Calcific tendinitis

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Background

  • Self-limiting disorder of calcium deposition within one or more tendons of the rotator cuff
    • With time, the calcium undergoes painful resorption with subsequent tendon healing
  • Middle-aged patients are most commonly affected (rarely seen in patients >70yrs)
  • Adhesive capsulitis is most common complication

Clinical Features

Precalcific phase

  • fibrocartilaginous metaplasia of the tendon
  • pain-free

Calcification phase

  • Formative phase
    • characterized by cell-mediated calcific deposits
    • +/- pain
  • Resting phase
    • lacks inflammation or vascular infiltration
    • +/- pain
  • Resorptive phase (1-2 wks)
    • characterized by phagocytic resorption and vascular infiltration
    • most painful phase
    • Sudden onset of severe pain, usually at rest, worse at night
    • Any shoulder motion reproduces significant pain
    • TTP over proximal humerus near tendinous insertion of rotator cuff

Post-calcific phase

  • variable levels of pain and shoulder dysfunction

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation

Calcific tendinitis
  • Imaging
    • Plain films will show calcification in the tendon(s) of the rotator cuff
    • Note: calcification is not specific for calcific tendinitis (may occur in asymptomatic patients)

Management

  • Nonoperative management is successful in most cases
    • NSAIDs
    • Physical therapy
    • Stretch and Strengthening
      • Avoid immobilization
        • Rest shoulder in abduction on back of a chair as soon as tolerable
        • Sleep with pillow beneath axilla
    • Steroid Injections

Disposition

  • Primary care referral within 1wk
  • If chronic, may consider ortho referral for operative management

See Also

References