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Die Kalkschulter – Tendinosis calcarea

Calcific tendinitis of the shoulder

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Zusammenfassung

Die Tendinosis calcarea der Rotatorenmanschette ist eine häufige Ursache von Schulterbeschwerden, v. a. bei Patienten im Alter zwischen 30 und 50 Jahren. Sie beginnt meist plötzlich, ohne erhöhte vorangegangene Belastung der Schulter, mit starken bewegungsunabhängigen Schmerzen. Die Diagnose wird durch Anamnese, klinische Untersuchung, Ultraschall und radiologischen Kalkdepotnachweis gesichert. Die Beschwerden entsprechen weitgehend denen eines Impingementsyndroms mit Schmerzausstrahlung in den proximalen Oberarm und Ruhe- und Nachtschmerz in der Resorptionsphase. In der Akutphase wird mittels temporärer Ruhigstellung, Schmerztherapie mit nichtsteroidalen Antirheumatika, subakromialen Infiltrationen mit Kortikoiden/Lokalanästhetikum sowie extrakorporaler Stoßwellentherapie behandelt. Bei Beschwerdepersistenz kann das Kalkdepot operativ entfernt werden. Die Behandlungsergebnisse sind mit Beschwerdefreiheit in >90% der Fälle sehr gut, die Rekonvaleszenz kann jedoch einige Monate dauern.

Abstract

Calcific tendinitis of the shoulder is a process involving crystal calcium deposition in the rotator cuff tendons, which mainly affects patients between 30 and 50 years of age. The etiology is still a matter of dispute. The diagnosis is made by history and physical examination with specific attention to radiologic and sonographic evidence of calcific deposits. Patients usually describe specific radiation of the pain to the lateral proximal forearm, with tenderness even at rest and during the night. Nonoperative management including rest, nonsteroidal anti-inflammatory drugs, subacromial corticosteroid injections, and shock wave therapy is still the treatment of choice. Nonoperative treatment is successful in up to 90% of patients. When nonsurgical measures fail, surgical removal of the calcific deposit may be indicated. Arthroscopic treatment provides excellent results in more than 90% of patients. The recovery process is very time consuming and may take up to several months in some cases.

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Authors and Affiliations

  1. Orthopädische Klinik und Poliklinik, Universität Rostock, Rostock, Deutschland

    P. Diehl & T. Tischer

  2. Orthopädiezentrum München Ost, Kellerstraße 8, 85667, Grafing, Deutschland

    P. Diehl & W. Sauer

  3. Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    L. Gerdesmeyer & H. Gollwitzer

  4. Sektion onkologische und rheumatologische Orthopädie , Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    L. Gerdesmeyer

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  1. P. Diehl
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Correspondence to P. Diehl.

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Diehl, P., Gerdesmeyer, L., Gollwitzer, H. et al. Die Kalkschulter – Tendinosis calcarea. Orthopäde 40, 733–746 (2011). https://doi.org/10.1007/s00132-011-1817-3

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