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Arthroscopic Calcium Deposit Removal

51 citationsUpdated Oct 2026
Illustration: shoulder

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Overview

Arthroscopic removal of calcific deposits in the shoulder provides good to excellent clinical results, significantly reducing pain and improving shoulder function and patient satisfaction [1, 20, 25, 26]. This procedure is indicated for patients with chronic calcific tendinitis, including those with osseous involvement, where it serves as a safe and effective treatment method comparable to cases with tendinous involvement only [16]. While most patients undergoing surgical management require a concomitant rotator cuff repair, arthroscopic removal without repairing the rotator cuff defect also results in significant improvement in function and pain levels, regardless of the deposit's location, size, type, or whether complete excision is achieved [4, 10].

Postoperative outcomes correlate strongly with the extent of calcium deposit resection; patients with postoperative elimination or reduction of deposits have significantly better outcomes than those with no radiographic change [2, 3, 17]. Consequently, complete removal is recommended, although this remains technically difficult [14]. Clinical improvements become statistically significant after at least six months of follow-up [5]. Recovery time and functional recovery do not correlate with calcium deposit size, tendon infiltration, or involvement of multiple tendons [6].

Preoperative ultrasound-guided marking of calcific deposits statistically significantly improves clinical results at six weeks and two years [11], and intra-operative ultrasound may facilitate curettage by visualizing the deposit without ionizing radiation [13]. Routine exploration of the gleno-humeral joint is not advisable as it significantly increases the risk of adhesive capsulitis without identifying sufficient lesions for therapeutic intervention [12]. The addition of subacromial decompression does not influence short-term functional outcomes [9], and repair with or without suture anchor after complete removal provides comparable results to minimal removal techniques [8]. However, patients treated with debridement and concomitant subacromial decompression require a longer time to return to unrestricted activity without pain [7]. Arthroscopic removal and tendon repair without acromioplasty yields excellent functional outcomes with 93% patient satisfaction [15].

Anatomy & Pathophysiology

Bony Anatomy

The proximal humerus comprises the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft [47]. The greater tuberosity serves as the attachment site for the supraspinatus, infraspinatus, and teres minor tendons of the rotator cuff [47], while the lesser tuberosity serves as the attachment site for the subscapularis tendon [47]. The glenoid is a convex structure of shallow depth shaped like an inverted pear that articulates with the humeral head [47]. This glenoid cavity is a shallow socket, approximately one third the size of the humeral head [48]. The subchondral bone of the glenoid is relatively flat, with articular concavity augmented by cartilage and a circumferential labrum [50].

The acromion, coracoacromial ligament, and coracoid process form the coracoacromial arch, a rigid bony-ligamentous structure that imparts stability to the shoulder girdle [47]. The rotator cuff, subacromial bursa, and subdeltoid bursa pass underneath this arch [47].

Humeral Head Morphometry: The humeral head averages 19° of retroversion and 41° of inclination (neck-shaft angle) [50]. Alternatively, the humeral head is retroverted an average of 30 degrees [48], and the neck-shaft angle measures an average of 135 degrees [48].

Glenoid Morphometry: The glenoid averages 5° of retroversion in relation to the axis of the scapular body [50].

Soft Tissue Anatomy

The rotator cuff consists of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles [48]. These muscles serve as depressors of the humeral head to allow the deltoid to efficiently abduct the humerus [48]. Specifically, the infraspinatus and teres minor are external rotators, while the subscapularis is an internal rotator of the humerus [48]. The rotator cuff is a sheet of conjoined tendons closely applied over the shoulder capsule and inserting mainly into the greater tuberosity of the humerus, with the subscapularis inserted into the lesser tuberosity [55]. It has an important function in stabilizing the head of the humerus by pulling it firmly into the glenoid whenever the deltoid lifts the arm forwards or sideways [55].

The subacromial bursa separates the rotator cuff tendons from the coracoacromial arch and allows them to glide [55]. The subscapular bursa lies between the subscapularis tendon and the neck of the scapula and communicates with the joint cavity between the superior and middle glenohumeral ligaments [51]. This bursa protects the tendon of the subscapularis at the point where it passes under the base of the coracoid process and over the neck of the scapula [51].

The rotator interval is defined medially by the base of the coracoid, superiorly by the supraspinatus tendon, and inferiorly by the subscapularis tendon [50]. It contains the coracohumeral ligament, the superior glenohumeral ligament, and the intra-articular portion of the long head of the biceps tendon [50].

