 Diagnosis (Shoulder) |
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Rehabilitation |
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Service |
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 Tendinosis calcarea (build-up of calcium deposits in the shoulder) |
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This condition is most common in patients who are middle-aged or older (> 40 years of age), but all age groups may be affected. In general women are more commonly affected. For reasons that are largely unknown (possibly low blood circulation in the base of the tendons), calcium deposits appear in the base area of the rotator cuff (most commonly in the supraspinal tendon). |
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Small, regionally restricted calcifications in the base of the tendons in the rotator cuff are often found purely coincidentally within the scope of x-rays and our sonographic examination, which is always performed on both sides as a comparison. A small calcium deposit is not necessarily associated with a painful phenomenon. |
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However, calcium deposits may well lead to inflammatory alterations in the surrounding tendon area. Even such local inflammation leads to classic, localised pain. If the calcium deposit is very large or if there are deposits in several tendon groups, the very high volume of change from the calcium build-up in the tendon leads to substantial dilation pain. A further clear increase in the pain then occurs if the synovial bursa between the acromion and the rotator cuff becomes inflamed and, with chronic waves of pain, adheres. During the course of the disorder, attacks of shooting waves of acute pain are experienced that are caused by spontaneous attempts to free the calcium deposits. The problem becomes more dramatic if there is also the accompanying problem of mechanical narrowing (mechanical impingement) so that the inflamed and swollen synovial bursa and the increased volume of the tendon structure have no “room to manoeuvre”. In the highly acute stage, anti-inflammatory injections in the subacromial space may be helpful. In many cases however, a minimally invasive arthroscopic operation is required in order to put a lasting end to a pain problem that has often endured for years. Extracorporeal shockwave treatment (ESWT) will often have no success. This is even more likely to be the case if the synovial bursa is adhered due to the chronic course of the condition. ESWT may lead to the break up of a large and solid calcium deposit, but it cannot free an inflamed and adhered synovial bursa, which is the primary reason for the pain. |
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| Complex course of movement of the LBT from the source on the upper edge of the socket, through the joint, into the bony vallecula of the head of the humerus |
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| Instability of the LBT |
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Moreover, the accompanying mechanical narrowing cannot be corrected by ESWT. If used correctly, ESWT can be beneficial. However, it is often misused because of the negative factors already mentioned. Removing the calcium deposits arthroscopically is usually possible without any problems. The calcium deposit is often visible.
Otherwise it can be located by puncturing with a thin cannula. The highly inflamed synovial bursa and the adhesions are removed. A healthy synovial bursa regeneration is formed very quickly. The calcium deposit can be opened and removed. If the subacromion space is narrowed, it is then widened precisely. The operation can also be carried out on a short-term in-patient basis. |
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| Arthroscope / Picture of an intact LBT |
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| Onset of a tear in the LBT and labrum anchor (SLAP IV) |
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| Resection of a highly inflamed and altered LBT (after tenodesis) |
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