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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Examination of concomitant glenohumeral pathologies in patients treated arthroscopically for calcific tendinitis of the shoulder and implications for routine diagnostic joint exploration

Authors: Gernot Lang, Kaywan Izadpanah, Eva Johanna Kubosch, Dirk Maier, Norbert Südkamp, Peter Ogon

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

Glenohumeral exploration is routinely performed during arthroscopic removal of rotator cuff calcifications in patients with calcific tendinitis of the shoulder (CTS). However, evidence on the prevalence of intraarticular co-pathologies is lacking and the benefit of glenohumeral exploration remains elusive. The aim of the present study was to assess and quantify intraoperative pathologies during arthroscopic removal of rotator cuff calcifications in order to determine whether standardized diagnostic glenohumeral exploration appears justified in CTS patients.

Methods

One hundred forty five patients undergoing arthroscopic removal of calcific depots (CD) that failed conservative treatment were included in a retrospective cohort study. Radiographic parameters including number/localization of calcifications and acromial types, intraoperative arthroscopic findings such as configuration of glenohumeral ligaments, articular cartilage injuries, and characteristics of calcifications and sonographic parameters (characteristics/localization of calcification) were recorded.

Results

One hundred forty five patients were analyzed. All CDs were removed by elimination with a blunt hook probe via “squeeze-and-stir-technique” assessed postoperatively via conventional X-rays. Neither subacromial decompression nor refixation of the rotator cuff were performed in any patient. Prevalence of glenohumeral co-pathologies, such as partial tears of the proximal biceps tendon (2.1%), superior labral tears from anterior to posterior (SLAP) lesions (1.4%), and/or partial rotator cuff tears (0.7%) was low. Most frequently, glenohumeral articular cartilage was either entirely intact (ICRS grade 0 (humeral head/glenoid): 46%/48%) or showed very mild degenerative changes (ICRS grade 1: 30%/26%). Two patients (1.3%) required intraarticular surgical treatment due to a SLAP lesion type III (n = 1) and an intraarticular rupture of CD (n = 1).

