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BASIS AND TREATMENT OF CALCIFICATION OF TENDINOCAPSULAR TISSUES, ESPECIALLY THE SUPRASPINATUS TENDON

BASIS AND TREATMENT OF CALCIFICATION OF TENDINOCAPSULAR TISSUES, ESPECIALLY THE SUPRASPINATUS TENDON Abstract Much has been written regarding the treatment of calcification of tendinocapsular tissues, especially in the region of the supraspinatus tendon.1 Little attention, however, has been paid to the question of the cause of this abnormal deposition of calcium. Most writers support the idea that trauma is the main causative agent. We felt it difficult to accept this opinion, since our experience included several subjects presenting multiple widespread areas of calcification without any clearcut evidence of trauma (accompanying illustration). In fact, it appears that calcification of the tendinocapsular tissues may be the result of a general disorder, possibly metabolic, and that any traumatic influence present merely precipitates the onset of local symptoms.2 Along these lines we noted the interesting experiments of Goettsch and Pappenheimer, Evans and others, which showed the production of degeneration, necrosis and calcification of voluntary muscle fibers in certain animals fed a diet deficient in vitamin References 1. (a) Brickner, W. M.: Pain in the Arm: Subdeltoid (Subacromial) Bursitis; a Further Study of Its Clinical Types, Pathology and Treatment , J. A. M. A. 69:1237-1242 ( (Oct. 13) ) 1917.Crossref 2. King, J. M., Jr., and Holmes, G. W.: The Diagnosis and Treatment of Four Hundred and Fifty Painful Shoulders , J. A. M. A. 89:1956-1960 ( (Dec. 3) ) 1927.Crossref 3. (b) Resnik, J.: Physiotherapy in Subdeltoid Bursitis , Physical Therap. 47:322-329, 1929. 4. (c) Titus, N. E.: Electrical Treatment of Subdeltoid Bursitis , Am. J. Surg. 6:318-334, 1929.Crossref 5. (d) Deering, G. E.: Physical Treatment of Subacromial Bursitis , Physical Therap. 48:362-366, 1930. 6. (e) Carnett, J. B.: The Calcareous Deposits of So-Called Calcifying Subacromial Bursitis , Surg., Gynec. & Obst. 41:404-421, 1925 7. So-Called Calcifying Subacromial Bursitis , Radiology 17:505-513, 1931. 8. (f) Mumford, E. B., and Martin, J. F.: Calcified Deposits in Subdeltoid Bursitis , J. A. M. A. 97:690-694 ( (Sept. 5) ) 1931. 9. (g) Tavernier, M. L.: Les calcifications périarticulaires de l'épaule , Bull. Soc. nat. de chir. 58:956-960, 1932. 10. (h) Gwynne, F. J., and Robb, D.: Calcareous Deposits in Supraspinatus Tendon and Subacromial Bursa , Australian & New Zealand J. Surg. 4:153-164, 1934. 11. (i) Haggart, G. E., and Allen, H. A.: Painful Shoulder: Diagnosis and Treatment with Particular Reference to Subacromial Bursitis , S. Clin. North America 15:1537-1560, 1935. 12. (j) Didiée, J.: Raideurs et douleurs de l'épaule. La part de la physiothérapie dans leur traitement , Médecine 17:437-453, 1936. 13. (k) Echtman, J.: Traumatic Subdeltoid Bursitis: Treatment by Physical Medicine , New York State J. Med. 36:503-506, 1936. 14. (l) Ferguson, L. K.: Painful Shoulder Arising from Lesions of Subacromial Bursa and Supraspinatus Tendon , Ann. Surg. 105:243-256, 1937. 15. (m) Lattman, I.: Treatment of Subacromial Bursitis by Roentgen Irradiation , Am. J. Roentgenol. 36:55-60, 1937. 16. (n) Patterson, R. L., and Darrach, W.: Treatment of Acute Bursitis (Subdeltoid) by Needle Irrigation , J. Bone & Joint Surg. 19:993-1002, 1937. 17. (o) Feldman, L.: Short Wave Diathermy in Subdeltoid Bursitis , Arch. Phys. Therapy 18:411-414, 1937. 