Treatment of conservative therapy resistant calcifying tendinitis of the shoulder: Evaluation of minimal invasive and surgical treatment options

This PhD-thesis is written based on several studies with a clinical character. Each individual studie is based on a clinical research questions in an attempt to optimize the treatment of patients with therapy resistant calcifying tendinitis of the shoulder. To this end several studies were executed en different therapies were evaluated. Up till now there is some discussion on what is the optimal care for patients in which the initial conservative treatment fail. Historically a surgical treatment was chosen. But what kind of surgical treatment? In this thesis the studies show that when a surgical treatment is chosen that the calcific deposits need to be debrided and only to perform an additional subacromial decompression when signs of subacromial impingement are present. However, in the majority a surgical treatment can be avoided by choosing a minimal invasive treatment for patients with therapy resistant calcifying tendinitis of the shoulder. Available options for this are needle aspiration of the calcific deposits (NACD) and shockwave therapy (ESWT). This thesis shows that both treatment modalities are safe and reduce the need for surgical treatment. Al the aforementioned statement led to the following updated treatment algorithm.