Kalkschulter – konservative und operative Therapie

Erkrankungen der Rotatorenmanschette beinhalten ein breites Spektrum, unter denen die Kalkschulter oder Tendinosis calcarea (TC) eine häufige Pathologie der Schulter darstellt und eine herausragende Rolle einnimmt. Das Erscheinungsbild kann dabei enorm variieren. Die Kalkschulter kann als Zufallsbefund bei der radiologischen Diagnostik auffallen, jedoch auch bis hin zu einem der stärksten Schulterschmerzen avancieren. Nachfolgend wird ein Überblick für das diagnostische und therapeutische Vorgehen gegeben.

Publication History

Article published online:
10 February 2023

• Literatur

• 1 Painter CF. Subdeltoid Bursitis. Boston Med Surg J 1907; 156: 345-349
• 2 Codman HE. The Shoulder: Rupture of the supraspinatus Tendon and other Lesions in or about the subacromial Bursa. Boston: Thomas Todd Co.; 1934
• 3 Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis, and management. J Am Acad Orthop Surg 1997; 5: 183-191
• 4 Merolla G, Singh S, Paladini P. et al. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment. J Orthop Traumatol 2016; 17: 7-14
• 5 Bosworth BM. Calcium deposits in the shoulder and subacromial bursitis. J Am Med Assoc 1941; 116: 2477-2482
• 6 Mavrikakis ME, Drimis S, Kontoyannis DA. et al. Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: a controlled study. Ann Rheum Dis 1989; 48: 211-214
• 7 Sansone VC, Meroni R, Boria P. et al. Are occupational repetitive movements of the upper arm associated with rotator cuff calcific tendinopathies?. Rheumatol Int 2015; 35: 273-280
• 8 Sansone V, Consonni O, Maiorano E. et al. Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders. Skeletal Radiol 2016; 45: 49-55
• 9 Louwerens JKG, Sierevelt IN, van Noort A. et al. Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis. J Shoulder Elbow Surg 2014; 23: 1240-1249
• 10 Uhthoff HK, Sarkar K. Calcifying tendinitis. Baillierer Clin Rheumatol 1989; 3: 567-581
• 11 Oliva F, Via AG, Maffulli N. Calcific tendinopathy of the rotator cuff tendons. Sports Med Arthrosc Rev 2011; 19: 237-243
• 12 Louwerens JKG, Sierevelt IN, van Hove RP. et al. Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. J Shoulder Elbow Surg 2015; 24: 1588-1593
• 13 Ogon P, Suedkamp NP, Jaeger M. et al. Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulder. Arthritis Rheum 2009; 60: 2978-2984
• 14 Tillmann B. Rotatorenmanschettenrupturen. Operat Orthop Traumatol 1992; 4: 181-184
• 15 Bi Y, Ehirchiou D, Kilts TM. et al. Identification of tendon stem/progenitor cells and the role of the extracellular matrix in their niche. Nature Medicine 2007; 13: 1219-1227
• 16 Zhang J, Wang JH-C. Mechanobiological response of tendon stem cells: Implications of tendon homeostasis and pathogenesis of tendinopathy. J Orthop Res 2010; 28: 639-643
• 17 Zhang J, Wang JH-C. Production of PGE2 increases in tendons subjected to repetitive mechanical loading and induces differentiation of tendon stem cells into non-tenocytes. J Orthop Res 2009; 28: 198-203
• 18 Uhthoff HK. Calcifying tendinitis, an active cell-mediated calcification. Virchows Arch 1975; 366: 51-58
• 19 Chiou H-J, Hung S-C, Lin S-Y. et al. Correlations among mineral components, progressive calcification process and clinical symptoms of calcific tendonitis. Rheumatology (Oxford) 2010; 49: 548-555
• 20 Rupp S, Seil R. Tendinosis calcarea der Rotatorenmanschette. Arthroskopie 2003; 16: 185-201
• 21 Jim YF, Hsu HC, Chang CY. et al. Coexistence of calcific tendinitis and rotator cuff tear: an arthrographic study. Skeletal Radiol 1993; 22: 183-185
