Calcific tendinitis - Revision history

Rossdonaldson1: /* Background */

2024-02-14T17:28:46Z

Background

← Older revision		Revision as of 17:28, 14 February 2024
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	==Background==		==Background==
			[[File:Gray326.png\|thumb\|Shoulder anatomy]]
			[[File:Shoulder_joint_back-en.png\|thumb\|Shoulder anatomy, anterior.]]
			[[File:Shoulder joint back 05r4v.png\|thumb\|Shoulder anatomy, posterior.]]
	*Self-limiting disorder of calcium hydroxyapatite deposition within one or more tendons of the rotator cuff		*Self-limiting disorder of calcium hydroxyapatite deposition within one or more tendons of the rotator cuff
	**Usually spontaneous, not necessarily caused by trauma or overuse		**Usually spontaneous, not necessarily caused by trauma or overuse

Patricklin at 15:21, 14 February 2024

2024-02-14T15:21:22Z

← Older revision		Revision as of 15:21, 14 February 2024
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	==Background==		==Background==
	*Self-limiting disorder of calcium deposition within one or more tendons of the rotator cuff		*Self-limiting disorder of calcium hydroxyapatite deposition within one or more tendons of the rotator cuff
			**Usually spontaneous, not necessarily caused by trauma or overuse
	**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 30-50 years are most commonly affected (rarely seen in patients >70yrs), and women are moreso affected<ref>Merolla G, Singh S, Paladini P, Porcellini G. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment. J Orthop Traumatol. 2016 Mar;17(1):7-14. doi: 10.1007/s10195-015-0367-6. Epub 2015 Jul 12. PMID: 26163832; PMCID: PMC4805635.</ref>
	*[[Adhesive capsulitis]] is most common complication		*[[Adhesive capsulitis]] is most common complication
			*Inflammatory reaction may exhibit warmth, swelling, or erythema that may mimic septic arthritis

	==Clinical Features==		==Clinical Features==
	===Precalcific phase===		===Precalcific phase===
	*Fibrocartilaginous metaplasia of the tendon		*Fibrocartilaginous metaplasia of the tendon, leading to chondrocyte formation
	*Pain-free		*Pain-free

	===Calcification phase===		===Calcification phase===
	*Formative phase		*Formative phase
	**~~characterized~~ by cell-mediated calcific deposits		**Characterized by cell-mediated calcific deposits
	**+/- Shoulder pain		**+/- Shoulder pain
	*Resting phase		*Resting phase
	**~~lacks~~ inflammation or vascular infiltration		**Lacks inflammation or vascular infiltration
	**+/- pain		**+/- pain
	*Resorptive phase (1-2 wks)		*Resorptive phase (1-2 wks)
	**~~characterized~~ by phagocytic resorption and vascular infiltration		**Characterized by phagocytic resorption and vascular infiltration
	**~~most~~ painful phase		**Most painful phase; due to inflammation in the resorptive process, increase in intratendinous pressure, or subacromial impingement
	**~~Sudden onset of severe pain,~~ usually at rest, worse at night		***Pain may be similar to rotator cuff tendinopathy; usually at rest, worse at night and with laying on affected side
	**Any shoulder motion reproduces significant pain		***Leakage of calcium crystals onto the bursa may lead to sudden dramatic pain
	**TTP over proximal humerus near tendinous insertion of rotator cuff		***Any shoulder motion reproduces significant pain; shoulder impingement tests are usually positive
			***TTP over proximal humerus near tendinous insertion of rotator cuff; may also be near AC joint or deltoid

	===Post-calcific phase===		===Post-calcific phase===
			*Calcific deposits have been resorbed; tendon returns to normal
	*Variable levels of pain and shoulder dysfunction		*Variable levels of pain and shoulder dysfunction

