Calcific Tendinitis of the Rotator Cuff: A Review

Abstract

Calcifying tendinitis of the rotator cuff is a common disorder; its underlying mechanism still remains unknown. Although details of the clinical presentation(s) and pathological changes which are associated with calcific tendinitis are available, conservative management of this condition remains a topic of debate. About 90% of the patients can be treated non - operatively, but as some are resistant to conservative treatment; newer techniques or surgery should be indicated. Rheumatologists and radiologists have often described this shoulder abnormality, leading to its progressive differentiation from other painful shoulder syndromes. The conservative treatment includes the use of non - steroidal anti - inflammatory agents, roentegen therapy, physical modalities for controlling the pain and for preventing loss of joint mobility, local steroid injections, and open or arthroscopic surgeries. Results of non - operative treatments have also been satisfactory. These include heat, cold, range of motion and pendulum exercises, diathermy, short - wave, and radiation therapy. Rest, immobilization with a sling, and oral non - steroidal and steroid anti - inflammatory medications have also been mentioned. This review aimed at looking at calcific tendinitis of the rotator cuff with a wide vision in the light of modern advances; while at the same time, not disregarding the past experiences.

Intramuscular migration of calcium hydroxyapatite crystal deposits involving the rotator cuff tendons of the shoulder: report of 11 patients

“…This characterizes the post-calcific stage, when granulation tissue replaces the space left behind by the hydroxyapatite crystals and eventually matures into a fibrotic scar [3].…”

“…Asymptomatic hydroxyapatite deposits are common, and may be found in the periarticular soft tissues of virtually every joint [2]. Symptomatic HADD typically affects middle-aged persons and represents a common cause of joint pain, related primarily to periarticular deposition of calcific material within tendons [3]. Clinical symptoms range from chronic or recurrent joint pain associated with a limited range of motion to acute severe pain and tenderness [4].…”

Effects of phonophoresis with acetic acid in the treatment of calcific tendinitis of the shoulder: case report

“…Added to this the fact that, ultrasound activates the endothelial cells which express and release a variety of substances, such as: chemokines (attractive protein of monocytes chemo, interleukin-8, regulated upon activation of normal T cells expressed and segregated [RANTES]) and cytokines (interleukin 2 and factor of stem cells), as well as macrophages migrants may be involved in the phagocytosis of calcified particles. The ultrasound applied in higher intensities can trigger or accelerate the breakdown of microcrystals of apatite into smaller crystals and stimulate macrophages to remove them by phagocytosis (7) . It should be noted that, as in any case report, the results of the study cannot be generalized and, therefore it would be advisable to continue this study with a larger sample of patients, since the physiotherapeutic approach was applied in only one individual.…”

“…Regarding its symptoms, it can be found in asymptomatic individuals, where calcification is a mere radiological finding (2) , or symptomatic, in which the pain and loss of range of motion (ROM) are the most reported complaints (5) . The calcific tendinitis is a self-limiting disease which corresponds to 17% of the syndromes of the shoulder (6) , and can be divided into three stages: pre-Calcification (where there is a metaplasia of the tendon tissue in fibrocartilage); calcification which is divided into resting phase and of reabsorption (the latter is the phase where there is intense pain and functional limitation, in which the calcium deposition looks like tooth paste) and; Post-calcification where there is spontaneous resorption of calcification and pain regression (7) . Despite of the surgical removal of calcification or percutaneous needle aspiration can be used, even if in the last case, conservative treatment is the most indicated in calcific tendinitis, which can be carried out with the use of: analgesics, non-steroid anti-inflammatory, infiltration of corticosteroids (8) , extracorporeal shock waves therapy and physiotherapy (9) .…”

Tendinitis cálcica del manguito rotador y su lavado por ultrasonido

“…Una de las dificultades del manejo de la tendinitis cálcica es que, dado que es una entidad autolimitada, donde la calcificación se resuelve en forma espontánea, el tratamiento busca mejorar la calidad de vida y acelerar la recuperación a través del alivio sintomático, por lo que éste debe ser efectivo, sin complicaciones y mínimamente invasivo 2 . Tradicionalmente el tratamiento de primera elección es el manejo conservador, donde se incluye el uso de terapia física y un curso corto de antiinflamatorios no esteroidales 3 . Una aproximación alternativa es extraer la calcificación vía procedimientos guiados por ultrasonido.…”