2. Calcific tendinitis
► Presence of macroscopic deposits of
calcium hydroxyapatite crystal in any
tendon of the rotator cuff
► Self-limited disease
3. Incidence
7.5 to 20 percent of adults with no symptoms
6.8 percent of those with shoulder pain
most common among people between 30 - 60
years of age
Women > Men
sedentary work > manual work
Bilateral involved:13-47%
4. Etiology
► Still unknow
Decreased local oxygen tension and hypoxia
Non degeneration
Non trauma
► Bursal side > articular site
► Usual involved Supraspinatus tendon
1-2 cm proximal to the tendon insertion on the
greater tuberosity (critical Zone)
8. DePalma and Kruper Classification
► Type I
Fluffy and amorphous
► Acute stages of the disease,
► calcific material may be liquid to semiliquid
► Type II
Defined and homogenous
► subacute or chronic disease
► calcific material forming a dry dense powder
13. Ultrasound
► Ebenbichler N Engl J Med 1999
Double blind control study
► Ultrasound vs control
Pain relief and function result are better in
ultrasound group
The result was no different after 9 months
follow-up
15. Extracorporeal Shock Wave
► Loew M, J Bone Joint Surg [Br] 1999;81
30-70% of patients obtained pain relief
20-77% of cases, the calcific deposit disappeared or
disintegrated.
► Rompe JD, J Shoulder Elbow Surg 1998
Good result
►High energy group 68%
►Low energy group 52%
Partial or complete disintegration of calcific deposit
►High energy group 64%
►Low energy group 50%
16. Extracorporeal Shock Wave
► Results of ECSW depend on the energy of the
waves and on the number of pulses
► The optimal dose has not yet been established.
► Advantage
Non invasive
Low complication
►hematomas develop in most patients (80% )
► Disadvantage
Pain
May need anesthesia for high energy
20. 20
Happiness is not something you postpone for the future; it is something
you design for the present. It is also like a butterfly; the more you chase
it, the more it will elude you, but if you turn your attention to other
things, it will come and sit softly on your shoulder.
Happiness comes when
your work and words
are of benefit to
yourself and others.