Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment

Valerio Sansone, Emanuele Maiorano, Alessandro Galluzzo, Valerio Pascale, Valerio Sansone, Emanuele Maiorano, Alessandro Galluzzo, Valerio Pascale

Abstract

Calcific tendinopathy (CT) of the shoulder is a common, painful condition characterized by the presence of calcium deposits in the rotator cuff tendons. Current theories indicate that CT may be the result of a cell-mediated process in which, after a stage of calcium deposition, calcifications are spontaneously resorbed. However, in a minority of cases, this self-healing process is somehow disrupted, resulting in symptoms. Recent literature shows an emerging role of biological and genetic factors underlying CT. This new evidence could supplement the classic mechanical theory of rotator cuff tendinopathy complicated by calcium precipitation, and it may also explain why the majority of the therapies currently in use are only able to provide partially satisfactory outcomes. This review aims to summarize the current knowledge about the pathological processes underlying CT of the shoulder and thereby justify the quest for advanced biological treatments of this condition when it becomes symptomatic.

Keywords: calcific deposits; calcific tendinopathy; review; rotator cuff tendons; shoulder; tendinitis.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

References

    1. Ea HK, Lioté F. Diagnosis and clinical manifestations of calcium pyro-phosphate and basic calcium phosphate crystal deposition diseases. Rheum Dis Clin North Am. 2014;40(2):207–229.
    1. Chiou HJ, Hung SC, Lin SH, Wei YS, Li MJ. Correlation among mineral components, progressive calcification process and clinical symptoms of calcific tendonitis. Rheumatology. 2010;49:548–565.
    1. Bosworth BM. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12,122 shoulders. J Am Med Assoc. 1941;116:2477–2482.
    1. Farin PU, Jaroma H. Sonographic findings of rotator cuff calcifications. J Ultrasound Med. 1995;14(1):7–14.
    1. Clavert P, Sirveaux F. Société française d’arthroscopie: Les tendinopathies calcifiantes de l’épaule [Shoulder calcifying tendinitis] Rev Chir Orthop Reparatrice Appar Mot. 2008;94(8):S336–S355.
    1. Mavrikakis ME, Drimis S, Kontoyannis DA, Rasidakis A, Moulo-poulou ES, Kontoyannis S. Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: a controlled study. Ann Rheum Dis. 1989;48(3):211–214.
    1. McKendry PJ, Uhthoff HK, Sarkar K, Hyslop PS. Calcifying tendonitis of the shoulder: prognostic value of clinical, histologic, and radiologic features in 57 surgically treated cases. J Rheumatol. 1982;9(1):75–90.
    1. DePalma AF, Kruper JS. Long-term study of shoulder joints affected with and treated for calcific tendinitis. Clin Orthop. 1961;20:61–72.
    1. Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis, and management. J Am Acad Orthop Surg. 1997;5(4):183–191.
    1. Rothman RH, Parke WW. The vascular anatomy of the rotator cuff. Clin Orthop Relat Res. 1965;41:176–186.
    1. Gosens T, Hofstee DJ. Calcifying tendinitis of the shoulder: advances in imaging and management. Curr Rheumatol Rep. 2009;11(2):129–134.
    1. Rüttimann G. Über Die Haufigkeit rontenologischer Veranderungen bei Patienten mit typischer Periarthritis humeroscapularis und Schultergesunden [Inaugural dissertation] Zurich, Switzerland: University of Zurich; 1959.
    1. Uhthoff HK. Anatomopathology of calcifying tendinitis of the cuff. In: Gazielly DF, Gleyze P, Thomas T, editors. The Cuff. Paris: Elsevier; 1997. pp. 144–147.
    1. Welfling J. Les calcifications de l’épaule. Diagnostic Clinique. Rev Rhum. 1964;31:265–271.
    1. Sansone VC, Meroni R, Boria P, Pisani S, Maiorano E. Are occupational repetitive movements of the upper arm associated with rotator cuff calcific tendinopathies? Rheumatol Int. 2015;35(2):273–280.
    1. Sansone V, Consonni O, Maiorano E, Meroni R, Goddi A. Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders. Skeletal Radiol. 2016;45(1):49–55.