Tendon Convergence: The tendons of the infraspinatus and supraspinatus muscles join approximately 15 mm proximal to their insertion and cannot be readily separated by blunt dissection [60]. The supraspinatus and subscapularis tendons join as a sheath that surrounds the biceps tendon at the entrance of the bicipital groove [60]. The coracohumeral ligament is a thick band of fibrous tissue extending from the coracoid process along the surface of the capsule to the tuberosities between the supraspinatus and subscapularis tendons [60].

Vascular Supply

The proximal humerus receives its blood supply from the anterior and posterior humeral circumflex branches from the third division of the axillary artery [47]. The anterior humeral circumflex artery provides vascular inflow to the humeral head by way of its terminal anterolateral branch known as the artery of Laing (also known as the arcuate artery) [47]. The ascending branch of the anterior humeral circumflex artery courses parallel to the lateral aspect of the long head biceps tendon and enters the humeral head at the interface of the bicipital groove and greater tuberosity [47]. The anterolateral ascending branch of the anterior humeral circumflex artery provides the primary blood supply to the humeral head [50]. The major blood supply to the humeral head is through the ascending branch of the anterior humeral circumflex artery, which penetrates the head at the bicipital groove and becomes the arcuate artery [48].

Pathophysiology

Stability and function of the glenohumeral joint are provided by the interaction of structures that promote a near global range of motion and purposeful function [47]. External loads transferred to the shoulder girdle are initially offset by joint surface anatomy, joint volume, atmospheric pressure, and joint fluid cohesion and adhesion [47]. Moderate and large loads are counterbalanced by the deltoid and rotator cuff and by the capsulolabral and bone structures, respectively [47]. Pathological humeral fractures alter complex interactions of the shoulder girdle, resulting in pain, decreased range of motion and stiffness, and disability [47].

The glenohumeral joint depends on static and dynamic stabilizers for movement and stability, especially the rotator cuff [59]. The rotator cuff stabilizes the glenohumeral joint while allowing greater freedom of motion and fixes the fulcrum of the upper extremity against which the deltoid can contract and elevate the humerus [59]. The rotator cuff must act simultaneously and synergistically with the deltoid muscle for normal function [59].

The glenohumeral joint has a "large ball–small socket" bony arrangement where the large humeral head articulates against and not within the small glenoid cavity [60]. The bony anatomy of the shoulder contributes little to stability and has been compared with a golf ball on a tee [60]. Most stability of the shoulder is provided by surrounding muscles and ligaments due to very little bony constraint [60]. The glenoid labrum increases the depth of the socket by 50% around the humeral head and increases stability [60].

The rotator cuff stabilizes the joint via joint compression [50]. Static stabilizers of the glenohumeral joint include articular congruity, the glenoid labrum, concavity-compression, negative intra-articular pressure, and the glenohumeral capsule and ligaments [50]. The glenoid labrum provides concavity and up to 50% of marginal glenoid socket depth [50]. Laxity of the rotator interval results in inferior laxity (the sulcus sign), and contracture of the interval is seen with adhesive capsulitis [50]. The coracoacromial ligament contributes to anterosuperior stability in rotator cuff deficiency and should be preserved with irreparable cuff tears to prevent anterosuperior escape [61].

Supraspinatus impingement and tendinitis, tears of the rotator cuff, acute calcific tendinitis, and biceps tendinitis and/or rupture comprise the rotator cuff syndrome [55]. In rotator cuff syndrome, pain is located over the front and lateral aspect of the shoulder with weakness on abduction for supraspinatus involvement, tears of the cuff and tendinitis, and over the front for biceps pathology [55].

Classification

Type I: Arthroscopic debridement is associated with superior functional improvement compared to ultrasound-guided percutaneous aspiration and lavage (US PAL) for Type I calcifications [32].

Clinical Presentation

The clinical course of calcific tendinitis is characterized by a variable timeline of pain relief following arthroscopic intervention. While only 15% of patients experience a sudden and nearly complete reduction of pain within the first three months [18], the majority undergo slow but continuous pain relief over 12 months [18]. Significant improvement in all clinical scores is observed from three months post-surgery [18], with recovery of shoulder function and pain relief lasting for six months [18]. Functional scores, including UCLA and ASES, improve slowly and reach more than 75 percent at six months after surgery [18]. Long-term outcomes are satisfactory clinically and radiologically at final follow-up [18]. However, ultrasonographic changes of the supraspinatus tendon remain visible in more than half of patients two years after surgery [19].

