Calcific tendinitis

Overview

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Calcific deposits in the shoulder tendon

Calcific tendinitis is a condition characterized by the deposition of calcium hydroxyapatite crystals in the tendons of the rotator cuff. It is a common cause of shoulder pain and dysfunction, particularly affecting the supraspinatus tendon.

Pathophysiology

The exact cause of calcific tendinitis is not well understood, but it is believed to involve a process of tendon degeneration followed by calcification. The condition progresses through three stages:

• Pre-calcific stage: This stage involves fibrocartilaginous metaplasia of the tendon tissue, which is not yet visible on radiographs.
• Calcific stage: Calcium deposits form within the tendon. This stage is further divided into formative, resting, and resorptive phases. During the resorptive phase, the deposits may cause significant inflammation and pain.
• Post-calcific stage: The calcium deposits are resorbed, and the tendon undergoes healing and remodeling.

Clinical Presentation

Patients with calcific tendinitis typically present with acute or chronic shoulder pain, which may be exacerbated by overhead activities. The pain is often localized to the anterior or lateral aspect of the shoulder and may radiate down the arm. Range of motion may be limited, particularly in abduction and external rotation.

Diagnosis

X-ray showing calcific deposits

Diagnosis is primarily based on clinical examination and imaging studies. X-rays are the most common imaging modality used to identify calcific deposits, which appear as radiopaque areas within the tendon. Ultrasound and MRI can also be used to assess the extent of calcification and associated soft tissue changes.

Treatment

Treatment options for calcific tendinitis include:

• Conservative management: This includes rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy.
• Corticosteroid injections: These can help reduce inflammation and pain.
• Extracorporeal shock wave therapy (ESWT): This non-invasive treatment uses shock waves to break down calcium deposits.
• Needling and lavage: A procedure where a needle is used to break up the calcium deposits, followed by lavage to remove the debris.
• Surgery: In cases where conservative treatments fail, surgical removal of the calcium deposits may be necessary.

Prognosis

The prognosis for calcific tendinitis is generally good, with many patients experiencing significant improvement with conservative treatment. However, some individuals may have recurrent episodes or persistent symptoms requiring more aggressive interventions.

Related Pages

• Tendinitis
• Rotator cuff
• Shoulder pain
• Musculoskeletal disorders

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  Calcific tendinitis marked

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  Calcific tendinitis