    1. Le Goff B, Berthelot JM, Guillot P, Glémarec J, Maugars Y. Assessment of calcific tendonitis of rotator cuff by ultrasonography: comparison between symptomatic and asymptomatic shoulders. Joint Bone Spine. 2010;77(3):258–263.
    1. Ogon P, Suedkamp NP, Jaeger M, Izadpanah K, Koestler W, Maier D. Prognostic factors in nonoperative therapy for chronic symptomatic cal-cific tendinitis of the shoulder. Arthritis Rheum. 2009;60(10):2978–2984.
    1. Sandstrom C. Peridentinis calcarea: a common disease of middle life. Its diagnosis pathology and treatment. AJR. 1938;40:1–21.
    1. Mohr W, Bilger S. Morphological basic structures of calcified tendinopathy and its importance in the pathogenesis. Z Rheumatol. 1990;49:346–355.
    1. Benjamin M, Rufai A, Ralphs JR. The mechanism of formation of bony spurs (enthesophytes) in the achilles tendon. Arthritis Rheum. 2000;43(3):576–583.
    1. Uhthoff HK. Calcifying tendinitis, an active cell-mediated calcification. Virchows Arch A Pathol Anat Histol. 1975;366(1):51–58.
    1. Yamamoto A, Takagishi K, Kobayashi T, Shitara H, Osawa T. Factors involved in the presence of symptoms associated with rotator cuff tears: a comparison of asymptomatic and symptomatic rotator cuff tears in the general population. J Shoulder Elbow Surg. 2011;20(7):1133–1137.
    1. Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012;31(4):589–604.
    1. Wendelboe AM, Hegmann KT, Gren LH, Alder SC, White GL, Lyon JL. Associations between body-mass index and surgery for rotator cuff tendinitis. J Bone Joint Surg Am. 2004;86(4):743–747.
    1. Gumina S, Candela V, Passaretti D, et al. The association between body fat and rotator cuff tear: the influence on rotator cuff tear sizes. J Shoulder Elbow Surg. 2014;23(11):1669–1674.
    1. Bi Y, Ehirchiou D, Kilts TM, et al. Identification of tendon stem/progenitor cells and the role of the extracellular matrix in their niche. Nat Med. 2007;13(10):1219–1227.
    1. Zhang J, Wang JH. Platelet-rich plasma releasate promotes differentiation of tendon stem cells into active tenocytes. Am J Sports Med. 2010;38(12):2477–2486.
    1. Scadden DT. The stem-cell niche as an entity of action. Nature. 2006;441(7097):1075–1079.
    1. Wang JH, Guo Q, Li B. Tendon biomechanics and mechanobiology – a mini review of basic concepts and recent advancements. J Hand Ther. 2012;25(2):133–140.
    1. Rui YF, Lui PP, Chan LS, Chan KM, Fu SC, Li G. Does erroneous differentiation of tendon-derived stem cells contribute to the pathogenesis of calcifying tendinopathy? Chin Med J (Engl) 2011;124(4):606–610.
    1. Zhang J, Wang JH. Production of PGE(2) increases in tendons subjected to repetitive mechanical loading and induces differentiation of tendon stem cells into non-tenocytes. J Orthop Res. 2010;28(2):198–203.
    1. Zhang J, Wang JH. Mechanobiological response of tendon stem cells: implications of tendon homeostasis and pathogenesis of tendinopathy. J Orthop Res. 2010;28(5):639–643.
    1. Jim YF, Hsu HC, Chang CY, Wu JJ, Chang T. Coexistence of calcific tendinitis and rotator cuff tear: an arthrographic study. Skeletal Radiol. 1993;22(3):183–185.
    1. Hurt G, Baker CL., Jr Calcific tendinitis of the shoulder. Orthop Clin North Am. 2003;34(4):567–575.
    1. Rosenthal AK, Gohr CM, Mitton E, Monnier VM, Burner T. Advanced glycation end products increase transglutaminase activity in primary porcine tenocytes. J Investig Med. 2009;57(2):460–466.