Prognostic factors significantly influence clinical outcomes. Rotator cuff repair and subacromial decompression serve as poor prognostic factors following arthroscopic treatment [18]. Conversely, outcome seems to correlate strongly only with the presence of residual calcium deposits in the tendon [2]. In athletes with calcifying tendinitis of the supraspinatus tendon who have failed nonoperative treatment, complete arthroscopic removal of calcific deposits and tendon repair without acromioplasty results in significant pain relief and improvement in functional outcomes [22]. Surgery shortens the painful period and may reduce the number of future rotator cuff ruptures [24].

Intraoperative considerations impact the efficiency and safety of deposit removal. Localization of the calcification via a marking suture after preoperative sonography enables fast and efficient removal of the deposit [23]. Evacuation of calcification was significantly better with ultrasound monitoring [34]. Arthroscopic CD removal, preserving the integrity of the rotator cuff, yielded good to excellent results in 90% of patients and avoided iatrogenic tendon defects in all cases [42]. Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement [44].

Glenohumeral co-pathologies in CTS are rare and most commonly do not require surgical treatment [28]. Routine diagnostic glenohumeral exploration does not appear mandatory in arthroscopic treatment of CTS [28]. Exploration of the glenohumeral joint in arthroscopic removal of CD should only be performed when relevant intraarticular injuries with therapeutic relevance are highly expected [28].

Investigations

Preoperative Imaging and Localization

Ultrasonography: Ultrasonography serves as a simple and accurate diagnostic tool for identifying rotator cuff tears and calcific tendinitis [64]. It provides immediate, real-time visualization of the rotator cuff, biceps tendon, and calcific deposits [71]. Preoperative ultrasound-guided marking of calcific deposits statistically significantly improves clinical results of arthroscopic surgery at 6 weeks and 2 years [11]. Localization of calcification via a marking suture after preoperative sonography enables fast and efficient removal of the deposit [23].

Wire Localization: Ultrasound-guided placement of a breast-lesion localization wire can aid with arthroscopic identification of calcific tendonitis lesions [81]. Perioperative ultrasound-guided wire marking is especially useful for challenging calcifications of the subscapularis or infraspinatus tendon and can greatly simplify the procedure [33].

Plain Radiography: Plain radiographs can be used to observe calcific tendinitis [71].

Intraoperative Imaging

Ultrasonography: Intraoperative ultrasound facilitates the localization of the calcific deposit during arthroscopic treatment without using ionizing radiation [13]. The intraoperative use of ultrasound significantly facilitates the arthroscopic debridement of calcific rotator cuff tendinitis [21].

Postoperative Imaging and Outcome Correlation

Residual Deposits: Outcome correlates strongly with the presence of residual calcium deposits in the tendon, and complete removal is recommended [2]. Postoperative outcome is only correlated with the extent of calcium deposit resection [17].

Treatment

Non-Operative

Patients who did not attempt conservative management experienced the greatest improvements following surgery, although excellent outcomes can be expected with surgery regardless of prior treatment [45].

Operative

Indications: All three available surgical treatment options demonstrate good functional and clinical outcomes in the short and midterm [31]. Patients achieve good to excellent clinical outcomes after high-energy ESWT, US-guided needling, and arthroscopy for calcific tendinopathy of the shoulder [40].

Surgical Approach / Technique: All surgical interventions provide substantial improvement in shoulder functions and pain control scores with no significant difference between these techniques [37]. For Type I calcifications, arthroscopic debridement is associated with superior functional improvement [32]. Intraosseous calcific tendinitis of the rotator cuff yields similar outcomes to intratendinous lesions despite worse preoperative scores [44].

Recovery Timeline: Patients show significant improvement in all clinical scores from 3 months after surgery, but recovery of shoulder function and pain relief lasts for six months [18]. All patient groups demonstrate significant pain relief and an improvement in shoulder function 6 months after surgery [30].

Other Considerations: Concomitant Procedures: The addition of a bioinductive implant for arthroscopic treatment of calcific tendinopathy defects may improve postoperative outcomes [43].

Intraoperative Considerations: Failure to accurately localize the calcific deposit within the tendon can lead to iatrogenic rotator cuff damage remote from the true location of the calcific defect [41]. Overzealous debridement of the rotator cuff tendon adjacent to the calcific deposit can result in an unnecessarily large defect that may be challenging to repair [41].

