肩甲下筋腱に発生した石灰性腱炎に対し鏡視下摘出術を施行した４例
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Calcific tendonitis is a common disease of the rotator cuff. Conservative treatments are frequently successful. Open or arthroscopic surgery is recommended only in chronic cases, which are associated with pain and discomfort. Calcific tendonitis is seen most commonly affecting the suprasupinatus tendon. Rarely, it has been reported affecting the subscapularis tendon. We report 4 cases undergoing arthroscopic resection for calcific tendonitis in the subscapularis tendon in which conservative treatment was ineffective. All cases were checked using 3 dimensional computed tomography(3D-CT) in order to locate the calcium deposits in the cuff. The clinical results were evaluated using the Japanese Orthopaedic Association(JOA)score. All patients underwent shoulder arthroscopy in the beach chair position under general anesthesia. Arthroscopic subacromial decompression(ASD) was performed. Using a cannula as a spacer from the anterior portal, we got working space in the subcoracoid space. After location of calcific deposits using a spinal needle, a longitudinal small incision using a knife was made in the line of the subscapularis fiber. The calcification was removed using arthroscopic scissors, shaver, and electrocautery. The incised regions were repaired using suture anchors in 2 cases. The calcific deposit disappeared on postoperative radiographs in all cases. JOA score improved from preoperative 57.8(range49-69) to postoperative 86.5(range76-100) on avarage. The literature reported that calcific tendinitis involving the subscapularis tendon is associated with subcoracoid stenosis or impingement, so they described the nessesity of subcoracoid decompression. But I think the calcific tendonitis of the subscapularis tendon is also associated with subacromial impingement, because we could removed it from bursal approach. We conclude that arthroscopic removal of the calcific deposits of the subscapularis tendon has a good clinical outcome. The use of a cannula as a spacer of the subcoracoid space allowed us to remove the deposit and was also useful for repair of the rotator cuff using suture anchors.
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