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	*Imaging		*Imaging
	**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)		***Usually in the supraspinatus tendon, proximal to its insertion site on the greater tuberosity<ref>Kim MS, Kim IW, Lee S, Shin SJ. Diagnosis and treatment of calcific tendinitis of the shoulder. Clin Shoulder Elb. 2020 Nov 27;23(4):210-216. doi: 10.5397/cise.2020.00318. PMID: 33330261; PMCID: PMC7726362.</ref>
			***Amount of calcification may not correlate with severity of symptoms<ref>Catapano, Michael, Robinson, David M., Schowalter, Sean and McInnis, Kelly C.. "Clinical evaluation and management of calcific tendinopathy: an evidence-based review" Journal of Osteopathic Medicine, vol. 122, no. 3, 2022, pp. 141-151. https://doi.org/10.1515/jom-2021-0213</ref>
			***Note: calcification is not specific for calcific tendinitis (may occur in asymptomatic patients)
			**Ultrasound is sensitive for detecting calcifications
			***May show hyperechoic areas and posterior acoustic shadowing
			***Can simultaneously detect rotator cuff tears or bursitis

	==Management==		==Management==
	*Nonoperative management is successful in most cases		*Nonoperative management is successful in most cases
	**[[NSAIDs]]		**[[NSAIDs]], oral and topical
	**Physical therapy		**Physical therapy for rotator/glenohumeral strength and ROM
	**Stretch and strengthening		**Stretch and strengthening
	***''Avoid'' immobilization		***''Avoid'' immobilization
	****Rest shoulder in abduction on back of a chair as soon as tolerable		****Rest shoulder in abduction on back of a chair as soon as tolerable
	****Sleep with pillow beneath axilla		****Sleep with pillow beneath axilla
	**[[~~Corticosteroid~~]] ~~injections~~		**Subacromial [[corticosteroid]] injection

	==Disposition==		==Disposition==
	*Primary care referral within 1wk		*Primary care referral within 1wk
	*If chronic, may consider ortho referral for operative management		*If chronic, may consider ortho referral for extracorporeal shock wave therapy, ultrasound-guided lavage, or operative management

	==See Also==		==See Also==

ClaireLewis at 16:26, 8 September 2019

2019-09-08T16:26:32Z

← Older revision		Revision as of 16:26, 8 September 2019
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	==Clinical Features==		==Clinical Features==
	===Precalcific phase===		===Precalcific phase===
	*~~fibrocartilaginous~~ metaplasia of the tendon		*Fibrocartilaginous metaplasia of the tendon
	*~~pain~~-free		*Pain-free

	===Calcification phase===		===Calcification phase===
	*Formative phase		*Formative phase
	**characterized by cell-mediated calcific deposits		**characterized by cell-mediated calcific deposits
	**+/- pain		**+/- Shoulder pain
	*Resting phase		*Resting phase
	**lacks inflammation or vascular infiltration		**lacks inflammation or vascular infiltration
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	===Post-calcific phase===		===Post-calcific phase===
	*~~variable~~ levels of pain and shoulder dysfunction		*Variable levels of pain and shoulder dysfunction

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Management==		==Management==
	*Nonoperative management is successful in most cases		*Nonoperative management is successful in most cases
	**NSAIDs		**[[NSAIDs]]
	**Physical therapy		**Physical therapy
	**Stretch and ~~Strengthening~~		**Stretch and strengthening
	***Avoid immobilization		***''Avoid'' immobilization
	****Rest shoulder in abduction on back of a chair as soon as tolerable		****Rest shoulder in abduction on back of a chair as soon as tolerable
	****Sleep with pillow beneath axilla		****Sleep with pillow beneath axilla
	**~~Steroid Injections~~		**[[Corticosteroid]] injections

	==Disposition==		==Disposition==

Rossdonaldson1 at 01:11, 10 May 2019

2019-05-10T01:11:22Z

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	[[Category:Orthopedics]]		[[Category:Orthopedics]]
			[[Category:Sports Medicine]]

Rossdonaldson1 at 13:55, 10 August 2017

2017-08-10T13:55:04Z

← Older revision		Revision as of 13:55, 10 August 2017
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	===Post-calcific phase===		===Post-calcific phase===
	*variable levels of pain and shoulder dysfunction		*variable levels of pain and shoulder dysfunction