Complications

Stiffness / Arthrofibrosis: Routine exploration of the gleno-humeral joint during arthroscopic removal of rotator cuff calcifications significantly increases the risk of adhesive capsulitis [12]. This increased risk occurs despite the fact that such routine exploration does not identify a sufficient number of lesions requiring a therapeutic procedure [12].

Other Considerations: Rotator cuff repair was a poor prognostic factor of clinical outcomes after arthroscopic treatment for calcific tendinitis [18]. Subacromial decompression was also a poor prognostic factor of clinical outcomes after arthroscopic treatment for calcific tendinitis [18].

Recovery

Functional Outcomes and Satisfaction: Arthroscopic removal of calcification leads to improved clinical outcomes in patients with chronic calcific tendinitis [5]. Surgical treatment of calcific tendinitis gives good results in 88.5% of patients resistant to medical treatment [82].

Recovery Timeline and Trajectory: Patients significantly improved in all clinical scores from 3 months after surgery [18]. ASES scores and Constant scores significantly improved from the 3-month follow-up through to the final follow-up in all patients [18]. The average score reached 80 points at six months [18]. 100% of active patients returned to work between three and six months after surgery [18]. At least 6 months of follow-up is needed for improvements in clinical outcomes to become statistically significant [5].

Prognostic Factors and Residual Disease: Complete removal is recommended [2].

