Calcifying Tendinitis of the Shoulder

Many reports have been published on the various methods of treatment of painful calcifications in the region of the shoulder joint. Some authors advocate needling, irrigation, or surgical excision. Others regard x-ray therapy as the procedure of choice. About 35 papers discussing the value of roentgen therapy have come to our attention since this method was first proposed in the European literature (1, 2, 3) and publicized in America by Lattman (4) and de Lorimier (5). The methods have varied from single very small doses to repeated or prolonged intensive courses of low- or high-voltage radiation. Seventy to 100 per cent of patients have reportedly benefited from irradiation. Occasional voices of skepticism as to the efficacy of radiation therapy have found expression in print: Guido (6) states that “the condition is sometimes self-limited and a few of the patients will obtain relief at least temporarily without any form of therapy.” Two of 11 patients in his series had complete remissions without treatment. Newell (7), discussing Baird's paper (8), said: “I have known calcium to disappear in a number of patients that were seen in the acute stage and were given no x-ray treatment. It is possible, therefore, that part of the clearing out of the calcium is due to the patient's reaction and not to the irradiation.” Klein and Klemes (9) observed spontaneous gradual absorption of calcification without therapy in 12 per cent of their cases. Twenty-five patients treated with physiotherapy alone had an average period of disability of fifty days compared with ten days for 27 patients also receiving x-ray therapy. Unfortunately, these data were not derived from a controlled study of unselected patients. Pendergrass and Hodes (10) found that “ordinarily, the acute symptoms subside in one or two weeks without treatment. The usual course in patients benefited by irradiation is less than one week.” The mechanism by which x-rays are believed to exert a beneficial effect on the calcified tendon is not known. Reference to some of the many theories is made by a number of authors, particularly in the excellent discussions by Borak (11) and Roxo Nobre and de Araujo Cintra (12). To our knowledge, no truly controlled series has been published. The present paper reports a controlled study of the effect of x-ray therapy on 38 patients with peritendinitis of the shoulder. Diagnosis Calcifications in the tendinous insertions or in the bursa are easily demonstrated by means of films of the shoulder in external and internal rotation of the humerus. The facets for insertion of the four shoulder muscles which are prone to calcify are outlined by pieces of lead foil on a right humerus in the two standard projections (Fig. 1). The insertions of the teres minor and subscapularis muscles may overlap completely in external rotation but will easily separate in internal rotation.