18. (p) Rubert, S. R.: Subacromial Bursitis , Arch. Surg. 37:619-641 ( (Oct.) 1938. 19. (q) Ellis, V. H.: Supraspinatus Lesions , Proc. Roy. Soc. Med. 31:451-453, 1938. 20. (r) Troedsson, B. S.: Diathermy in Calcium Deposits Around Subacromial Bursa and Supraspinatus Tendon , Arch. Phys. Therapy 19:166-172, 1938. 21. (s) Leriche, R., and Jung, A.: Traitement des calcifications sous-deltoïdiennes par l'infiltration novocaïnique , Rev. de chir., Paris 76:382-385, 1938. 22. (t) Bettman, E.: Pathology and Therapy of "Shoulder Joint Complex," Am. J. Surg. 41:201-212, 1938.Crossref 23. (u) Mustakallio, S.: Ueber die Roentgen behandlung der Periarthritis humeroscapularis , Acta radiol. 20:22-32, 1939.Crossref 24. (v) Rogers, M. H.: Treatment of Subdeltoid Bursitis , Am. J. Surg. 43:292-297, 1939.Crossref 25. (a) Codman, E. A.: Bursitis Subacromialis or Periarthritis of the Shoulder Joint , Boston M. & S. J. 154:613-620, 1906 26. The Shoulder, Boston, The Author, 1934. 27. (b) Brickner, W. B.: Prevalent Fallacies Concerning Subacromial Bursitis: Its Pathogenesis and Rational Operative Treatment , Am. J. M. Sc. 149:351-364, 1915. 28. (c) Moschowitz, E.: Histopathology of Calcification of the Spinatus Tendons as Associated with Subacromial Bursitis , Am. J. M. Sc. 150:115-126, 1915. 29. (d) Harbin, M.: Deposition of Calcium Salts in the Tendon of the Supraspinatus Muscle , Arch. Surg. 18:1491-1512 ( (June) ) 1929. 30. (e) Jung, A., and Brunschwig, A.: Calcification de labourse séreuse sous-acromiale et métabolisme calcique local , Rev. de chir., Paris 50:611-616, 1931. 31. (f) Elmslie, R. C.: Calcareous Deposits in the Supraspinatus Tendon , Brit. J. Surg. 20:190-196, 1932. 32. (g) Leriche, R., and Jung, A.: Les calcifications sous-deltoïdiennes de l'épaule , Rev. d'orthop. 20:289-299, 1933. 33. (h) Polichetti, E.: Contributo alla ezio pathogenesi e localizzazione della periartrite calcarea scapolo-omerale , Arch. di ortop. 49:195-210, 1933. 34. (i) Ferguson, L. K.: Shoulder Pain and Disability Due to Lesions of the Subdeltoid Bursa and Supraspinatus Tendon , Internat. Abstr. Surg. 66:472-487, 1938 35. in Surg., Gynec. & Obst. , (May) 1938. 36. (a) Goettsch, M., and Pappenheimer, A. M.: Nutritional Muscular Dystrophy in the Guinea Pig and Rabbit , J. Exper. Med. 54:145-166, 1931. 37. (b) Pappenheimer, A. M.: The Pathology of Nutritional Muscular Dystrophy in Young Rats , Am. J. Path. 15:179-183, 1939 38. Certain Nutritional Disorders of Laboratory Animals Due to Vitamin E Deficiency , J. Mt. Sinai Hosp. 7:65-76, 1940. 39. (c) Morgulis, S., and Spencer, H. C.: A Study of the Dietary Factors Concerned in Nutritional Muscular Dystrophy , J. Nutrition 11:573-592, 1936. 40. (d) Evans, H. M.; Emerson, G. A., and Telford, I. R.: Degeneration of Cross-Striated Musculature in Vitamin E Low Rats , Proc. Soc. Exper. Biol. & Med. 38:625-627, 1938. 41. (e) Evans, H. M.: New Light on the Biological Role of Vitamin E , J. Mt. Sinai Hosp. 6:233-244, 1940. 42. (f) Einarson, L., and Ringsted, A.: Effect of Chronic Vitamin E Deficiency on the Nervous System and the Skeletal Musculature in Adult Rats , London, Oxford University Press, 1938. 43. (g) Knowlton, G. C., and Hines, H. M.: Effect of Vitamin E Deficient Diet upon Skeletal Muscle , Proc. Soc. Exper. Biol. & Med. 38:665-667, 1938. 44. (h) Chor, H., and Dolkart, R. E.: Experimental Muscular Dystrophy in the Guinea Pig , Arch. Path. 27:497-509 ( (March) ) 1939. 