Key Evidence

  • [L3] Arthroscopic removal of calcific deposits of the shoulder shows good clinical results for pain reduction, shoulder function and patient satisfaction. [1] (10.1007/s00167-008-0507-0)
  • [L4] Outcome seems to correlate strongly only with the presence of residual calcium deposits in the tendon; complete removal is recommended. [2] (10.1016/j.jse.2004.04.001)
  • [L4] Patients with postoperative elimination or reduction of the calcific deposits had significantly better outcomes than those who had no radiographic change. [3] (10.1016/s1058-2746(98)90180-x)
  • [L3] Most patients who undergo surgical management for removal of the calcific deposit required a concomitant RTC repair and had significant improvements in shoulder pain and function. [4] (10.1016/j.jseint.2021.01.013)
  • [L4] Arthroscopic removal of calcification leads to improved clinical outcomes in patients with chronic calcific tendinitis, but at least 6 months of follow-up is needed for these improvements to become statistically significant. [5] (10.5397/cise.2018.21.2.75)
  • [L3] Calcium deposit size, tendon infiltration by calcium deposits, and involvement of multiple tendons did not correlate with recovery time or the recovery of function. [6] (10.1177/03635465231217733)
  • [L3] Patients treated by debridement of the calcific deposit and concomitant subacromial decompression required a longer time to return to unrestricted activity without pain. [7] (10.1016/j.jse.2010.10.038)
  • [L4] Repair with or without suture anchor after complete removal of calcific material provides comparable clinical results to previous literature with minimal removal technique. [8] (10.1007/s00167-010-1067-7)
  • [L1] This study has demonstrated that the short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression. [9] (10.1016/j.arthro.2015.05.015)
  • [L3] Arthroscopic removal of calcific deposits without repairing the rotator cuff defect resulted in significant improvement in function and pain level, regardless of the deposit's location, size, type, and whether or not complete excision was achieved. [10] (10.1302/0301-620x.105b6.bjj-2022-1137.r1)
  • [L3] Preoperative ultrasound-guided marking of calcific deposits is a procedure that statistically significantly improves the clinical results of arthroscopic surgery as seen at 6 weeks and 2 years. [11] (10.1016/j.arthro.2006.08.005)
  • [L3] Routine exploration of the gleno-humeral joint during arthroscopic removal of rotator cuff calcifications is not advisable as it significantly increases the risk of adhesive capsulitis without identifying a sufficient number of lesions requiring a therapeutic procedure. [12] (10.1016/j.otsr.2021.102915)
  • [L4] This new technique may alleviate arthroscopic calcific deposit curettage by visualizing the deposit without using ionizing radiation. [13] (10.1007/s00167-010-1227-9)
  • [L4] The complete removal of the calcification is difficult. [14] (10.1016/s1058-2746(95)80103-0)
  • [L4] Arthroscopic removal of calcific deposits and tendon repair without acromioplasty yielded excellent functional outcomes with high (93%) levels of patient satisfaction with the procedure. [15] (10.1177/2325967115577957)
  • [L4] Arthroscopic removal of intraosseous and intratendinous deposits to treat calcifying tendinitis with osseous involvement seems to be as safe and effective a treatment method as the arthroscopic removal of intratendinous deposits in cases of tendinous involvement only. [16] (10.1016/j.arthro.2008.12.024)
  • [L4] In our study the postoperative outcome is only correlated with the extent of calcium deposit resection. [17] (10.1016/s1058-2746(96)80313-2)
  • [L4] [18] (10.1016/j.otsr.2020.03.005)
  • [L4] Ultrasonographic changes of the supraspinatus tendon are still visible in more than half of the patients 2 years after surgery. [19] (10.1016/j.arthro.2006.01.012)
  • [L1] Arthroscopic treatment of calcifying tendinitis provides good results. [20] (10.1016/s1058-2746(95)80074-3)
  • [L1] [21] (10.1007/s00402-014-1927-6)
  • [L4] In athletes with calcifying tendinitis of the supraspinatus tendon with failed nonoperative treatment, complete arthroscopic removal of calcific deposits and tendon repair without acromioplasty results in significant pain relief and improvement in functional outcomes. [22] (10.1177/2325967116669310)
  • [L4] Localization of the calcification via a marking suture after preoperative sonography enables fast and efficient removal of the deposit. [23] (10.1016/j.jse.2006.06.012)
  • [L3] Surgery shortens the painful period and may reduce the number of future rotator cuff ruptures. [24] (10.1007/s004020000195)
  • [L3] Arthroscopic treatment of calcifying tendinitis provides good to excellent clinical results. [25] (10.1177/03635465211037690)
  • [Paper] Arthroscopic debridement of calcific tendonitis can yield excellent functional results and high patient satisfaction. [26] (10.1016/j.eats.2013.11.003)
  • [L3] [28] (10.1186/s12891-017-1839-z)
  • [L2] All patient groups showed significant pain relief and an improvement in shoulder function 6 months after surgery. [30] (10.1186/s13018-022-03373-1)
  • [L1] All three available surgical treatment options show good functional and clinical outcomes in the short and midterm. [31] (10.5312/wjo.v8.i5.424)
  • [L3] For Type I calcifications, AD was associated with superior functional improvement. [32] (10.1016/j.jse.2026.07.029)
  • [L4] The method is especially useful for challenging calcifications of the subscapularis or infraspinatus tendon and can greatly simplify the procedure. [33] (10.1007/s00402-010-1186-0)
  • [L3] Evacuation of calcification was significantly better with ultrasound monitoring. [34] (10.1016/j.jseint.2024.06.001)
  • [L1] All surgical interventions provide substantial improvement in shoulder functions and pain control scores with no significant difference between these surgical techniques. [37] (10.1016/j.xrrt.2024.03.013)
  • [L4] Patients can achieve good to excellent clinical outcomes after high-energy ESWT, US-guided needling, and arthroscopy for calcific tendinopathy of the shoulder. [40] (10.1016/j.arthro.2015.06.049)
  • [Paper] [41] (10.1016/j.eats.2019.05.018)
  • [L4] Arthroscopic CD removal, preserving the integrity of the rotator cuff, yielded good to excellent results in 90% of patients and avoided iatrogenic tendon defects in all cases. [42] (10.1016/j.arthro.2013.01.031)
  • [Paper] The addition of a bioinductive implant for arthroscopic treatment of calcific tendinopathy defects may improve postoperative outcomes. [43] (10.1016/j.eats.2016.08.013)
  • [L3] Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement. [44] (10.1007/s00167-022-06870-2)
  • [L3] Patients who did not attempt conservative management experienced the greatest improvements following surgery, but excellent outcomes can be expected with surgery regardless of prior treatment. [45] (10.1177/2325967121s00210)
  • [L4] Ultrasound-guided placement of a breast-lesion localization wire can aid with arthroscopic identification of calcific tendonitis lesions. [81] (10.1097/bte.0b013e31824f6192)
  • [L4] Surgical treatment of calcific tendinitis gives good results in 88.5% of patients resistant to medical treatment. [82] (10.1007/s100670050108)

See Also

References

[1] Influence of deposit stage and failed ESWT on the surgical results of arthroscopic treatment of calcifying tendonitis of the shoulder. Knee Surgery, Sports Traumatology, Arthroscopy. 2008. DOI: 10.1007/s00167-008-0507-0

