In hard-to-treat cases, calcium deposits in the rotator cuff can be removed arthroscopically, a new study shows.

That's not to say arthroscopy is preferable to nonsurgical treatments, however.

"Nonoperative measures should always be the first choice in cases of symptomatic rotator cuff calcium deposits," Dr. Mohamed Taha El Shewy writes in The American Journal of Sports Medicine, online February 24.

But the procedure should be the go-to method when that fails, he says, "as long as the cuff is not markedly degenerative."

Many people with calcium deposits in the rotator cuff have no symptoms, and in others, symptoms subside with physical therapy and nonsteroidal anti-inflammatory drugs. However, in patients whose pain persists following non-operative treatment, the deposits need to be removed either arthroscopically or through open surgery.

Dr. El Shewy, of the Kasr Al Aini Teaching Hospital at Cairo University, reports on 54 people who were treated arthroscopically for calcium deposits in the tendons of the rotator cuff. All had pain that did not respond to a 3-month protocol of rest, physical therapy, and anti-inflammatory drugs. None of the patients had received corticosteroid shots.

Calcium deposits, in the form of caseous material or a semi-solid paste, were removed as fully as possible following subacromial bursectomy; subacromial decompression was done when necessary. Postoperative x-rays showed that deposits were removed completely in 29 patients and almost completely in 25 patients.

Patients resumed passive range of motion exercises within 2 weeks and progressed from assisted to active exercise while also completing strengthening exercises for 6 to 8 weeks. Follow-up visits gradually decreased in frequency to once each year. By the end of the study, 7 to 10 years had elapsed since each patient had undergone surgery.

The average age at surgery was 49 years; two-thirds of the patients were male.

At the final follow-up, every patient had returned to his or her original activity level. Patients had significantly improved on three different measures of pain, activity level, and range of motion: the University of California at Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) scores, and the Constant score.

Two patients developed rotator cuff tears between 2 and 3 years after surgery. In both cases, tendon degeneration was noticeable during the original arthroscopic procedure.

Occasionally, the researcher writes, arthroscopy may be less effective than open surgery at complete excision of the calcium deposit, but on the other hand open surgery is associated with more intraoperative complications.

His current findings, Dr. El Shewy adds, confirm previous evidence that deposits do not necessarily need to be removed fully to ensure complete recovery, and in these cases, "arthroscopic removal is clearly a better option."

SOURCE: Abstract

Am J Sports Med 2011.