Arthroscopic Calcific Debridement
Calcific tendonitis is an unusual condition in which calcium is deposited in the tendons of the rotator cuff. Although it can affect any of the four rotator cuff tendons, the supraspinatus is the tendon most commonly affected.
The treatment for a calcific deposit is usually non-operative however if symptoms persist despite undergoing either injection therapies, barbotage, physiotherapy, tand arthroscopic surgery can all be used to help address the symptoms.
The aim of surgery is to remove any calcific debris whilst not damaging the rotator cuff. In order to adequately examine the rotator cuff, an arthroscopic examination of the shoulder is undertaken and any inflammatory tissue is removed. This is referred to as a bursectomy. Once undertaken, the rotator cuff can be inspected for the presence of any calcific deposits within the rotator cuff. These deposits can be quite superficial and therefore easy to see, but they can also be deep within the body of the tendon and therefore might only be located by probing the tendon with an instrument or needle.
Calcific deposits can transition through three main stages; the Formative Phase, the Resorptive Phase and the Reparative Phase. The two main stages that can result in symptoms requiring treatment are the Formative phase, when the calcium is chalk like in consistency and the Reparative phase, when it is either of toothpaste consistency or a liquid. The chalk like material is more difficult to liberate with a probe of needle and therefore a subacromial decompression might be needed to prevent any ongoing impingement like symptoms. However, the paste /liquid form of the calcific deposit is usually easy expressed from the tendon and therefore one can often avoid undertaking a subacromial decompression is such cases. The calcium is however believed to be an irritant to the shoulder and therefore a thorough arthroscopic washout is also necessary to reduce the risk of postoperative shoulder stiffness.
Information for patients / operative Information
Risks and complications
- Nerve injury
- Continued discomfort / recurrence
- Please bring any X-rays or scans with you to the hospital. This will usually be on a CD disc. These will not be needed if it was Mr Falworth who organised the investigations.
- No food for 6 hours, or drink for 4 hours, prior to surgery.
- Please avoid smoking for 12 hours prior to surgery
- An arthroscopic excision of a calcific deposit is usually performed as a day case procedure or as a single overnight stay.
- Two to three incisions, each approximately 1 cm in length, are made around the shoulder. These are closed with dissolving sutures and Steri-strips.
- Splash proof dressings will be applied but the wound should remain dry for 10 days.
- Prior to your discharge, a physiotherapist will demonstrate some simple exercises as part of your rehabilitation protocol. These exercises should be undertaken when you’re at home and will help your shoulder recover from the surgery before your outpatient physiotherapy commences.
What to Expect
- Swelling; Immediately after an arthroscopic procedure there can be quite a lot of swelling around the shoulder but this settles after approximately 24 hours. A cryocuff or alternative cold therapy compress can be helpful in minimising swelling and inflammation.
- Pain; An Interscalene Block is often used to reduce immediate post-operative pain. If any discomfort arises after 18-24 hours once the block has worn off, simple oral analgesics can be taken to manage this.
- Bleeding; There may be some oozing through the bandages but this should settle soon after the operation.
- A sling will be provided to help rest the shoulder. This should be used for the first 7 - 14 days post surgery. To prevent the development of undue shoulder stiffness, the belt that is attached to your sling should be removed 24 hours after your operation.
- The wound should be kept dry for 10 days.
- After 10 days the dressing and paper Steristrips can be gently removed. If the wound is dry then it is all right to wash the wound, if not please consult Mr Falworth or your GP for further advice.
- The most important part of your post-operative care is to start an early exercise programme with your physiotherapist to maximise the benefit of your operation. The exercises demonstrated to you whilst you were in hospital will be enough until you see your out-patient physiotherapist.
- You will be reviewed in clinic approximately 3 weeks following your surgery.
Estimated return to functional activities
- Driving 2 weeks
- Light duties 4 weeks
- Return to work Usually 2 weeks but depends on occupation
- Heavy Lifting 12 weeks
- Repetitive overhead activity/sport 12-16 weeks