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Arthroscopic Removal of Chronic Symptomatic Calcifications of the Supraspinatus Tendon Without Acromioplasty: Analysis of Postoperative Recovery and Outcome Factors.

Maier D, Jaeger M, Izadpanah K, Köstler W, Bischofberger AK, Südkamp NP, Ogon P - Orthop J Sports Med (2014)

Bottom Line: Abduction was significantly (P = .008) lower in patients with type III (170° ± 17.5°) compared with type I (174° ± 20.7°) and type II (179° ± 4.5°) acromions.Also, abduction was significantly (P = .001) lower in patients with long-standing symptoms (>72 months).Minor calcific remnants were found in 19 of 105 shoulders (18.1%), but affected neither postoperative recovery nor outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany.

ABSTRACT

Background: Little knowledge exists on postoperative recovery of pain and shoulder function following arthroscopic removal of calcific deposits of the supraspinatus tendon (ACDSSP). Certain factors may influence outcome, including acromial morphology.

Purpose: To examine postoperative recovery following ACDSSP without acromioplasty and to analyze influential outcome factors.

Study design: Case series; Level of evidence, 4.

Methods: This prospective study evaluated 82 patients (105 shoulders) after ACDSSP without acromioplasty. Time periods for postoperative recovery of pain and subjective shoulder function were recorded. The absolute and normalized Constant scores (CSabs and CSnorm, respectively), Oxford Shoulder Score (OSS), DASH score (DS), and subjective shoulder value (SSV) were measured after a mean follow-up of 33.9 months. Analyzed outcome factors included localization of the calcific deposit (CD), acromial morphology, radiographic extent of CD removal, type of nonoperative treatment, and preoperative duration of symptoms.

Results: Mean duration of postoperative pain was 2.2 weeks. Recovery of subjective shoulder function required 11.1 weeks on average. Mean ± standard deviation follow-up values were 91.1 ± 8.3 for CSabs, 104.2% ± 8.2% for CSnorm, 13.1 ± 2.6 for OSS, 1.81 ± 4.59 for DS, and 93.8% ± 10.7% for SSV. Abduction was significantly (P = .008) lower in patients with type III (170° ± 17.5°) compared with type I (174° ± 20.7°) and type II (179° ± 4.5°) acromions. Also, abduction was significantly (P = .001) lower in patients with long-standing symptoms (>72 months). Minor calcific remnants were found in 19 of 105 shoulders (18.1%), but affected neither postoperative recovery nor outcome.

Conclusion: ACDSSP without acromioplasty yielded favorable outcomes and effected fast remission of pain regardless of acromial morphology. However, recovery of subjective shoulder function required almost 3 months on average. Minimal restriction of abduction occurred in patients with hook-shaped acromions and long-standing preoperative symptoms. The present data do not support routine performance of acromioplasty.

No MeSH data available.


Related in: MedlinePlus

Operative technique. (A) Partial subacromial bursectomy is performed in the suspected region of calcific deposit (CD) localization (left shoulder). The CD appears as a bump as a result of swelling of the affected supraspinatus tendon. (B) A needle is used to locate the center of the deposit. (C) A blunt hook probe is inserted into the center of the deposit without incising the tendon. (D) “Squeezing” and (E) “stirring” with the hook probe effectuates blunt elimination of carbonate apatite. (F) After CD removal, an indentation is noted at the site of the former bump.
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fig1-2325967114533646: Operative technique. (A) Partial subacromial bursectomy is performed in the suspected region of calcific deposit (CD) localization (left shoulder). The CD appears as a bump as a result of swelling of the affected supraspinatus tendon. (B) A needle is used to locate the center of the deposit. (C) A blunt hook probe is inserted into the center of the deposit without incising the tendon. (D) “Squeezing” and (E) “stirring” with the hook probe effectuates blunt elimination of carbonate apatite. (F) After CD removal, an indentation is noted at the site of the former bump.

Mentions: All surgeries were performed by the same surgeon (senior author, P.O.). Patients received general anesthesia and were positioned in lateral decubitus. A diagnostic glenohumeral arthroscopy was performed to exclude relevant intra-articular pathologies. The arthroscope was placed into the subacromial space, and a lateral portal was established within the affected quadrant. All CDs could be reliably detected by means of the quadrant technique.23 A shaver was used to perform partial bursectomy within the suspected area. The tendon was sparsely needled until the deposit was localized. Another needle was used to approximate the center of the CD. A blunt hook probe was inserted into the center of the CD without performing a tendon incision. The hook probe was used as a “stir” to eliminate the carbonate apatite out of the deposit. The CD was “squeezed out” by applying blunt pressure with the probe (Figure 1). This blunt technique (“squeeze and stir”) of CD removal preserved integrity of the supraspinatus tendon and avoided necessity of rotator cuff repair. No concomitant procedures, such as subacromial decompression or coracoacromial ligament resection, were performed in any case.


