Calcific tendinitis

Background

• Self-limiting disorder of calcium deposition w/in 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

• "Calcification" phase
  • Patient may be asymptomatic or have mild pain at rest or at night
• "Resorptive" phase (1-2wks)
  • 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

Diagnosis

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)

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

• Shoulder Dislocation
  • Anterior shoulder dislocation
  • Posterior shoulder dislocation
  • Inferior 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
  • Rucksack paralysis
• Axillary artery thrombosis
• Thoracic outlet syndrome
• Subclavian steal syndrome
• Pancoast tumor
• Myocardial infarction
• Pneumonia
• Pulmonary embolism

Management

• Nonoperative management is successful in 90% of cases
• Analgesia
  • NSAIDs, opioids
• Avoid immobilization
  • Rest shoulder in abduction on back of a chair as soon as tolerable
  • Sleep with pillow beneath axilla

Disposition

• Primary care referral within 1wk

See Also

• Shoulder diagnoses
• Biceps Tendinitis