    1. Harvie P, Pollard TC, Carr AJ. Calcific tendinitis: natural history and association with endocrine disorders. J Shoulder Elbow Surg. 2007;16(2):169–173.
    1. Hajiroussou VJ, Webley M. Familial calcific periarthritis. Ann Rheum Dis. 1983;42(4):469–470.
    1. Cannon RB, Schmid FR. Calcific periarthritis involving multiple sites in identical twins. Arthritis Rheum. 1973;16(3):393–396.
    1. Fong CM. Calcific tendinitis of the supraspinatus tendon in a 7-year-old boy: diagnostic challenges. Hong Kong Med J. 2011;17(5):414–416.
    1. Sengar DPS, McKendry RJ, Uhthoff HK. Increased frequency of HLA-A1 in calcifying tendonitis. Tissue Antigens. 1987;29(3):173–174.
    1. Gärtner J. Is tendinosis calcarea associated with HLA-A1? [in Ger-man] Z Orthop Ihre Grenzgeb. 1993;31(5):461–469.
    1. Ho AM, Johnson MD, Kingsley DM. Role of the mouse ank gene in control of tissue calcification and arthritis. Science. 2000;289(5477):265–270.
    1. Peach CA, Zhang Y, Dunford JE, Brown MA, Carr AJ. Cuff tear arthropathy: evidence of functional variation in pyrophosphate metabolism genes. Clin Orthop Relat Res. 2007;462:67–72.
    1. Maldonado I, Reginato AM, Reginato AJ. Familial calcium crystal diseases: what have we learned? Curr Opin Rheumatol. 2001;13(3):225–233.
    1. Chiou HJ, Chou YH, Wu JJ, Hsu CC, Huang DY, Chang CY. Evaluation of calcific tendonitis of the rotator cuff: role of color Doppler ultrasonography. J Ultrasound Med. 2002;21(3):289–295.
    1. Chiou HJ, Chou YH, Wu JJ, et al. The role of high-resolution ultrasonography in management of calcific tendonitis of the rotator cuff. Ultrasound Med Biol. 2001;27(6):735–743.
    1. Draghi F, Scudeller L, Draghi AG, Bortolotto C. Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study. J Ultrasound. 2015;18(2):151–158.
    1. Merolla G, Bhat MG, Paladini P, Porcellini G. Complication of cal-cific tendinitis of the shoulder: a concise rewiev. J Orthop Traumatol. 2015;16:175–183.
    1. Molé D, Kempf JF, Gleyze P, Rio B, Bonnomet F, Walch G. Results of endoscopic treatment of non-broken tendinopathies of the rotator cuff. 2. Calcifications of the rotator cuff. Rev Chir Orthop Reparatrice Appar Mot. 1993;79(7):532–541.
    1. Maier M, Schnidt-Ramsin J, Glaser C, Kunz A, Kuchenhoff H, Tischer T. Intra- and interobserver reliability of classification scores in calcific tendinitis using plain radiographs and CT scans. Acta Orthop Belg. 2008;74(5):590–595.
    1. Gärtner J, Heyer A. Calcific tendinitis of the shoulder. Orthopade. 1995;24(3):284–302.
    1. Papatheodorou A, Ellinas P, Takis F, Tsanis A, Maris I, Batakis N. US of the shoulder: rotator cuff and non-rotator cuff disorders. Radiographics. 2006;26(1):e23.
    1. Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K. Detection and quantification of rotator cuff tears: comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am. 2004;86-A(4):708–716.
    1. Entrekin RR, Porter BA, Sillesen HH, Wong AD, Cooperberg PL, Fix CH. Real-time spatial compound imaging: application to breast, vascular, and musculoskeletal ultrasound. Semin Ultrasound CT MR. 2001;22(1):50–64.
    1. Chen W, Zhu W, Kovanlikaya I, et al. Intracranial calcifications and hemorrages: characterization with quantitative susceptibility mapping. Radiology. 2014;270(2):496–505.
    1. Porcellini G, Paladini P, Campi F, Pegreffi F. Osteolytic lesion of greater tuberosity in calcific tendinitis of the shoulder. J Shoulder Elbow Surg. 2009;18(2):210–215.