[2] Arthroscopic treatment of calcifying tendinitis of the shoulder: Clinical and ultrasonographic follow-up findings at two to five years. Journal of Shoulder and Elbow Surgery. 2004. DOI: 10.1016/j.jse.2004.04.001

[3] Arthroscopic treatment of calcific tendinitis of the shoulder. Journal of Shoulder and Elbow Surgery. 1998. DOI: 10.1016/s1058-2746(98)90180-x

[4] Predictive factors for failure of conservative management in the treatment of calcific tendinitis of the shoulder. JSES International. 2021. DOI: 10.1016/j.jseint.2021.01.013

[5] Functional Recovery of the Shoulder after Arthroscopic Treatment for Chronic Calcific Tendinitis. Clinics in Shoulder and Elbow. 2018. DOI: 10.5397/cise.2018.21.2.75

[6] Arthroscopic Surgery Versus Nonoperative Treatment for Calcific Tendinitis of the Shoulder: A Retrospective Cohort Study. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465231217733

[7] Calcific tendonitis of the shoulder: is subacromial decompression in combination with removal of the calcific deposit beneficial?. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.10.038

[8] Arthroscopic treatment of chronic calcific tendinitis with complete removal and rotator cuff tendon repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1067-7

[9] Short‐Term Outcome After Arthroscopic Bursectomy Debridement of Rotator Cuff Calcific Tendonopathy With and Without Subacromial Decompression: A Prospective Randomized Controlled Trial. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.05.015

[10] Arthroscopic decompression of calcific tendinitis without cuff repair. The Bone & Joint Journal. 2023. DOI: 10.1302/0301-620x.105b6.bjj-2022-1137.r1

[11] Value of Preoperative Ultrasound Marking of Calcium Deposits in Patients Who Require Surgical Treatment of Calcific Tendinitis of the Shoulder. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.08.005

[12] Is routine gleno-humeral exploration a risk factor for adhesive capsulitis after arthroscopic removal of rotator cuff calcifications? A comparative retrospective study in 340 cases. Orthopaedics & Traumatology: Surgery & Research. 2021. DOI: 10.1016/j.otsr.2021.102915

[13] Intra‐operative ultrasound facilitates the localization of the calcific deposit during arthroscopic treatment of calcifying tendinitis. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1227-9

[14] Arthrosoopic treatment of the calcifying tendinitis of the rotator cuff. Journal of Shoulder and Elbow Surgery. 1995. DOI: 10.1016/s1058-2746(95)80103-0

[15] Arthroscopic Removal and Rotator Cuff Repair Without Acromioplasty for the Treatment of Symptomatic Calcifying Tendinitis of the Supraspinatus Tendon. Orthopaedic Journal of Sports Medicine. 2015. DOI: 10.1177/2325967115577957

[16] Arthroscopic Removal of Intraosseous and Intratendinous Deposits in Calcifying Tendinitis of the Rotator Cuff. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2008.12.024

[17] Operative treatment of calcifying tendinitis with endoscopic subacromial decompression (ESD). Journal of Shoulder and Elbow Surgery. 1996. DOI: 10.1016/s1058-2746(96)80313-2

[18] Recovery pattern after arthroscopic treatment for calcific tendinitis of the shoulder. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2020.03.005

[19] Arthroscopic Treatment of Chronically Painful Calcifying Tendinitis of the Supraspinatus Tendon. Arthroscopy. 2006. DOI: 10.1016/j.arthro.2006.01.012

[20] Arthroscopic treatment of calcifying tendinitis: Is acromioplasty usefull?. Journal of Shoulder and Elbow Surgery. 1995. DOI: 10.1016/s1058-2746(95)80074-3

[21] The intraoperative use of ultrasound facilitates significantly the arthroscopic debridement of calcific rotator cuff tendinitis. Archives of Orthopaedic and Trauma Surgery. 2014. DOI: 10.1007/s00402-014-1927-6

[22] Return to Sports After Arthroscopic Treatment of Rotator Cuff Calcifications in Athletes. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116669310

[23] Intraoperative localization of calcification in the supraspinatus via a percutaneous marking suture after preoperative ultrasound. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.06.012

[24] Surgical or conservative treatment for chronic rotator cuff calcifying tendinitis - a matched-pair analysis of 100 patients. Archives of Orthopaedic and Trauma Surgery. 2000. DOI: 10.1007/s004020000195

