Les moyens et la stratégie thérapeutiques face à une calcification de la coiffe des rotateurs

Calcific tendinitis of the rotator cuff is one of the most common causes of shoulder pain. The most efficient treatment for this disease is still debated. This review discusses efficacy of the different therapies currently available to help in the choice of the best therapeutic strategy. First, this disease can be treated by conservative treatment (physical therapy and nonsteroidal anti-inflammatory drugs) with good results. However, the improvement can be slow to occur and no clear factor has been identified to predictive the spontaneous disappearance of the calcific deposit. Subacromial corticosteroid injections have a short term effect but can also have long term efficiency in about a third of the patients. Needling and lavage of the calcification under ultrasound or extracorporeal shock wave therapy are the next available options. The former seems more efficient on pain and to decrease the size of calcium deposits than the latter and therefore might the treatment of choice for nonsurgical options of treatment in calcific tendinitis of the shoulder. However, more studies are needed to draw any definite conclusion on this topic. Needling and lavage can be performed with one needle and under ultrasonography with the same efficacy than with the 2-needle technic. Finally, arthroscopic debridement of calcific has not shown any significant difference with the other treatment. Therefore, it should be considered as a secondary and more invasive option for patients who failed medical treatment.