    1. Bachmann GF, Melzer CH, Heinrics CM, Möhring B, Rominger MB. Diagnosis of rotator cuff lesions: comparison of US and MRI on 38 joint specimens. Eur Radiol. 1997;7(2):192–197.
    1. Chan R, Kim D, Millet P, Weissman BN. Calcifying tendinitis of rotator cuff with cortical bone erosion. Skeletal Radiol. 2004;33(10):596–599.
    1. Cho NS, Lee BG, Rhee YG. Radiologic course of the calcific deposits in calcific tendinitis of the shoulder: does the initial radiologic aspect affect the final results? J Shoulder Elbow Surg. 2010;19(2):267–272.
    1. Coxib and Traditional NSAIDs Trialists’ (CNT) Collaboration. Bhala N, Emberson J, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomized trials. Lancet. 2013;382(9894):769–779.
    1. Kearney PM, Baigent C, Godwin J, et al. Do selective cyclo-oxygenases-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increased the risk of atherothrombosis? Meta-analysis of randomized trials. BMJ. 2006;332(7553):1302–1308.
    1. Trelle S, Reichenbach S, Wandel S, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011;342:c7086.
    1. Yokoyama M, Aono H, Takeda A, Morita K. Cimetidine for chronic calcifying tendinitis of the shoulder. Reg Anesth Pain Med. 2003;28(3):248–252.
    1. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain and rehabilitation. Arthroscopy. 2003;19(6):641–661.
    1. Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003;11(2):142–151.
    1. Noel E, Carillon Y, Gaillard T, Bouvier M. Needle aspiration irrigation in calcifying tendinitis of rotator cuff. In: Gazielly DF, Gleyze PT, editors. The cuff. Paris: Elsevier; 1997. pp. 152–157.
    1. Tillander B, Franzen LE, Karlsson MH, Norlin R. Effect of steroid injections on the rotator cuff: an experimental study in rats. J Shoulder Elbow Surg. 1999;8(3):271–274.
    1. Rompe JD, Kirkpatrick CJ, Kullmer K, Schwitalle M, Krischek O. Dose-related effects of shock waves on rabbit tendo Achillis: a sonographic and histological study. J Bone Joint Surg Br. 1998;80(3):546–552.
    1. Farr S, Sevelda F, Mader P, Graf A, Petje G, Sabeti-Aschraf M. Extracorporeal shockwave therapy in calcifying tendinitis of the shoulder. Knee Surg Sports Traumatol Arthrosc. 2011;19(12):2085–2089.
    1. Ioppolo F, Tattoli M, Di Sante L, et al. Extracorporeal shock-wave therapy for supraspinatus calcifying tendinitis: a randomized clinical trial comparing two different energy levels. Phys Ther. 2012;92(11):1376–1385.
    1. Hsu CJ, Wang DY, Tseng KF, Fong YC, Hsu HC, Jim YF. Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. J Shoulder Elbow Surg. 2008;17(1):55–59.
    1. Krasny C, Enenkel M, Aigner N, Wlk M, Landsiedl F. Ultrasound-guided needling combined with shock-wave therapy for the treatment of calcifying tendonitis of the shoulder. J Bone Joint Surg Br. 2005;87(4):501–507.
    1. Daecke W, Kusnierczak D, Loew M. Long-term effects of extracorporeal shockwave therapy in chronic calcific tendinitis of the shoulder. J Shoulder Elbow Surg. 2002;11(5):476–480.
    1. Berta L, Fazzari A, Ficco AM, Enrica PM, Catalano MG, Frairia R. Extracorporeal Shock Wave enhance normal fibroblast proliferation in vitro and activate mRNA expression for TGF-β1 and for collagen types I and III. Acta Orthop. 2009;80(5):612–617.
    1. Brañes J, Conteras HR, Cabello P, Antonic V, Guiloff LJ, Brannes M. Shoulder rotator cuff responses to extracorporeal shockwave therapy: morphological and immunohistochemical analysis. Shoulder Elbow. 2012;4(3):163–168.
