Calcific Tendonitis of the Shoulder

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

 

• Calcific tendinitis of the shoulder refers to calcium deposits in the supraspinatus tendon. It occurs mostly in adults, predominantly females, during the 4th decade of life. It’s also common in diabetic and hypothyroid patients.
• It occurs due to deposition of calcium carbonate apatite crystals in the rotator cuff tendon. This reduces the space between the rotator cuff and acromion leading to shoulder impingement.
• It also causes chemical irritation of the rotator cuff. This causes severe pain in the shoulder which exacerbates on above 90 degree elevation of arm.
• It also decreases the range of motion of the joint. Symptoms are similar to impingement syndrome of the shoulder.

Aetiology is unknown.

Investigation:

• X ray is the gold standard investigation.
• It shows calcium deposits 1-2cm above supraspinatus insertion.
• It can either be well circumscribed, dense calcification or have fluffy/cloudy appearance with poorly defined peripheries where patient has more pain.

MRI is another investigation performed.

• It shows black signals above the supraspinatus tendon.
• MRI is not required for the diagnosis of this condition, but it’s often done to rule out other rotator cuff pathology such as rotator cuff tear.

Treatment:

• It involves conservative management and surgical management.
• Conservative management usually improves the symptoms after 6 months in about 60-70 percent patients. It involves physiotherapy to stretch and strengthen the rotator cuff, Anti-inflammatory medications and Subacromial injections.
• Surgical management is performed when conservative management fails or in larger lesions. It involves the removal of the lesion and repair of the rotator cuff tendon.