitpathologien bei Tendinosis calcarea des Schultergelenks

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Abstract

Background

Additional pathologies accompanying calcific tendinitis of the rotator cuff still remain unknown. The hypothesis of this study was that there are various additional pathologies accompanying calcific tendinitis, which might need further treatment. This study aimed to document intra-articular pathologies and investigate whether the location and spread of calcific tendinitis are associated with intra-articular pathologies and impairment in range of motion.

Methods

Arthroscopy was performed on 53 patients for chronic calcific tendinitis. Documentation included demographic baseline variables, intraoperative findings of all structures in the glenohumeral joint, range of motion, joint laxity under general anesthesia, and basic details of intraoperative procedures.

Results

In all, 189 additional pathologies were found, 77 during intra-articular arthroscopy. Of all extra- and intra-articular pathologies, 74 and 70%, respectively, required surgical treatment. A mean of 3.6 additional pathologic findings per patient were observed; 19% of all patients had multiple (i. e., ≥2) calcific spots. The main additional pathologies were bursitis (87%), type II–III acromion (Bigliani classification, 70%), and synovitis (47%). No statistical significance was found for any associations tested between the localization of the deposit and the documented pathologies.

Conclusion

Patients with symptomatic, chronic calcific tendinitis of the shoulder may suffer from multiple and therapeutically relevant disorders of the glenohumeral joint requiring surgical care. The frequency of findings underlines the importance of a diagnostic and therapeutic arthroscopy of the shoulder in order to ensure that surgeons properly address intra-articular pathologies.

Zusammenfassung

Hintergrund

Mögliche Begleitbefunde der Tendinosis calcarea des Schultergelenkes sind bis dato nicht ausreichend geklärt. Die Hypothese der vorliegenden Studie lautet, dass zahlreiche Begleitbefunde bei einer Tendinosis calcarea vorliegen dürften, welche ebenfalls therapiebedürftig seien. Zielsetzung dieser Studie war die Dokumentation intraartikulärer pathologischer Veränderungen und die Untersuchung möglicher Korrelationen der Lage und Verteilung der Kalkdepots mit intraartikulären Veränderungen sowie Bewegungseinschränkungen.

Methoden

Aufgrund einer chronischen Tendinosis calcarea wurden 53 Patienten arthroskopisch therapiert. Die Dokumentation umfasste demographische Basisvariablen der Patienten, intraoperative Befunde aller Strukturen des Glenohumeralgelenks, passive Bewegungsumfänge, Instabilitätszeichen in Allgemeinnarkose sowie Grundinformationen zum intraoperativen Vorgehen.

Ergebnisse

Es wurden 189 pathologische Veränderungen entdeckt, 77 während der Arthroskopie. Chirurgisch therapiert wurden 74 % aller (extra- und intra-) bzw. 70 % der intraartikulären Befunde. Im Mittel wurden 3,6 zusätzliche pathologische Veränderungen pro Patient dokumentiert. Bei 19 % der Patienten bestanden mehrere (≥2) kalzifizierende Herde. Die häufigsten begleitenden Veränderungen waren Bursitis (87 %), ein Akromion vom Typ II–III (Bigliani-Klassifikation, 70 %) oder Synovialitis (47 %). Es wurde kein statistisch signifikanter Zusammenhang zwischen der Kalklokalisation und den dokumentierten Begleitbefunden festgestellt.

Schlussfolgerung

Patienten mit symptomatischer chronischer Tendinosis calcarea können multiple und therapeutisch relevante Begleitverletzungen aufweisen, welche eine chirurgische Therapie notwendig machen. Dies unterstreicht den Stellenwert der Arthroskopie bei diesem Krankheitsbild.

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Acknowledgements

The authors thank Prof. Peter Habermeyer for performing some of the surgeries and for supporting the study. The authors thank Dr. Roland Ventura for scientific advice.

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Authors and Affiliations

  1. Abteilung für Obere Extremität, Hand- und Mikrochirurgie, Immanuel Krankenhaus Berlin, Königstraße 63, 14109, Berlin, Germany

    Sophia M. Hünnebeck

  2. Clinical Research Center, Unfallkrankenhaus Berlin/Trauma Hospital Berlin, Warener Str. 7, 12683, Berlin, Germany

    Dirk Stengel & Claas Güthoff

  3. German Joint Center Heidelberg, ATOS Clinic Heidelberg, Bismarckstraße 9–15, 69115, Heidelberg, Germany

    Sven Lichtenberg & Markus Loew

Authors
  1. Sophia M. Hünnebeck
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  2. Dirk Stengel
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  3. Sven Lichtenberg
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  4. Claas Güthoff
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  5. Markus Loew
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Corresponding author

Correspondence to Sophia M. Hünnebeck.

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Conflict of interest

S.M. Hünnebeck, D. Stengel, S. Lichtenberg, C. Güthoff, and M. Loew declare that they have no competing interests.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975. Informed consent was obtained from all patients included in the study. Ethical committee approval was received by the ethical committee of the ATOS Clinic Heidelberg, no. 5/14.

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Hünnebeck, S.M., Stengel, D., Lichtenberg, S. et al. Intra-articular findings in shoulder joints affected by calcific tendinitis. Obere Extremität 12, 242–247 (2017). https://doi.org/10.1007/s11678-017-0429-x

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  • DOI: https://doi.org/10.1007/s11678-017-0429-x

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