    1. Chao YH, Tsuang YH, Sun JS, et al. Effect of Shock Waves on tenocyte proliferation and extracellular matrix metabolism. Ultrasound Med Biol. 2008;34(5):841–852.
    1. Chen YJ, Wang CJ, Yang KD, et al. Extracorporeal Shock Wave promote healing of collagenase-induced Achilles tendinitis and increase TGF-β1 and IGF-I expression. J Orthop Res. 2004;22(4):854–861.
    1. Han SH, Lee JW, Guyton GP, et al. Effect of extracorporeal Shock Wave Therapy on cultured tenocytes. Foot Ankle Int. 2009;30(2):93–98.
    1. Hsu RW, Hsu WH, Tai CL, Lee KF. The effect of Shock-Wave therapy on patellar tendinopathy in a rabbit model. J Orthop Res. 2004;22(1):221–227.
    1. Wang CJ, Wang FS, Yang KD, Weng LH, Sun YC, Yang YJ. The effect of Shock Wave Treatment at the tendon-bone interface – an histomorphological and biomechanical study in rabbits. J Orthop Res. 2005;23(2):274–280.
    1. Ioppolo F, Tattoli M, Di Sante L, et al. Clinical improvement and resorption of calcifications in calcific tendinitis of the shoulder after shock wave therapy at 6 months’ follow up: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2013;94(9):1699–1706.
    1. Kim YS, Lee HJ, Kim YV, Kong CG. Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. J Shoulder Elbow Surg. 2014;23(11):1640–1646.
    1. Rebuzzi E, Coletti N, Schiavetti S, Giusto F. Arthroscopy surgery versus shock wave therapy for chronic calcifying tendinitis of the shoulder. J Orthop Trauma. 2008;9(4):179–185.
    1. Farin PU, Räsänen H, Jaroma H, Harju A. Rotator cuff calcifications: treatment with ultrasound-guided percutaneous needle aspiration and lavage. Skeletal Radiol. 1996;25(6):551–554.
    1. Farin PU. Consistency of rotator-cuff calcifications. Observations on plain radiography, sonography, computed tomography, and at needle treatment. Invest Radiol. 1996;31(5):300–304.
    1. Serafini G, Sconfienza LM, Lacelli F, et al. Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment–nonrandomized controlled trial. Radiology. 2009;252(1):157–164.
    1. Sconfienza LM, Bandirali M, Serafini G, et al. Rotator cuff calcific tendinitis: does warm saline solution improve the short-term outcome of double-needle US-guided treatment? Radiology. 2012;262(2):560–566.
    1. Bradley M, Bhamra MS, Robson MJ. Ultrasound guided aspiration of symptomatic supraspinatus calcific deposits. Br J Radiol. 1995;68(811):716–719.
    1. del Cura JL, Torre I, Zabala R, Legórburu A. Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results. AJR Am J Roentgenol. 2007;189(3):W128–W134.
    1. Saboeiro GR. Sonography in the treatment of calcific tendinitis of the rotator cuff. J Ultrasound Med. 2012;31(10):1513–1518.
    1. Yoo JC, Koh KH, Park WH, Park JC, Kim SM, Yoon YC. The outcome of ultrasound-guided needle decompression and steroid injection in calcific tendinitis. J Shoulder Elbow Surg. 2010;19(4):596–600.
    1. Ciampi P, Vitali M. Ultrasound-guided percutaneous needle aspiration of rotator cuff calcifications. Medicina e chirugia orthopedica. 2011;1:67–69.
    1. Greis AC, Derrington SM, McAuliffe M. Evaluation and nonsurgical management of rotator cuff calcific tendinopathy. Orthop Clin North Am. 2015;46(2):293–302.
    1. Stellos K, Kopf S, Paul A, et al. Platelets in regeneration. Semin Thromb Hemost. 2010;36:175–184.
    1. Fong KP, Barry C, Tran AN, et al. Deciphering the human platelet sheddome. Blood. 2011;117:e15–e26.
    1. Masuki H, Okudera T, Watanebe T, et al. Growth factor and pro-inflammatory cytokine contents in platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), advanced platelet rich fibrin (A-PRF), and concentrated growth factors (CGF) Int J Implant Dent. 2016;2(1):19.
