Calcific tendinitis: Difference between revisions
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**With time, the calcium undergoes painful resorption with subsequent tendon healing | **With time, the calcium undergoes painful resorption with subsequent tendon healing | ||
*Middle-aged patients are most commonly affected (rarely seen in patients >70yrs) | *Middle-aged patients are most commonly affected (rarely seen in patients >70yrs) | ||
*Adhesive capsulitis is most common complication | *[[Adhesive capsulitis]] is most common complication | ||
==Clinical Features== | ==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 | **Sudden onset of severe pain, usually at rest, worse at night | ||
**Any shoulder motion reproduces significant pain | **Any shoulder motion reproduces significant pain | ||
**TTP over proximal humerus near tendinous insertion of rotator cuff | **TTP over proximal humerus near tendinous insertion of rotator cuff | ||
* | |||
===Post-calcific phase=== | |||
*variable levels of pain and shoulder dysfunction | |||
==Differential Diagnosis== | |||
{{Shoulder DDX}} | |||
==Evaluation== | ==Evaluation== | ||
| Line 19: | Line 35: | ||
**Plain films will show calcification in the tendon(s) of the rotator cuff | **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) | **Note: calcification is not specific for calcific tendinitis (may occur in asymptomatic patients) | ||
==Management== | ==Management== | ||
*Nonoperative management is successful in | *Nonoperative management is successful in most cases | ||
* | **NSAIDs | ||
** | **Physical therapy | ||
*Avoid immobilization | **Stretch and Strengthening | ||
**Rest shoulder in abduction on back of a chair as soon as tolerable | ***Avoid immobilization | ||
**Sleep with pillow beneath axilla | ****Rest shoulder in abduction on back of a chair as soon as tolerable | ||
****Sleep with pillow beneath axilla | |||
**Steroid Injections | |||
==Disposition== | ==Disposition== | ||
*Primary care referral within 1wk | *Primary care referral within 1wk | ||
*If chronic, may consider ortho referral for operative management | |||
==See Also== | ==See Also== | ||
| Line 40: | Line 56: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Sports Medicine]] | |||
Revision as of 01:11, 10 May 2019
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:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Evaluation
- 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
- Avoid immobilization
- Steroid Injections
Disposition
- Primary care referral within 1wk
- If chronic, may consider ortho referral for operative management