Aanhoudende schouderklachten bij tendinitis calcarea*

Objective

We assessed the most important demographics and radiological characteristics at the time of diagnosis of rotator cuff calcific tendinitis (RCCT), and their associations with long-term clinical outcome.

Design

Observational study.

Method

Baseline characteristics and treatment were evaluated in 342 patients in whom RCCT had been diagnosed. Interobserver agreement of the radiological investigations was analysed. Patients were sent a general questionnaire and 2 shoulder questionnaires, the “Western Ontario rotator cuff” (WORC) and the “Disabilities of the arm, shoulder and hand” (DASH) for evaluation of long-term clinical outcome. Associations between baseline characteristics and long-term outcomes were analysed using logistic regression.

Results

Mean age at diagnosis was 49.0 years (SD = 10.0), and 60% were female. The dominant arm was affected in 66%, and 21% had bilateral RCCT. Calcifications were on average 18.7 mm in size (SD = 10.1, ICC = 0.84 (p < 0.001)) and located 10.1 mm (SD = 11.8) medially to the acromion (ICC = 0.77 (p < 0.001)). 32% of the calcifications had a Gärtner type I classification (κ: 0.47 (p<0.001)). After a mean follow-up of 14 years (SD =7.1), median WORC score was 72.5 (range: 3.0-100.0) and median DASH score 17.0 (range: 0.0-82.0). Female gender, dominant arm involvement, bilateral disease, longer duration of symptoms at presentation, and presence of multiple calcifications were associated with inferior long-term outcomes.

Conclusion

RCCT is not self-limiting. Radiological variations have no significant predictive value. We identified specific prognostic factors for inferior long-term outcome; more intensive follow-up and treatment should be considered in patients with these characteristics.

Conflict of interest and financial support: this study was funded as part of a larger project by ZonMw (the Netherlands Organisation for Health Research and Development; project number 40-00703-98-8564) and the Reumafonds (the Netherlands Rheumatism Fund; grant number 09-1-303).