Treatment of shoulder calcifications

Historically classified as calcific periarthritis of the shoulder, calcifications in the tendons that constitute the rotator cuff have a new pathological description, which opens new horizons to various theories on their genesis and on possible treatments that can be used as an alternative to invasive surgical operations.

Treatment of shoulder calcificationWith the use of ultrasound of the shoulder, we asses the state, typology, and location of the calcification before treatment to classify the disease better, correlate the clinical symptoms reported by the patient, and establish the right moment to perform any treatment. This treatment of shoulder tendon calcifications, under sonographic guidance, is an innovative method, performed under local anesthesia, and represents an effective therapeutic tool, as an alternative to surgery, which is thus limited to selected cases. We have been using this method since 2002 with extremely satisfactory results, testified by a constant increase in the demand for it by patients. After sonography, treatment is performed by an ultrasound physician, orthopedic surgeon, and helped by a nursing operator specialized in the method. Having determined the site and type of the calcification, the patient lies down on the surgery bed, the sterile field is prepared, and local anesthesia is administered, first superficially and then around the calcifications under sonographic guidance. Then two needles are inserted, which break up the calcification, and subsequently, the injection of physiological solution from one of the needles favours its dissolution, and elimination from the other needle. The introduction of a small catheter, guided by sonography, allows lavage of the residual irritating calcification, contained in the "subacromial bursa." The targeted injection of a steroidal anti-inflammatory drug favours the process of functional recovery. After dressing the wound, the patient is taken to the ward to stay for the rest of the day. A follow-up sonography exam is performed after one month to check the process of healing.

Fig. 1 X-ray of the calcification

Sonography of the calcification

Content updated 22/11/2010 - 15:12
Content edited by: Stefano Galletti, MD; Paola Pollastri (paola.pollastri@ior.it)
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