Conclusions

Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of CTS due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment. Exploration of the glenohumeral joint in arthroscopic removal of CD should only be performed in case of founded suspicion of relevant concomitant intraarticular pathologies.
Literature
1.
Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12,122 shoulders. J Am Med Assoc. 1941;116:2477–82.CrossRef
2.
Rupp S, Seil R, Kohn D. Tendinosis calcarea der Rotatorenmanschette. Orthopade. 2000;29:852–67.CrossRef
3.
4.
Del Castillo-Gonzalez F, Ramos-Alvarez JJ, Rodriguez-Fabian G, Gonzalez-Perez J, Calderon-Montero J. Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study. Muscles Ligaments Tendons J. 2014;4:407–12.PubMed
5.
Gatt DL, Charalambous CP. Ultrasound-guided barbotage for calcific tendonitis of the shoulder: a systematic review including 908 patients. Arthroscopy. 2014;30:1166–72.CrossRefPubMed
6.
Maier D, Jaeger M, Izadpanah K, Bornebusch L, Suedkamp NP, Ogon P. Rotator cuff preservation in arthroscopic treatment of calcific tendinitis. Arthroscopy. 2013;29:824–31.CrossRefPubMed
7.
Ark JW, Flock TJ, Flatow EL, Bigliani LU. Arthroscopic treatment of calcific tendinitis of the shoulder. Arthroscopy. 1992;8:183–8.CrossRefPubMed
8.
Gschwend N, Patte D, Zippel J. Therapy of calcific tendinitis of the shoulder. Arch Orthop Unfallchir. 1972;73:120–35.CrossRefPubMed
9.
Yoo JC, Park WH, Koh KH, Kim SM. Arthroscopic treatment of chronic calcific tendinitis with complete removal and rotator cuff tendon repair. Knee Surg Sports Traumatol Arthrosc. 2010;18:1694–9.CrossRefPubMed
10.
Porcellini G, Paladini P, Campi F, Paganelli M. Arthroscopic treatment of calcifying tendinitis of the shoulder: clinical and ultrasonographic follow-up findings at two to five years. J Shoulder Elb Surg. 2004;13:503–8.CrossRef
11.
12.
Louwerens JK, Veltman ES, van Noort A, van den Bekerom MP. The effectiveness of high-energy extracorporeal shockwave therapy versus ultrasound-guided needling versus arthroscopic surgery in the Management of Chronic Calcific Rotator Cuff Tendinopathy: a systematic review. Arthroscopy. 2016;32:165–75.CrossRefPubMed
13.
Moen TC, Rudolph GH, Caswell K, Espinoza C, Burkhead WZ, Jr., Krishnan SG: Complications of shoulder arthroscopy. J Am Acad Orthop Surg 2014, 22:410–419.
14.
Cogan A, Boyer P, Soubeyrand M, Hamida FB, Vannier JL, Massin P. Cranial nerves neuropraxia after shoulder arthroscopy in beach chair position. Orthop Traumatol Surg Res. 2011;97:345–8.CrossRefPubMed
15.
Park TS, Kim YS. Neuropraxia of the cutaneous nerve of the cervical plexus after shoulder arthroscopy. Arthroscopy. 2005;21:631.PubMed
16.
Bhatti MT, Enneking FK. Visual loss and ophthalmoplegia after shoulder surgery. Anesth Analg. 2003;96:899–902. table of contentsCrossRefPubMed
17.
Zmistowski B, Austin L, Ciccotti M, Ricchetti E, Williams G Jr. Fatal venous air embolism during shoulder arthroscopy: a case report. J Bone Joint Surg Am. 2010;92:2125–7.CrossRefPubMed
18.
Sirveaux F, Gosselin O, Roche O, Turell P, Mole D. postoperative results after arthroscopic treatment of rotator cuff calcifying tendonitis, with or without associated glenohumeral exploration. Rev Chir Orthop Reparatrice Appar Mot. 2005;91:295–9.CrossRefPubMed
19.
Maier D, Jaeger M, Izadpanah K, Kostler W, Bischofberger AK, Sudkamp NP, Ogon P. Arthroscopic removal of chronic symptomatic calcifications of the supraspinatus tendon without Acromioplasty: analysis of postoperative recovery and outcome factors. Orthop J Sports Med. 2014;2:2325967114533646.PubMedPubMedCentral
20.
Ogon P, Ogon M, Jager A. Technical note: the quadrant technique for arthroscopic treatment of rotator cuff calcifications. Arthroscopy. 2001;17:E13.CrossRefPubMed
21.
Bigliani LUMD, April EW. He morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;(1986):10–228.
22.
Morgan CDRR, Snyder SJ. Arthroscopic assessment of the glenohumeral ligaments associated with recurrent anterior shoulder instability. Washington, DC: Paper presented at the Fifty-NInth Annual Meeting of the American Academy of Orthopaedic Surgeons; 1992.
23.
Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am. 2003;85-A(Suppl 2):58–69.CrossRef
24.
Snyder SJ, Karzel RP, Pizzo WD, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6:274–9.CrossRefPubMed
25.
Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res. 1990:64–74.
26.
Bayne OBJ. Long-term results of surgical repair of full-thickness rotator cuff tears. Philadelphia. 1984;
27.
Oliva F, Via AG, Maffulli N. Calcific tendinopathy of the rotator cuff tendons. Sports Med Arthrosc. 2011;19:237–43.CrossRefPubMed
28.
Dhupar R, Evankovich J, Klune JR, Vargas LG, Hughes SJ. Delayed operating room availability significantly impacts the total hospital costs of an urgent surgical procedure. Surgery. 2011;150:299–305.CrossRefPubMed
29.
Moody AE, Moody CE, Althausen PL. Cost savings opportunities in perioperative Management of the Patients with Orthopaedic Trauma. J Orthop Trauma. 2016;30(Suppl 5):S7–s14.CrossRefPubMed
30.
31.
Rizzello G, Franceschi F, Longo UG, Ruzzini L, Meloni MC, Spiezia F, Papalia R, Denaro V. Arthroscopic management of calcific tendinopathy of the shoulder--do we need to remove all the deposit? Bull NYU Hosp Jt Dis. 2009;67:330–3.PubMed
32.
Hurt G, Baker CL, Jr.: Calcific tendinitis of the shoulder. Orthop Clin North Am 2003, 34:567–575.
