CALCIFYING TENDINITIS - RESULTS AFTER NEEDLING

In a prospective study, 33 patients with calcifying tendinitis had a needling in local anaesthesia performed under control of an image converter. There was at least a one year follow-up period. Resorption of the hydroxyapatite deposits was seen in 23 instances; 75% of all patients were free of symptoms or had considerably improved (Table 3). For better assessment of these results we embarked on an additional retrospective study observing the spontaneous evolution of 235 hydroxyapatite deposits for 3 years on average. On the x-ray, these deposits had a characteristic appearance and could be classified into one of three types: either sharply outlined and densely structured (type I), or with cloudy limitations and transparent in structure (type III). In addition we saw deposits combining the features of both of the above named types (type II) (Table 5, Fig. 6). Based on this classification, a clear correlation was revealed to exist between initial x-ray findings and the frequency of resorption after needling: with type I, complete resorption was seen in 33% of the cases, with type II in 71%, and with type III in 85% of the cases (Table 6). With type II, however, only half of the patients were free of symptoms. Surgical removal of the hydroxypatite deposits became necessary in 3 patients because of persisting heavy pains. As complication we observed intraoperatively an incomplete tear of the rotator cuff, the relation of which to the needling remained unsure. In this context, the question is discussed whether calcifying tendinitis and rupture of the rotator cuff may represent two disease entities of identical origin. Based on histological investigations the rotator cuff rupture is mainly due to degenerative processes whereas in calcifying tendinitis there is active calcification with spontaneous resorption. To clarify the simultaneous occurrence of calcifying tendinitis and rupture of the rotator cuff in our own patient population, arthrography was performed in 63 patients with calcifying tendinitis. This revealed only one rupture of the cuff and one incomplete tear juxta-articular. These two disease entities are therefore unlikely to occur simultaneously. In practice, the uncomplicated type of needling described here may be recommended for type II hydroxyapatite deposits where freedom of symptoms and resorption of the deposit may be expected in about 50% of the cases. In most of the cases, type III deposits are already undergoing spontaneous resorption; therefore requiring rather lavage than needling. Type I does not present a good indication for needling.