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Treatment of Peritendinitis Calcarea in the Shoulder Joint

1941; Radiological Society of North America; Volume: 37; Issue: 3 Linguagem: Inglês

10.1148/37.3.325

1527-1315

Itzik Klein, I. S. Klemes,

Elbow and Forearm Trauma Treatment

There is an extensive literature dealing with the diagnosis, pathology, and treatment of peritendinitis calcarea, a condition which is often designated as “bursitis calcarea.” The material available on its diagnosis and pathology is thorough and there is little to gain by further discussion of these aspects; a bibliography for general use on the subject is appended. In this paper we shall consider only the treatment, since this phase of the problem has various solutions. The treatments in use for peritendinitis calcarea must be evaluated in view of their ability to relieve the condition speedily and also to bring about a cure. In considering statistics relative to the results of any form of therapy it must be kept in mind that both the symptoms and the calcification itself may disappear spontaneously. In our series there was gradual absorption of the calcification without treatment in about 12 per cent of the cases. The majority of patients must be treated by one form of therapy or another. The most radical of the methods of treating peritendinitis calcarea of the shoulder joint is surgery. These cases are managed by incision and curettement of the calcification in the tendon sheath. At times, needling is used. A more conservative procedure, in a large percentage of cases, is physiotherapy. This treatment may bring about relief of the symptoms but has the disadvantage of rarely effecting a disappearance of the calcification. Furthermore, patients treated by this method have a long period of disability, about fifty days, with or without reduction in calcification. The method of treatment which we suggest as the most effective both for the relief of the symptomatology and the reduction of calcification is roentgen irradiation. With roentgen therapy the average disability period is reduced to about ten days. The acute symptoms are gone within a week. The accompanying table shows clearly the relative disability periods with physiotherapy and irradiation. The cases tabulated come from several industrial organizations, and in all except a few latent cases the peritendinitis calcarea of the shoulder joint was caused directly by trauma or activity connected with routine work. These cases cover a period which includes 1932 and runs through September 1940. From 1932 to 1937 treatment was by physiotherapy only; from 1937 to 1940 by roentgen therapy. Physiotherapy took the form of infra-red therapy and diathermy. Roentgen therapy was given as follows: 75 to 100 r in air every three to seven days for four doses. The second course, when given, followed after a month's rest period and was the same as the first. The fields were varied. The factors were 125 kv., 4.0 mm. A1, 5 ma., 30 cm. distance, field 8 × 8 cm., or 180 kv. 4 ma., 40 cm. distance, 0.5 mm. Cu and 1.0 mm. A1, field 10 × 10 cm. The response was the same from both methods. The method was determined by the thickness of the shoulder.