    1. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259–2272.
    1. Cross JA, Cole BJ, Spatny KP, et al. Leukocyte-reduced platelet-rich plasma normalizes matrix metabolism in torn human rotator cuff tendons. Am J Sports Med. 2015;43(12):2898–2906.
    1. Virchenko O, Grenegard M, Aspenberg P. Independent and additive stimulation of tendon repair by thrombin and platelets. Acta Orthop. 2006;77(6):960–966.
    1. Yan R, Gu Y, Ran J, et al. Intratendon delivery of leukocyte-poor platelet-rich plasma improves healing compared with leukocyte- rich platelet-rich plasma in a rabbit achilles tendinopathy model. Am J Sports Med. 2017;45(8):1909–1920.
    1. Chen L, Dong SW, Tao X, Liu JP, Tang KL, Xu JZ. Autologous platelet-rich clot releasate stimulates proliferation and inhibits differentiation of adult rat tendon stem cells towards non-tenocyte lineages. J Int Med Res. 2012;40(4):1399–1409.
    1. de Almeida AM, Demange MK, Sobrado MF, Rodrigues MB, Pedrinelli A, Hernandez AJ. Patellar tendon healing with platelet-rich plasma: a prospective randomized controlled trial. Am J Sports Med. 2012;40(6):1282–1288.
    1. Seijas R, Ares O, Alvarez P, Cusco X, Garcia-Balletbo M, Cugat R. Platelet-rich plasma for calcific tendinitis of the shoulder: a case report. J Orthop Surg. 2012;20(1):126–130.
    1. Ark JW, Flock TJ, Flatow EL, Bigliani LU. Arthroscopic treatment of calcific tendinitis of the shoulder. Arthroscopy. 1992;8(2):183–188.
    1. Seil R, Litzenburger H, Kohn D, Rupp S. Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy. 2006;22(5):521–527.
    1. Balke M, Bielefeld R, Schmidt C, Dedy N, Liem D. Calcifying tendinitis of the shoulder: midterm results after arthroscopic treatment. Am J Sports Med. 2012;40(3):657–661.
    1. Porcellini G, Paladini P, Campi F, Paganelli M. Arthroscopic treatment of calcifying tendinitis of the shoulder: clinical and ultrasonographic follow-up findings at two to five years. J Shoulder Elbow Surg. 2004;13(5):503–508.
    1. Gazielly DF, Bruyère G, Gleyze P, Thomas T. Open acromioplasty with excision of calcium deposits and tendon suture. In: Gazielly DF, Gleyze P, Thomas T, editors. The Cuff. Paris: Elsevier; 1997. pp. 172–175.
    1. Rizzello G, Franceschi F, Longo UG, et al. Arthroscopic management of calcific tendinopathy of the shoulder: do we need to remove all the deposit? Bull NYU Hosp Jt Dis. 2009;67:330–333.
    1. Jerosch J, Strauss JM, Schmiel S. Arthroscopic treatment of cal-cific tendinitis: how important to remove it? Arthroskopie. 1996;9:241–245.
    1. Neer CSII, Marberrey TA. Calcium deposits. In: Neer CS 2nd, editor. Shoulder Reconstruction. Philadelphia: Saunders; 1990. pp. 774–789.
    1. Rubenthaler F, Ludwig J, Wiese M, Wittenberg RH. Prospective randomized surgical treatments for calcifying tendinopathy. Clin Orthop. 2003;410:278–284.
    1. Gleyze P, Montes P, Thomas T, Gazielly DF. Compared results of the different treatments in calcifying tendinitis of the rotator cuff A multicenter study of 149 shoulders. In: Gazielly DF, Gleyze P, Thomas T, editors. The Cuff. Paris: Elsevier; 1997. pp. 181–184.
    1. Hofstee DJ, Gosens T, Bonnet M, de Waal Malefi J., Jr Calcifications in the cuff: take it or leave it? Br J Sports Med. 2007;41(11):832–835.
    1. Tillander BM, Norlin RO. Change of calcifications after arthroscopic sub-acromial decompression. J Shoulder Elbow Surg. 1998;7(3):213–217.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera