Evaluating treatment options for calcific tendinitis of the rotator cuff

Calcific tendinitis is a frequent cause of shoulder pain. The condition is characterized by the deposition of hydroxyapatite crystals in the rotator cuff tendons. Patients experience activity-related pain with abduction that is similar to the combination of symptoms described as subacromial pain syndrome (SAPS). A detailed introduction to this topic is provided in Chapter 1.
This thesis focusses on improving the care for patients with calcific tendinitis of the rotator cuff, with an emphasis on evaluating the effectiveness of extracorporeal shockwave therapy (ESWT) and ultrasound-guided needling. First, by giving insight in the prevalence and radiographic assessment of the condition (Chapter 2 and 3). Second, by providing a comprehensive literature overview exploring all minimally invasive treatment options, and to compare these results with surgical treatment (Chapter 4 and 5). Finally, by evaluating the outcome of a randomized controlled trial comparing high-energy ESWT and ultrasound-guided needling in patients with refractory rotator cuff calcific tendinitis. The clinical and work-related outcome is discussed, and the clinical metric properties of the outcome measures are analysed (Chapter 6 - 8). Chapter 9 presents the general discussion. In this chapter the most important findings of the thesis are summarized as clinical implications, and future perspectives are discussed. A Dutch treatment flowchart is presented in the appendix.
The most important finding of this thesis is hat both high-energy ESWT and ultrasound-guided needling have proven to be safe and effective in the treatment of calcific tendinitis of the rotator cuff. The availability of these treatment options limit the necessity for arthroscopic surgery in calcific tendinitis of the rotator cuff.