			==Differential Diagnosis==
			{{Shoulder DDX}}

	==Evaluation==		==Evaluation==
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	**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)

	~~==Differential Diagnosis==~~
	~~{{Shoulder DDX}}~~

	==Management==		==Management==
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	==References==		==References==
	<references/>		<references/>


	[[Category:Orthopedics]]		[[Category:Orthopedics]]

Rossdonaldson1: /* Calcification phase */

2017-08-10T13:54:18Z

Calcification phase

← Older revision		Revision as of 13:54, 10 August 2017
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	**characterized by cell-mediated calcific deposits		**characterized by cell-mediated calcific deposits
	**+/- pain		**+/- pain
	*~~resting~~ phase		*Resting phase
	**lacks inflammation or vascular infiltration		**lacks inflammation or vascular infiltration
	*+/- pain		**+/- pain
	*Resorptive phase (1-2 wks)		*Resorptive phase (1-2 wks)
	**characterized by phagocytic resorption and vascular infiltration		**characterized by phagocytic resorption and vascular infiltration

Rossdonaldson1: /* Clinical Features */

2017-08-10T13:52:54Z

Clinical Features

← Older revision		Revision as of 13:52, 10 August 2017
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	==Clinical Features==		==Clinical Features==
	*Precalcific phase		===Precalcific phase===
	**fibrocartilaginous metaplasia of the tendon		*fibrocartilaginous metaplasia of the tendon
	*pain-free		*pain-free
	*Calcification phase
	**Formative phase		===Calcification phase===
	***characterized by cell-mediated calcific deposits		*Formative phase
	***+/- pain		**characterized by cell-mediated calcific deposits
	**resting phase
	***lacks inflammation or vascular infiltration
	**+/- pain		**+/- pain
	**Resorptive phase (1-2 wks)		*resting phase
	***characterized by phagocytic resorption and vascular infiltration		**lacks inflammation or vascular infiltration
	***most painful phase		*+/- pain
	***Sudden onset of severe pain, usually at rest, worse at night		*Resorptive phase (1-2 wks)
	***Any shoulder motion reproduces significant pain		**characterized by phagocytic resorption and vascular infiltration
	***TTP over proximal humerus near tendinous insertion of rotator cuff		**most painful phase
	*Postcalcific phase		**Sudden onset of severe pain, usually at rest, worse at night
	**variable levels of pain and shoulder dysfunction		**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

	==Evaluation==		==Evaluation==

Ravillaa: /* Disposition */

2017-08-09T13:20:59Z

Disposition

← Older revision		Revision as of 13:20, 9 August 2017
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	==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==

Ravillaa: /* Management */

2017-08-09T13:18:19Z

Management

← Older revision		Revision as of 13:18, 9 August 2017
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	==Management==		==Management==
	*Nonoperative management is successful in ~~90% of~~ cases		*Nonoperative management is successful in most cases
	*~~Analgesia~~		**NSAIDs
	**~~NSAIDs, opioids~~		**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==

Ravillaa: /* Clinical Features */

2017-08-09T13:10:28Z

Clinical Features

← Older revision		Revision as of 13:10, 9 August 2017
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	==Clinical Features==		==Clinical Features==
	*"Calcification" phase		*Precalcific phase
	**~~Patient may be asymptomatic~~ or ~~have mild~~ pain ~~at rest or at night~~		**fibrocartilaginous metaplasia of the tendon
	*"Resorptive" phase (1-~~2wks~~)		*pain-free
	**Sudden onset of severe pain, usually at rest, worse at night		*Calcification phase
	**Any shoulder motion reproduces significant pain		**Formative phase
	**TTP over proximal humerus near tendinous insertion of rotator cuff		***characterized by cell-mediated calcific deposits
	*"Postcalcific" phase		***+/- 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
			*Postcalcific phase
	**variable levels of pain and shoulder dysfunction		**variable levels of pain and shoulder dysfunction