• 22 Hurt G, Baker CL. Calcific tendinitis of the shoulder. Orthop Clin North Am 2003; 34: 567-575
• 23 Harvie P, Pollard TCB, Carr AJ. Calcific tendinitis: Natural history and association with endocrine disorders. J Shoulder Elbow Surg 2007; 16: 169-173
• 24 le Goff B, Berthelot J-M, Guillot P. et al. Assessment of calcific tendonitis of rotator cuff by ultrasonography: Comparison between symptomatic and asymptomatic shoulders. Joint Bone Spine 2010; 77: 258-263
• 25 Patte DGD. Periarthritis of the shoulder. Calcifications. Rev Chir Orthop Reparatrice Appar Mot 1988; 74: 277-278
• 26 Depalma AF, Kruper JS. Long-term study of shoulder joints afflicted with and treated for calcific tendinitis. Clin Orthop 1961; 20: 61-72
• 27 Gärtner JHA. Tendinosis calcarea der Schulter. Orthopäde 1995; 24: 284-302
• 28 Gärtner J, Simons B. Analysis of calcific deposits in calcifying tendinitis. Clin Orthop Relat Res 1990; 254: 111-120
• 29 Gärtner J. Tendinosis calcarea – Behandlungsergebnisse mit dem Needling. Z Orthop Unfall 1993; 131: 461-469
• 30 Farin PU, Jaroma H. Sonographic findings of rotator cuff calcifications. J Ultrasound Med 1995; 14: 7-14
• 31 Papatheodorou A, Ellinas P, Takis F. et al. US of the Shoulder: Rotator Cuff and Non-Rotator Cuff Disorders. RadioGraphics 2006; 26: e23-e23
• 32 Teefey SA, Rubin DA, Middleton WD. et al. Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am Vol 2004; 86: 708-716
• 33 Löhr JF, Uhthoff HK. Tendinosis calcarea. Orthopäde 1996; 25: 484-493
• 34 Merolla G, Bhat MG, Paladini P. et al. Complications of calcific tendinitis of the shoulder: a concise review. J Orthop Traumatol 2015; 16: 175-183
• 35 FARIN PU. Consistency of rotator-cuff calcifications. Investig Radiol 1996; 31: 300-304
• 36 Wölk T, Wittenberg R. Kalzifizierendes Subakromialsyndrom – Klinische und sonographische Ergebnisse unter nicht-operativer Therapie. Z Orthop Grenzgebiete 2008; 135: 451-457
• 37 Cho NS, Lee BG, Rhee YG. Radiologic course of the calcific deposits in calcific tendinitis of the shoulder: Does the initial radiologic aspect affect the final results?. J Shoulder Elbow Surg 2010; 19: 267-272
• 38 Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2003; 2003: CD004016
• 39 Gaujoux-Viala C, Dougados M, Gossec L. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a metaanalysis of randomised controlled trials. Ann Rheum Dis 2009; 68: 1843-1849
• 40 Rubenthaler F, Ludwig J, Wiese M. et al. Prospective Randomized Surgical Treatments for Calcifying Tendinopathy. Clin Orthop Related Res 2003; 410: 278-284
• 41 Busse P, Vater C, Stiehler M. et al. Cytotoxicity of drugs injected into joints in orthopaedics. Bone Joint Res 2019; 8: 41-48
• 42 Tillander B, Franzén LE, Karlsson MH. et al. Effect of steroid injections on the rotator cuff: An experimental study in rats. J Shoulder Elbow Surg 1999; 8: 271-274
• 43 Chao Y-H, Tsuang Y-H, Sun J-S. et al. Effects of Shock Waves on Tenocyte Proliferation and Extracellular Matrix Metabolism. Ultrasound Med Biol 2008; 34: 841-852
• 44 Han SH, Lee JW, Guyton GP. et al. J. Leonard Goldner Award 2008: Effect of extracorporeal shock wave therapy on cultured tenocytes. Foot Ankle Int 2009; 30: 93-98
• 45 Ioppolo F, Tattoli M, di Sante L. et al. Clinical Improvement and Resorption of Calcifications in Calcific Tendinitis of the Shoulder After Shock Wave Therapy at 6 Monthsʼ Follow-Up: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2013; 94: 1699-1706
• 46 Gerdesmeyer L, Wagenpfeil S, Haake M. et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff. JAMA 2003; 290: 2573-2580
