Calcification of the rotator cuff (Calcifying tendinitis)

Introduction
For reasons yet to be understood, deposits of calcium can build up, typically close to the attachment of the tendon at the humeral head. These deposits can (but not in all cases) cause considerable pain. An acute episode of pain results when a deposit enters the bursa and dissolves. Many such deposits disappear over months or years, others cause no symptoms and are discovered incidentally. In the case of persistent complaints due to a calcium deposit inside the tendon, arthroscopic removal of the deposit has proven to be the therapeutic option.

Surgical procedure
The procedure is the same as the one described in chapter 3. In many cases, the calcific deposit can be localised from the joint side, as a reddening of the tendon is observed. However, the deposit is removed from the bursa side, that is from above. Following localisation of the deposit, the rotator tendon is incised in the direction of the fibres; often the crumbly calcific deposit then evacuates under pressure and is carefully removed.

If necessary, a sparse expansion of the subacromial space can be carried out at the same time. The wound in the tendon tissue normally tends to heal without problems, but I often reinforce the tendon with gathering stitches.

Follow-up and prognosis
The follow-up is identical to that for impingement, that is immediate mobilisation of the shoulder without restriction is allowed and desirable. If the tendon has been sutured, however, we apply the rotator cuff protocol.

Often post-operative X-rays show persistent remains of the calcific deposit, but, as a rule, these spontaneously dissolve in the following weeks. The operation is considered successful in over 95 % of cases. Although a recurrence of the calcific deposit is possible, this phenomenon is not observed frequently. A not insignificant number of patients have calcific deposits on both sides.