Bosworth surveyed how often calcium deposits occur in the rotator cuff tendons of supposedly normal working adults, which tendons they involve, and how they relate to subacromial bursitis.
Fluoroscopic survey of 6,061 unselected people (5,061 employees and 1,000 applicants) at the Metropolitan Life Insurance Company home office, New York, 1937 to 1939.
Methods
Design
Survey by routine fluoroscopic examination
Data source
Metropolitan Life Insurance Company employees, New York
Patients
6,061 people screened
Analysis limited to 5,061 employees reexamined annually
76.7% women, 89.4% under 40, 94.1% clerks or typists
138 employees with deposits in 202 shoulders, nearly half bilateral
Follow-up
3 years of annual examinations, 1937 to 1939
Outcomes
Prevalence of visible calcium deposits
Tendon involved
Deposit size
Symptoms while under observation
Key Findings
Calcium showed on fluoroscopy in 165 of 6,061 people (2.7%), and among the 5,061 employees deposits were relatively more frequent in men (3.6%) than in women (2.5%).
Just over half of involved shoulders had calcium in the supraspinatus, 44.5% in the infraspinatus and 23.3% in the teres minor, while only 5 shoulders had subscapularis deposits.
Of the 202 shoulders with deposits, 70 (34.6%) were painful at some point, and nocturnal discomfort was the most frequent complaint.
One third of the large deposits caused no complaints at all during the observation period.
Bosworth favored prompt excision for the acute attack on his own conviction, noting that statistics could not yet compare treatments, and reported a 4‑day average stay with return to full duty and motion in 3 weeks.
Heat treatment often set off an acute attack or worsened a mildly painful shoulder.
Board pearl
Of 13 deposits that disappeared completely during the study, the 4 that resolved without symptoms were all medium or tiny, and every large deposit caused symptoms before it disappeared.
Authors' conclusion
Medium and tiny deposits may disappear without symptoms, but large deposits always result in a painful shoulder sooner or later, though they may remain quiescent and symptomless for months or years. Excision of the deposit is recommended as the best treatment for the acute attack, since it offers immediate, certain, complete and permanent relief.
Bosworth surveyed how often calcium deposits occur in the rotator cuff tendons of supposedly normal working adults, which tendons they involve, and how they relate to subacromial bursitis.
Fluoroscopic survey of 6,061 unselected people (5,061 employees and 1,000 applicants) at the Metropolitan Life Insurance Company home office, New York, 1937 to 1939.
Methods
Design
Survey by routine fluoroscopic examination
Data source
Metropolitan Life Insurance Company employees, New York
Patients
6,061 people screened
Analysis limited to 5,061 employees reexamined annually
76.7% women, 89.4% under 40, 94.1% clerks or typists
138 employees with deposits in 202 shoulders, nearly half bilateral
Follow-up
3 years of annual examinations, 1937 to 1939
Outcomes
Prevalence of visible calcium deposits
Tendon involved
Deposit size
Symptoms while under observation
Key Findings
Calcium showed on fluoroscopy in 165 of 6,061 people (2.7%), and among the 5,061 employees deposits were relatively more frequent in men (3.6%) than in women (2.5%).
Just over half of involved shoulders had calcium in the supraspinatus, 44.5% in the infraspinatus and 23.3% in the teres minor, while only 5 shoulders had subscapularis deposits.
Of the 202 shoulders with deposits, 70 (34.6%) were painful at some point, and nocturnal discomfort was the most frequent complaint.
One third of the large deposits caused no complaints at all during the observation period.
Bosworth favored prompt excision for the acute attack on his own conviction, noting that statistics could not yet compare treatments, and reported a 4‑day average stay with return to full duty and motion in 3 weeks.
Heat treatment often set off an acute attack or worsened a mildly painful shoulder.
Board pearl
Of 13 deposits that disappeared completely during the study, the 4 that resolved without symptoms were all medium or tiny, and every large deposit caused symptoms before it disappeared.
Authors' conclusion
Medium and tiny deposits may disappear without symptoms, but large deposits always result in a painful shoulder sooner or later, though they may remain quiescent and symptomless for months or years. Excision of the deposit is recommended as the best treatment for the acute attack, since it offers immediate, certain, complete and permanent relief.