Thanks to our own extremely gentle arthroscopic surgical technique(squeeze and stir according to Ogon), the calcium in the tendon can be completely removed in most cases without unnecessarily injuring the tendon.
No prolonged immobilization of the shoulder is required, the arm can be moved immediately and the pain is usually largely gone the day after the operation.
The aim of the operation is to remove the calcium completely without damaging the tendon (cutting it open) or unnecessarily damaging the surrounding tissue.
Prior to the operation, the calcium deposit is precisely localized using the quadrant technique according to Ogon, so that only the part of the tendon and the overlying bursa that is actually affected needs to be opened.
During the operation, the tendon is carefully opened using a camera that is slightly larger than a ballpoint pen and an instrument as thin as a ballpoint pen, and the calcium is squeezed out and flushed out.(Squeeze and stir according to Ogon).
As the squeeze and stir technique is similar to a pick, the calcium is only carefully squeezed out and the muscles are rinsed afterwards, the tendon does not have to be cut open. This means that no tendon defects occur, the tendon does not need to be sutured and the shoulder is therefore pain-free and able to bear weight again much sooner.
Our arthroscopic (minimally invasive) procedure is characterized by a very gentle opening of the calcific deposit. Nothing is removed from the bone and the tendon is not sutured. Patients are usually free of pain at rest immediately after the operation, although pain during movement and at night can still be felt for a few days.
Nopost-operative bleeding or major swelling:
We can prevent post-operative bleeding by avoiding incisions on the tendon or milling on the bone and by treating the smallest of bleedings intraoperatively. This significantly reduces the tendency to swell after the operation and thus the pressure on the joint capsule.
Nodrainage:
This means we can almost always dispense with the insertion and subsequent removal of a drain.
Specialpain blockade: Intraoperatively, patients receive an injection to the nerves of the arm to block pain, so that patients do not feel any pain for up to 24 hours immediately after the operation.
Nostitches necessary:
Thanks tothe use of self-dissolving cosmetic sutures, our patients do not need to remove stitches.
From the first day after the operation, patients begin active and passive movement exercises in physiotherapy and lymphatic drainage.
The bandage is removed on the first postoperative day. A drain is generally no longer inserted due to our gentle surgical method, which means that patients no longer have to pull out the painful drain.
Showering is possible from the 4th postoperative day.
Absorbable (self-dissolving) stitches are used so that it is no longer necessary to remove the stitches. For this reason, bathing and saunas should be avoided for 10 days.
You should wait until the 6th week before starting strength exercises.
The operation itself usually takes 45 to 60 minutes and is performed under general anesthesia.
In most cases, the operation is performed on an inpatient basis, as an additional pain block is applied before the operation so that the patient usually feels no discomfort for 24 hours after the operation. On the first postoperative day, the shoulder is mobilized and the wounds are checked. The patient can usually go home on the second day after the operation.
The shoulder can be moved normally from the first postoperative day.
On average 2-3 weeks after the operation.
However, if the work is physically strenuous, you should wait until the tendon has fully healed to be on the safe side. This requires a 6-week break from work.
You should refrain from weight-bearing sports for up to 12 weeks.
Otherwise, sports that do not put too much strain on the shoulders can normally be resumed 3 weeks after the operation.
The decision to operate is mainly determined by the patient's symptoms. Even without surgery, there is no major risk to the shoulder joint.
The calcification only causes discomfort, but does not lead to damage to the tendon or premature osteoarthritis. In rare cases, pain can lead to frozen shoulder.
Once the calcium has been removed, calcification in this tendon area does not actually recur.
As this arthroscopic (minimally invasive) operation uses a lot of fluid for irrigation, infection practically never occurs. Should this occur, an antibiotic would have to be administered.
There is normally no risk of major injury to the tendon, bone or nerves.
- Conservative therapy alone to treat pain with tablets or local infiltrations
- If movement is restricted, cautious physiotherapy twice a week for 3-6 weeks
Conservative therapy aims to restore normal mobility of the shoulder joint with as little pain as possible. Physiotherapy, medication and infiltrations can be used for this purpose. Of course, this cannot remove the calcium. In some cases (approx. 30%), however, a calcification will resolve spontaneously within a year. Otherwise, conservative therapy may only be able to achieve not only a reduction in symptoms but also the complete dissolution of the calcification by means of shock wave treatment.
However, the often very agonizing pain at rest and at night can in most cases be quickly eliminated by targeted conservative therapy, even without surgery. However, there is always a risk of pain recurring, as the calcification remains in the shoulder area.
Conservative therapy with shockwave treatment once a week, 3-6 appointments are usually required.
Shock wave therapy can be used to improve blood circulation, reduce pain and improve mobility. In many cases, it is also possible to completely dissolve calcium deposits (this can be determined by ultrasound examinations and x-rays).
Most patients notice a significant reduction in pain after the 1st or 2nd shock wave therapy. Mobility also improves noticeably after just 1-2 applications. The symptoms of all calcium deposits can actually be significantly reduced and improved after 5-6 applications. A dissolution or at least a significant reduction in the size of the calcium deposit can also be achieved in many cases. This naturally also leads to a reduction in the swelling in the area of the tendon and therefore also to a reduction in the symptoms under the acromion.
Surgery can then still be performed if the symptoms persist. Prior shock wave treatment does not worsen the chances of success of the operation.
Acupuncture can be used very well as supportive pain therapy and to reduce the tendency to swell in osteoarthritis.
1x - 2x per week for 10 weeks