45. (i) Telford, I. R.; Emerson, G. A., and Evans, H. M.: Histologic Changes in Skeletal Musculature of Paralyzed Suckling Young of E-Low Rats , Proc. Soc. Exper. Biol. & Med. 41:291-295, 1939. 46. (i) Knowlton, G. C.; Hines, H. M., and Brinkhous, K. M.: Cure and Prevention of Vitamin E Deficient Muscular Dystrophy with Synthetic A-Tocopherol Acetate , Proc. Soc. Exper. Biol. & Med. 42:804-809, 1939. 47. Telford, I. R. Emerson, G. A., and Evans, H. M.: Microscopic Lesions Without Functional Impairment of Striated Musculature of Suckling E-Low Rats , Proc. Soc. Exper. Biol. & Med. 45:135-136, 1940. 48. (a) Knowlton, G. C.; Hines, H. M., and Brinkhous, K. M.: Effect of Wheat-Germ Oil upon E-Deficient Muscular Dystrophy , Proc. Soc. Exper. Biol: & Med. 41:453-456, 1939. 49. (b) Mackenzie, C. G., and McCollum, E. V.: The Care of Nutritional Muscular Dystrophy in the Rabbit by Alpha-Tocopherol and Its Effect on Creatine Metabolism , J. Nutrition 19:345-361, 1940. 50. (c) Krakower, C., and Axtmayer, J. H.: Effect of Alpha-Tocopherol on Lesions of Skeletal Muscles in Rats on Vitamin A-Deficient Diets , Proc. Soc. Exper. Biol. & Med. 45:583-586. 1940. 51. (a) Vitamin E.: A Symposium , Society of Chemical Industry, Cambridge, England, W. Heffer & Sons, 1939. 52. (b) Vogt-Møller, P.: The Therapeutic Application of Vitamin E in Human Clinical Medicine , Acta obst. et gynec. Scandinav. 20:85-97, 1940. 53. (c) Cuthbertson, W. F. J.; Ridgeway, R. R., and Drummond, J. C.: The Fate of Tocopherols in the Animal Body , Biochem. J. 34:34-39, 1940. 54. Sutro, C. J.: Unpublished data. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

BASIS AND TREATMENT OF CALCIFICATION OF TENDINOCAPSULAR TISSUES, ESPECIALLY THE SUPRASPINATUS TENDON

Archives of Surgery , Volume 42 (6) – Jun 1, 1941

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American Medical Association
Copyright
Copyright © 1941 American Medical Association. All Rights Reserved.
ISSN
0004-0010
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1538-3644
DOI
10.1001/archsurg.1941.01210120100012
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Abstract

Abstract Much has been written regarding the treatment of calcification of tendinocapsular tissues, especially in the region of the supraspinatus tendon.1 Little attention, however, has been paid to the question of the cause of this abnormal deposition of calcium. Most writers support the idea that trauma is the main causative agent. We felt it difficult to accept this opinion, since our experience included several subjects presenting multiple widespread areas of calcification without any clearcut evidence of trauma (accompanying illustration). In fact, it appears that calcification of the tendinocapsular tissues may be the result of a general disorder, possibly metabolic, and that any traumatic influence present merely precipitates the onset of local symptoms.2 Along these lines we noted the interesting experiments of Goettsch and Pappenheimer, Evans and others, which showed the production of degeneration, necrosis and calcification of voluntary muscle fibers in certain animals fed a diet deficient in vitamin References 1. (a) Brickner, W. M.: Pain in the Arm: Subdeltoid (Subacromial) Bursitis; a Further Study of Its Clinical Types, Pathology and Treatment , J. A. M. A. 69:1237-1242 ( (Oct. 13) ) 1917.Crossref 2. King, J. M., Jr., and Holmes, G. W.: The Diagnosis and Treatment of Four Hundred and Fifty Painful Shoulders , J. A. M. A. 89:1956-1960 ( (Dec. 3) ) 1927.Crossref 3. (b) Resnik, J.: Physiotherapy in Subdeltoid Bursitis , Physical Therap. 