Arthroscopic Removal of Chronic Symptomatic Calcifications of the Supraspinatus Tendon Without Acromioplasty: Analysis of Postoperative Recovery and Outcome Factors.

Maier D, Jaeger M, Izadpanah K, Köstler W, Bischofberger AK, Südkamp NP, Ogon P - Orthop J Sports Med (2014)

Operative technique. (A) Partial subacromial bursectomy is performed in the suspected region of calcific deposit (CD) localization (left shoulder). The CD appears as a bump as a result of swelling of the affected supraspinatus tendon. (B) A needle is used to locate the center of the deposit. (C) A blunt hook probe is inserted into the center of the deposit without incising the tendon. (D) “Squeezing” and (E) “stirring” with the hook probe effectuates blunt elimination of carbonate apatite. (F) After CD removal, an indentation is noted at the site of the former bump.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555535&req=5

fig1-2325967114533646: Operative technique. (A) Partial subacromial bursectomy is performed in the suspected region of calcific deposit (CD) localization (left shoulder). The CD appears as a bump as a result of swelling of the affected supraspinatus tendon. (B) A needle is used to locate the center of the deposit. (C) A blunt hook probe is inserted into the center of the deposit without incising the tendon. (D) “Squeezing” and (E) “stirring” with the hook probe effectuates blunt elimination of carbonate apatite. (F) After CD removal, an indentation is noted at the site of the former bump.
Mentions: All surgeries were performed by the same surgeon (senior author, P.O.). Patients received general anesthesia and were positioned in lateral decubitus. A diagnostic glenohumeral arthroscopy was performed to exclude relevant intra-articular pathologies. The arthroscope was placed into the subacromial space, and a lateral portal was established within the affected quadrant. All CDs could be reliably detected by means of the quadrant technique.23 A shaver was used to perform partial bursectomy within the suspected area. The tendon was sparsely needled until the deposit was localized. Another needle was used to approximate the center of the CD. A blunt hook probe was inserted into the center of the CD without performing a tendon incision. The hook probe was used as a “stir” to eliminate the carbonate apatite out of the deposit. The CD was “squeezed out” by applying blunt pressure with the probe (Figure 1). This blunt technique (“squeeze and stir”) of CD removal preserved integrity of the supraspinatus tendon and avoided necessity of rotator cuff repair. No concomitant procedures, such as subacromial decompression or coracoacromial ligament resection, were performed in any case.

Bottom Line: Abduction was significantly (P = .008) lower in patients with type III (170° ± 17.5°) compared with type I (174° ± 20.7°) and type II (179° ± 4.5°) acromions.Also, abduction was significantly (P = .001) lower in patients with long-standing symptoms (>72 months).Minor calcific remnants were found in 19 of 105 shoulders (18.1%), but affected neither postoperative recovery nor outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany.

ABSTRACT

Background: Little knowledge exists on postoperative recovery of pain and shoulder function following arthroscopic removal of calcific deposits of the supraspinatus tendon (ACDSSP). Certain factors may influence outcome, including acromial morphology.

Purpose: To examine postoperative recovery following ACDSSP without acromioplasty and to analyze influential outcome factors.

Study design: Case series; Level of evidence, 4.

Methods: This prospective study evaluated 82 patients (105 shoulders) after ACDSSP without acromioplasty. Time periods for postoperative recovery of pain and subjective shoulder function were recorded. The absolute and normalized Constant scores (CSabs and CSnorm, respectively), Oxford Shoulder Score (OSS), DASH score (DS), and subjective shoulder value (SSV) were measured after a mean follow-up of 33.9 months. Analyzed outcome factors included localization of the calcific deposit (CD), acromial morphology, radiographic extent of CD removal, type of nonoperative treatment, and preoperative duration of symptoms.

Results: Mean duration of postoperative pain was 2.2 weeks. Recovery of subjective shoulder function required 11.1 weeks on average. Mean ± standard deviation follow-up values were 91.1 ± 8.3 for CSabs, 104.2% ± 8.2% for CSnorm, 13.1 ± 2.6 for OSS, 1.81 ± 4.59 for DS, and 93.8% ± 10.7% for SSV. Abduction was significantly (P = .008) lower in patients with type III (170° ± 17.5°) compared with type I (174° ± 20.7°) and type II (179° ± 4.5°) acromions. Also, abduction was significantly (P = .001) lower in patients with long-standing symptoms (>72 months). Minor calcific remnants were found in 19 of 105 shoulders (18.1%), but affected neither postoperative recovery nor outcome.

Conclusion: ACDSSP without acromioplasty yielded favorable outcomes and effected fast remission of pain regardless of acromial morphology. However, recovery of subjective shoulder function required almost 3 months on average. Minimal restriction of abduction occurred in patients with hook-shaped acromions and long-standing preoperative symptoms. The present data do not support routine performance of acromioplasty.

No MeSH data available.


Related in: MedlinePlus