Management of rotator cuff calcifications.

Although investigators do not agree on the etiology of calcification of the rotator cuff, it may be linked to hypoxia of the tissue. New evidence suggests that there may be a genetic predisposition linked to the HLA-A1 antigen. The initial phases of formation of the calcification are rarely symptomatic. The acute phase symptoms that debilitate the patient are usually associated with the resorptive phase, in which there is vascular invasion and influx of phagocytic cells, increasing the intratendinous pressure and exacerbating the symptoms. Conservative treatment including local injections of anesthetic, needling, and barbotage is frequently successful. Steroid injections are controversial and may slow the long-term resorption of calcium. A small group of patients remain symptomatic. For these patients and for the chronic subacute patient who fails to resolve with conservative treatment, excision of calcium offers reliable relief. Previous experience with open excision provided predictable results but with a surprisingly long time to recovery. Recent experiences with arthroscopic excision have decreased the morbidity, and several investigators have reported uniformly excellent results. The technique is demanding, but arthroscopy permits reliable removal of the calcification and resolution of pain. Acromioplasty with or without coracoacromial ligament resection should be performed only in patients in whom impingement has been demonstrated by physical examination or intraoperative arthroscopic examination.