47:322-329, 1929. 4. (c) Titus, N. E.: Electrical Treatment of Subdeltoid Bursitis , Am. J. Surg. 6:318-334, 1929.Crossref 5. (d) Deering, G. E.: Physical Treatment of Subacromial Bursitis , Physical Therap. 48:362-366, 1930. 6. (e) Carnett, J. B.: The Calcareous Deposits of So-Called Calcifying Subacromial Bursitis , Surg., Gynec. & Obst. 41:404-421, 1925 7. So-Called Calcifying Subacromial Bursitis , Radiology 17:505-513, 1931. 8. (f) Mumford, E. B., and Martin, J. F.: Calcified Deposits in Subdeltoid Bursitis , J. A. M. A. 97:690-694 ( (Sept. 5) ) 1931. 9. (g) Tavernier, M. L.: Les calcifications périarticulaires de l'épaule , Bull. Soc. nat. de chir. 58:956-960, 1932. 10. (h) Gwynne, F. J., and Robb, D.: Calcareous Deposits in Supraspinatus Tendon and Subacromial Bursa , Australian & New Zealand J. Surg. 4:153-164, 1934. 11. (i) Haggart, G. E., and Allen, H. A.: Painful Shoulder: Diagnosis and Treatment with Particular Reference to Subacromial Bursitis , S. Clin. North America 15:1537-1560, 1935. 12. (j) Didiée, J.: Raideurs et douleurs de l'épaule. La part de la physiothérapie dans leur traitement , Médecine 17:437-453, 1936. 13. (k) Echtman, J.: Traumatic Subdeltoid Bursitis: Treatment by Physical Medicine , New York State J. Med. 36:503-506, 1936. 14. (l) Ferguson, L. K.: Painful Shoulder Arising from Lesions of Subacromial Bursa and Supraspinatus Tendon , Ann. Surg. 105:243-256, 1937. 15. (m) Lattman, I.: Treatment of Subacromial Bursitis by Roentgen Irradiation , Am. J. Roentgenol. 36:55-60, 1937. 16. (n) Patterson, R. L., and Darrach, W.: Treatment of Acute Bursitis (Subdeltoid) by Needle Irrigation , J. Bone & Joint Surg. 19:993-1002, 1937. 17. (o) Feldman, L.: Short Wave Diathermy in Subdeltoid Bursitis , Arch. Phys. Therapy 18:411-414, 1937. 18. (p) Rubert, S. R.: Subacromial Bursitis , Arch. Surg. 37:619-641 ( (Oct.) 1938. 19. (q) Ellis, V. H.: Supraspinatus Lesions , Proc. Roy. Soc. Med. 31:451-453, 1938. 20. (r) Troedsson, B. S.: Diathermy in Calcium Deposits Around Subacromial Bursa and Supraspinatus Tendon , Arch. Phys. Therapy 19:166-172, 1938. 21. (s) Leriche, R., and Jung, A.: Traitement des calcifications sous-deltoïdiennes par l'infiltration novocaïnique , Rev. de chir., Paris 76:382-385, 1938. 22. (t) Bettman, E.: Pathology and Therapy of "Shoulder Joint Complex," Am. J. Surg. 41:201-212, 1938.Crossref 23. (u) Mustakallio, S.: Ueber die Roentgen behandlung der Periarthritis humeroscapularis , Acta radiol. 20:22-32, 1939.Crossref 24. (v) Rogers, M. H.: Treatment of Subdeltoid Bursitis , Am. J. Surg. 43:292-297, 1939.Crossref 25. (a) Codman, E. A.: Bursitis Subacromialis or Periarthritis of the Shoulder Joint , Boston M. & S. J. 154:613-620, 1906 26. The Shoulder, Boston, The Author, 1934. 27. (b) Brickner, W. B.: Prevalent Fallacies Concerning Subacromial Bursitis: Its Pathogenesis and Rational Operative Treatment , Am. J. M. Sc. 149:351-364, 1915. 28. (c) Moschowitz, E.: Histopathology of Calcification of the Spinatus Tendons as Associated with Subacromial Bursitis , Am. J. M. Sc. 150:115-126, 1915. 29. (d) Harbin, M.: Deposition of Calcium Salts in the Tendon of the Supraspinatus Muscle , Arch. Surg. 18:1491-1512 ( (June) ) 1929. 30. (e) Jung, A., and Brunschwig, A.: Calcification de labourse séreuse sous-acromiale et métabolisme calcique local , Rev. de chir., Paris 50:611-616, 1931. 