Calcareous tendinitis of the shoulder. Treatment by needling

Calcareous tendinitis (calcifying tendinitis) of the shoulder is a disease characterized by the formation of macroscopic deposits of hydroxyapatite (a crystalline calcium phosphate) in any tendon of the rotator cuff. It presents clinically as sudden intense pain flares resembling gout. It can be treated most effectively by invasive methods such as surgery or needling. The latter is associated with lower risks and fewer organizational and financial demands. The aim of this study is to promote the use of needling in orthopaedic outpatient departments where ultrasonography is available for diagnosis and guided intervention. In the period from 2000 to 2006, a total of 38 shoulders (36 patients) with calcareous tendinitis were treated. In one patient both shoulders were effected five years apart, and one patient experienced recurrence in the same shoulder after 2 years. Needling was performed in 36 shoulders, two cases were treated arthroscopically. Needling as the primary therapy was indicated immediately after the diagnosis had been established usually on the first patient's visit, and was carried out under local anaesthesia as an outpatient procedure. The tendon with calcareous deposits was perforated with a needle under sonographic guidance and, in the majority of cases, this calcareous material was aspirated. When signs of subacromial bursitis were present, Depomedrol was administered during or following the procedure. The outcome was evaluated at an average follow-up of 23.4 months (range, 5 to 89). All outcomes were from excellent to satisfactory, with no poor result. Five patients underwent further treatment for impingement syndrome which two of them had already had before the needling procedure. One patient reported slightly restricted range of motion due to subsequent adhesive capsulitis. However, she was not limited in her daily activities and therefore did not require any further therapy. Five patients with occasional unspecific complaints, usually in relation to weather changes or exercise, did not ask for any further treatment either. Needling is an effective method to treat calcareous tendinitis and provides results comparable with those of arthroscopy, but without operative risks. It is much less expensive (10- to 20-times) with no additional demands for either the patient or the institution. Today, the majority of orthopaedic outpatient departments in the Czech Republic have the necessary facilities and should include needling in the procedures