• 47 Verstraelen FU, in den Kleef NJHM, Jansen L. et al. High-energy versus low-energy extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: which is superior? A metaanalysis. Clin Orthop Relat Res 2014; 472: 2816-2825
• 48 Saboeiro GR. Sonography in the treatment of calcific tendinitis of the rotator cuff. J Ultrasound Med 2012; 31: 1513-1518
• 49 Harmon PH. Methods and results in the treatment of 2,580 painful shoulders, with special reference to calcific tendinitis and the frozen shoulder. Am J Surg 1958; 95: 527-544
• 50 Greis AC, Derrington SM, McAuliffe M. Evaluation and nonsurgical management of rotator cuff calcific tendinopathy. Orthop Clin North Am 2015; 46: 293-302
• 51 Depalma AF, Kruper JS. Long-term study of shoulder joints afflicted with and treated for calcific tendinitis. Clin Orthop 1961; 20: 61-72
• 52 Malahias M-A, Chronopoulos E, Raoulis V. et al. Questioning the therapeutic value of corticosteroid bursal injection after ultrasound-guided irrigation and lavage for the treatment of shoulder calcific tendinosis. J Orthop 2019; 18: 16-22
• 53 de Witte PB, Selten JW, Navas A. et al. Calcific tendinitis of the rotator cuff. Am J Sports Med 2013; 41: 1665-1673
• 54 Zhang T, Duan Y, Chen J. et al. Efficacy of ultrasound-guided percutaneous lavage for rotator cuff calcific tendinopathy: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98: e15552
• 55 Cai Y, Zhang C, Lin X. Efficacy of platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis. J Shoulder Elbow Surg 2015; 24: 1852-1859
• 56 Seijas R, Ares O, Alvarez P. et al. Platelet-Rich Plasma for Calcific Tendinitis of the Shoulder: A Case Report. J Orthop Surg (Hong Kong) 2012; 20: 126-130
• 57 Koppenfels RV. Die Strahlenbehandlung entzündlicher und degenerativer Erkrankungen im Schulterbereich. Orthop Prax 1975; 11: 321-324
• 58 Arner O, Lindvall N, Rieger A. Calcific tendinitis (tendinitis calcarea) of the shoulder joint. Acta Chir Scand 1958; 114: 319-331
• 59 Abel MS, Lomhoff II. The treatment of bursitis and peritendonitis calcarea of the shoulder joint by roentgen therapy. Perm Found Med Bull 1949; 7: 90-93
• 60 Plenk HP. Calcifying tendinitis of the shoulder. Radiology 1952; 59: 384-389
• 61 Balke M, Bielefeld R, Schmidt C. et al. Calcifying tendinitis of the shoulder: midterm results after arthroscopic treatment. Am J Sports Med 2012; 40: 657-661
• 62 Seil R, Litzenburger H, Kohn D. et al. Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy 2006; 22: 521-527
• 63 Hurt G, Baker CL. Calcific tendinitis of the shoulder. Orthop Clin North Am 2003; 34: 567-575
• 64 Jerosch J, Strauss JM, Schmiel S. Arthroscopic treatment of calcific tendinitis of the shoulder. J Shoulder Elbow Surg 1998; 7: 30-37
• 65 Rizzello G, Franceschi F, Longo UG. et al. Arthroscopic management of calcific tendinopathy of the shoulder-do we need to remove all the deposit?. Bull NYU Hosp Jt Dis 2009; 67: 330-333
• 66 Porcellini G, Paladini P, Campi F. et al. Arthroscopic treatment of calcifying tendinitis of the shoulder: Clinical and ultrasonographic follow-up findings at two to five years. J Shoulder Elbow Surg 2004; 13: 503-508
• 67 Sansone V, Maiorano E, Galluzzo A. et al. Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment. Orthop Res Rev 2018; 10: 63-72
• 68 Verstraelen FU, Fievez E, Janssen L et al. Surgery for calcifying tendinitis of the shoulder: A systematic review. World J Orthop 2017; 8. Im Internet (Stand: 29.04.2022): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434349/pdf/WJO-8-424