31. (f) Elmslie, R. C.: Calcareous Deposits in the Supraspinatus Tendon , Brit. J. Surg. 20:190-196, 1932. 32. (g) Leriche, R., and Jung, A.: Les calcifications sous-deltoïdiennes de l'épaule , Rev. d'orthop. 20:289-299, 1933. 33. (h) Polichetti, E.: Contributo alla ezio pathogenesi e localizzazione della periartrite calcarea scapolo-omerale , Arch. di ortop. 49:195-210, 1933. 34. (i) Ferguson, L. K.: Shoulder Pain and Disability Due to Lesions of the Subdeltoid Bursa and Supraspinatus Tendon , Internat. Abstr. Surg. 66:472-487, 1938 35. in Surg., Gynec. & Obst. , (May) 1938. 36. (a) Goettsch, M., and Pappenheimer, A. M.: Nutritional Muscular Dystrophy in the Guinea Pig and Rabbit , J. Exper. Med. 54:145-166, 1931. 37. (b) Pappenheimer, A. M.: The Pathology of Nutritional Muscular Dystrophy in Young Rats , Am. J. Path. 15:179-183, 1939 38. Certain Nutritional Disorders of Laboratory Animals Due to Vitamin E Deficiency , J. Mt. Sinai Hosp. 7:65-76, 1940. 39. (c) Morgulis, S., and Spencer, H. C.: A Study of the Dietary Factors Concerned in Nutritional Muscular Dystrophy , J. Nutrition 11:573-592, 1936. 40. (d) Evans, H. M.; Emerson, G. A., and Telford, I. R.: Degeneration of Cross-Striated Musculature in Vitamin E Low Rats , Proc. Soc. Exper. Biol. & Med. 38:625-627, 1938. 41. (e) Evans, H. M.: New Light on the Biological Role of Vitamin E , J. Mt. Sinai Hosp. 6:233-244, 1940. 42. (f) Einarson, L., and Ringsted, A.: Effect of Chronic Vitamin E Deficiency on the Nervous System and the Skeletal Musculature in Adult Rats , London, Oxford University Press, 1938. 43. (g) Knowlton, G. C., and Hines, H. M.: Effect of Vitamin E Deficient Diet upon Skeletal Muscle , Proc. Soc. Exper. Biol. & Med. 38:665-667, 1938. 44. (h) Chor, H., and Dolkart, R. E.: Experimental Muscular Dystrophy in the Guinea Pig , Arch. Path. 27:497-509 ( (March) ) 1939. 45. (i) Telford, I. R.; Emerson, G. A., and Evans, H. M.: Histologic Changes in Skeletal Musculature of Paralyzed Suckling Young of E-Low Rats , Proc. Soc. Exper. Biol. & Med. 41:291-295, 1939. 46. (i) Knowlton, G. C.; Hines, H. M., and Brinkhous, K. M.: Cure and Prevention of Vitamin E Deficient Muscular Dystrophy with Synthetic A-Tocopherol Acetate , Proc. Soc. Exper. Biol. & Med. 42:804-809, 1939. 47. Telford, I. R. Emerson, G. A., and Evans, H. M.: Microscopic Lesions Without Functional Impairment of Striated Musculature of Suckling E-Low Rats , Proc. Soc. Exper. Biol. & Med. 45:135-136, 1940. 48. (a) Knowlton, G. C.; Hines, H. M., and Brinkhous, K. M.: Effect of Wheat-Germ Oil upon E-Deficient Muscular Dystrophy , Proc. Soc. Exper. Biol: & Med. 41:453-456, 1939. 49. (b) Mackenzie, C. G., and McCollum, E. V.: The Care of Nutritional Muscular Dystrophy in the Rabbit by Alpha-Tocopherol and Its Effect on Creatine Metabolism , J. Nutrition 19:345-361, 1940. 50. (c) Krakower, C., and Axtmayer, J. H.: Effect of Alpha-Tocopherol on Lesions of Skeletal Muscles in Rats on Vitamin A-Deficient Diets , Proc. Soc. Exper. Biol. & Med. 45:583-586. 1940. 51. (a) Vitamin E.: A Symposium , Society of Chemical Industry, Cambridge, England, W. Heffer & Sons, 1939. 52. (b) Vogt-Møller, P.: The Therapeutic Application of Vitamin E in Human Clinical Medicine , Acta obst. et gynec. Scandinav. 20:85-97, 1940. 53. (c) Cuthbertson, W. F. J.; Ridgeway, R. R., and Drummond, J. C.: The Fate of Tocopherols in the Animal Body , Biochem. J. 34:34-39, 1940. 54. Sutro, C. J.: Unpublished data.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jun 1, 1941

References