Summary
We report a clinicopathological study of 90 patients who had calcifying tendinitis, and propose a rationale for its treatment based upon pathogenetic mechanisms. Pain, the cardinal symptom of calcifying tendinitis, is probably subclinical before and during calcification, when tissue hypoxia is primarily responsible for the structural alterations. The pain becomes extremely severe during the resorptive phase, when hyperaemia prevails. Corticosteroid injections at this time will lessen pain, but would impede the process of resorption because steroids inhibit macrophage function. Therefore, as soon as the pain subsides, pendulum movements of the arm with rest in abduction should be promoted to maintain vascular perfusion and calcium resorption. In case of recurrence of the acute pain, surgical removal of the calcium deposits is a better alternative than repeated corticosteroid injections.
Résumé
Les auteurs présentent une étude clinique et anatomo-pathologique de 90 malades porteurs d'une tendinite calcifiante et proposent des règles thérapeutiques basées sur la pathogénie de cette affection. La douleur, principal symptôme de la tendinite calcifiante, est probablement infra-clinique avant et pendant la période de calcification, quand l'hypoxie tissulaire détermine les lésions structurales. La douleur devient extrêmement vive à la phase de résorption quand prédomine l'hyperhémie.
A ce stade, les injections de corticoïdes peuvent diminuer les douleurs, mais elles sont susceptibles d'entraver le processus de résorption car elles inhibent la fonction des macrophages. Donc, tant que la douleur persiste, les mouvements pendulaires du membre supérieur et le repos, bras en abduction, doivent être préconisés afin d'entretenir la circulation et la résorption calcique. En cas de récidive des douleurs aiguës, l'ablation chirurgicale des calcifications est préférable aux injections itératives de corticoïdes.
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Uhthoff, H.K., Sarkar, K. Calcifying tendinitis. International Orthopaedics 2, 187–193 (1978). https://doi.org/10.1007/BF00266076
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DOI: https://doi.org/10.1007/BF00266076