American Shoulder and Elbow Surgeons
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A patient has shoulder pain and dysfunction. The radiograph is shown in Fig A. If this patient undergoes shoulder arthroscopy, which structure is most likely to be abnormal?
glenohumeral articular cartilage
biceps tendon (long head)
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The radiograph shows calcific tendinitis of the supraspinatus tendon. This is the most common structure involved in this disease process.
Uthoff describes stages of calcific tendonosis. The "Pre-calcific" stage shows metaplasia of tenocytes into chondrocytes. The "Calcific" stage has three sub-parts: Formative phase, Resting phase, Resorptive phase. The "Post-calcific" stage is last.
Two types are seen on X-Ray: Type I has as fluffy and fleecy appearance with a poorly defined periphery. This is associated with an acute pain and is usually seen during the formative phase of the calcific stage. Type II is characterized by discrete homogeneous deposits with uniform density and a well defined periphery. This is seen in subacute and chronic cases. Persistent cases may respond to arthroscopic debridement of the deposits with a shaver or spinal needle.
Seyahi et al describes arthroscopic removal of calcifying deposits involving the tendon alone compared to those with additional osseous involvement. The results were similar in both groups.
Seyahi A, Demirhan M
Arthroscopy. 2009 Jun;25(6):590-6. PMID: 19501287 (Link to Abstract)
Seyahi, ASCOPY 2009
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