[25] Clinical and Structural Results of Rotator Cuff Repair Compared With Rotator Cuff Debridement in Arthroscopic Treatment of Calcifying Tendinitis of the Shoulder. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211037690

[26] Arthroscopic Treatment of Calcific Tendonitis. Arthroscopy Techniques. 2014. DOI: 10.1016/j.eats.2013.11.003

[28] Examination of concomitant glenohumeral pathologies in patients treated arthroscopically for calcific tendinitis of the shoulder and implications for routine diagnostic joint exploration. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1839-z

[30] Comparison of clinical and radiological outcomes after three different surgical treatments for resistant calcifying tendinitis of the shoulder: a short-term randomized controlled trial. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03373-1

[31] Surgery for calcifying tendinitis of the shoulder: A systematic review. World Journal of Orthopedics. 2017. DOI: 10.5312/wjo.v8.i5.424

[32] Gärtner Type and Outcomes After US PAL Versus Arthroscopic Debridement for Calcific Tendinitis: A Retrospective Cohort Study. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.07.029

[33] Perioperative ultrasound-guided wire marking of calcific deposits in calcifying tendinitis of the rotator cuff. Archives of Orthopaedic and Trauma Surgery. 2010. DOI: 10.1007/s00402-010-1186-0

[34] Could intraoperative ultrasound improve clinical and radiological outcomes during arthroscopic calcification evacuation of rotator cuff?. JSES International. 2024. DOI: 10.1016/j.jseint.2024.06.001

[37] Surgical approaches of shoulder calcific tendonitis: a systematic review and meta-analysis. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2024.03.013

[40] The Effectiveness of High‐Energy Extracorporeal Shockwave Therapy Versus Ultrasound‐Guided Needling Versus Arthroscopic Surgery in the Management of Chronic Calcific Rotator Cuff Tendinopathy: A Systematic Review. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.06.049

[41] Management Strategies for Rotator Cuff Defects After Calcific Tendinitis Debridement. Arthroscopy Techniques. 2019. DOI: 10.1016/j.eats.2019.05.018

[42] Rotator Cuff Preservation in Arthroscopic Treatment of Calcific Tendinitis. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.01.031

[43] Management of Rotator Cuff Defects After Calcific Tendinopathy Debridement Using a Bioinductive Collagen Implant. Arthroscopy Techniques. 2016. DOI: 10.1016/j.eats.2016.08.013

[44] Intraosseous calcific tendinitis of the rotator cuff yields similar outcomes to those of intratendinous lesions despite worse preoperative scores. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-06870-2

[45] Relative Efficacy of Three of Nonsurgical Treatments for Calcific Tendinitis: Physical Therapy vs Steroid Injection vs Ultrasound-Guided Aspiration. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00210

[47] Rockwood And Matsen S The Shoulder. Shoulder and Elbow Specialty Clinic Workers’ Survey > ANATOMY.

[48] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 2Musculoskeletal Trauma Surgery > SHOULDER AND ARM INJURIES.

[50] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Shoulder, Arm, and Elbow > I. Shoulder.

[51] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Bursae.

[55] Apley And Solomon S Concise System Of Orthopaedics And Trauma. DISORDERS OF THE ROTATOR CUFF.

[59] Campbell S Operative Orthopaedics 4 Volume Set. RECONSTRUCTIVE PROCEDURES OF THE SHOULDER AND ELBOW IN ADULTS > ANATOMY AND BIOMECHANICS.

[60] Campbell S Operative Orthopaedics 4 Volume Set. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH BONE-PATELLAR TENDON-BONE GRAFT > SHOULDER INJURIES > ANATOMY AND BIOMECHANICS.

[61] Miller S Review Of Orthopaedics. Genetics of musculoskeletal conditions and abnormalities are summarized in Table 1.27 > UPPER EXTREMITY > SHOULDER.

[64] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INVESTIGATION.

[71] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Shoulder Anatomy and Biomechanics, Clinical Evaluation, Imaging > Clinical Evaluation > Imaging.

[81] Ultrasound-guided Placement of a Localization Wire For Arthroscopic Treatment of Calcific Tendonitis. Techniques in Shoulder & Elbow Surgery. 2012. DOI: 10.1097/bte.0b013e31824f6192

[82] Surgical Management of Calcific Tendinitis of the Shoulder: An Analysis of 26 Cases. Clinical Rheumatology. 1999. DOI: 10.1007/s100670050108

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