33.
Seyahi A, Demirhan M. Arthroscopic removal of intraosseous and intratendinous deposits in calcifying tendinitis of the rotator cuff. Arthroscopy. 2009;25:590–6.CrossRefPubMed
34.
Jacobs R, Debeer P. Calcifying tendinitis of the rotator cuff: functional outcome after arthroscopic treatment. Acta Orthop Belg. 2006;72:276–81.PubMed
35.
Randelli P, Castagna A, Cabitza F, Cabitza P, Arrigoni P, Denti M. Infectious and thromboembolic complications of arthroscopic shoulder surgery. J Shoulder Elb Surg. 2010;19:97–101.CrossRef
36.
Borgeat A, Bird P, Ekatodramis G, Dumont C. Tracheal compression caused by periarticular fluid accumulation: a rare complication of shoulder surgery. J Shoulder Elb Surg. 2000;9:443–5.CrossRef
37.
Weber SC, Abrams JS, Nottage WM. Complications associated with arthroscopic shoulder surgery. Arthroscopy. 2002;18:88–95.CrossRefPubMed
38.
Merolla G, Bhat MG, Paladini P, Porcellini G. Complications of calcific tendinitis of the shoulder: a concise review. J Orthop Traumatol. 2015;16:175–83.CrossRefPubMedPubMedCentral
39.
Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elb Surg. 2011;20:502–14.CrossRef
40.
White D, Choi H, Peloquin C, Zhu Y, Zhang Y. Secular trend of adhesive capsulitis. Arthritis Care Res (Hoboken). 2011;63:1571–5.CrossRef
41.
Brislin KJ, Field LD, Savoie FH 3rd. Complications after arthroscopic rotator cuff repair. Arthroscopy. 2007;23:124–8.CrossRefPubMed
42.
Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS. Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy. 2009;25:880–90.CrossRefPubMed
43.
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987:160–4.
44.
Itoi E, Arce G, Bain GI, Diercks RL, Guttmann D, Imhoff AB, Mazzocca AD, Sugaya H, Yoo YS. Shoulder stiffness: current concepts and concerns. Arthroscopy. 2016;32:1402–14.CrossRefPubMed
45.
Shields E, Thirukumaran C, Thorsness R, Noyes K, Voloshin I. An analysis of adult patient risk factors and complications within 30 days after arthroscopic shoulder surgery. Arthroscopy. 2015;31:807–15.CrossRefPubMed
46.
Seil R, Litzenburger H, Kohn D, Rupp S. Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy. 2006;22:521–7.CrossRefPubMed
47.
Pauzenberger L, Grieb A, Hexel M, Laky B, Anderl W, Heuberer P. Infections following arthroscopic rotator cuff repair: incidence, risk factors, and prophylaxis. Knee Surg Sports Traumatol Arthrosc. 2017;25:595–601.CrossRefPubMed
48.
Brislin KJ, Field LD, Savoie FH. Complications after arthroscopic rotator cuff repair. Arthroscopy. 2007;23:124–8.CrossRefPubMed
49.
Johnson LL, Shneider DA, Austin MD, Goodman FG, Bullock JM, DeBruin JA. Two per cent glutaraldehyde: a disinfectant in arthroscopy and arthroscopic surgery. J Bone Joint Surg Am. 1982;64:237–9.CrossRefPubMed
50.
McFarland EG, O'Neill OR, Hsu CY. Complications of shoulder arthroscopy. J South Orthop Assoc. 1997;6:190–6.PubMed
51.
Namdari S, Nicholson T, Parvizi J, Ramsey M. Preoperative doxycycline does not decolonize Propionibacterium acnes from the skin of the shoulder: a randomized controlled trial. J Shoulder Elb Surg. 2017;26:1495–9.CrossRef
52.
Murray MR, Saltzman MD, Gryzlo SM, Terry MA, Woodward CC, Nuber GW. Efficacy of preoperative home use of 2% chlorhexidine gluconate cloth before shoulder surgery. J Shoulder Elb Surg. 2011;20:928–33.CrossRef
53.
Savage JW, Weatherford BM, Sugrue PA, Nolden MT, Liu JC, Song JK, Haak MH. Efficacy of surgical preparation solutions in lumbar spine surgery. J Bone Joint Surg Am. 2012;94:490–4.CrossRefPubMed
54.
Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL. Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am. 2009;91:1949–53.CrossRefPubMed
55.
Dodson CC, Craig EV, Cordasco FA, Dines DM, Dines JS, DiCarlo E, Brause BD, Warren RF. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elb Surg. 2010;19:303–7.CrossRef
56.
Horneff JG, Hsu JE, Huffman GR. Propionibacterium acnes infections in shoulder surgery. Orthop Clin N Am. 2014;45:515–21.CrossRef
57.
Mook WR, Klement MR, Green CL, Hazen KC, Garrigues GE. The incidence of Propionibacterium acnes in open shoulder surgery: a controlled diagnostic study. J Bone Joint Surg Am. 2015;97:957–63.CrossRefPubMed
58.
Sethi PM, Sabetta JR, Stuek SJ, Horine SV, Vadasdi KB, Greene RT, Cunningham JG, Miller SR. Presence of Propionibacterium acnes in primary shoulder arthroscopy: results of aspiration and tissue cultures. J Shoulder Elb Surg. 2015;24:796–803.CrossRef
59.
Matsen FA, Butler-Wu S, Carofino BC, Jette JL, Bertelsen A, Bumgarner R. Origin of Propionibacterium in surgical wounds and evidence-based approach for culturing Propionibacterium from surgical sites. J Bone Joint Surg Am. 2013;95:e181.CrossRefPubMedCentral
60.
Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008;90:62–9.CrossRefPubMed
61.
Peersman G, Laskin R, Davis J, Peterson MG, Richart T. Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J. 2006;2:70–2.CrossRefPubMedPubMedCentral
Metadata
Title
Examination of concomitant glenohumeral pathologies in patients treated arthroscopically for calcific tendinitis of the shoulder and implications for routine diagnostic joint exploration
Authors
Gernot Lang
Kaywan Izadpanah
Eva Johanna Kubosch
Dirk Maier
Norbert Südkamp
Peter Ogon
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1839-z

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