Calcific Tendinopathy: Calcium Deposit Morphology Directly Affects Pain and Function of the Shoulder

Abstract

The aim of this study was to determine conventional ultrasonography characteristics of calcium deposits in patients diagnosed with calcific tendinopathy, to determine vascularization around deposits by power Doppler, and to compare morphological and power Doppler findings with clinical findings by use of two questionnaires. Pain and function were evaluated using the visual analog scale and two questionnaires, Constant Shoulder Score and Oxford Shoulder Score. All subjects underwent ultrasonography examination and evaluation of vascularization (flow) along calcium deposit using power Doppler. Fifty-one subjects were included in the study. The χ 2-test, a non-parametric statistics method was used because of the categorical type of variables. The level of statistical significance was set at p<0.05. In the inactive phase, calcium deposit was shown as a hyperechoic focal point with dorsal acoustic shadow and negative power Doppler finding, whereas in the resorptive phase it appeared as fragmented irregular hyperechoic focal points with positive power Doppler findings. This study showed the patients with fragmented, cloudy calcification to have statistically significantly worse results on functional questionnaires and more positive power Doppler findings (grades II and III) and to experience stronger pain (visual analog scale 8-10). Upon defining the stage of calcific tendinopathy, the method of treatment can be determined and further course of the disease predicted. Defining the stage of calcification precisely helps avoid unnecessary and long-lasting physical therapy while introducing an effective treatment option, depending on the stage of the disease.

Magnetic resonance imaging evaluation of the correlation between calcific tendinitis and rotator cuff injury

“…Recent studies have shown that the metaplasia mechanism of CaT is that tendon fibers transform into fibrocartilage and are calcified [ 14 ]. It has been reported in subsequent studies that metaplasia of tendon fibers, differentiation of tendon stem cells into chondrocytes and osteoblasts [ 15 ], endocrine disorders (thyroxine, estrogen, insulin) [ 16 ], and genetic factors [ 17 , 18 ] may also be related to the development of CaT. In this study, the incidence of diabetes and hypothyroidism was high, but this high incidence was not statistically significant in the two groups of patients.…”

Arthroscopic removal of arch-shaped rotator cuff calcifying tendinitis without rotator cuff repair and acromioplasty is an excellent treatment regarding pain relief and function

“…Calcific tendinopathy is easily diagnosed by using conventional radiography and ultrasound examination. Ultrasound examination is a fundamental tool for diagnosis and treatment, especially for determination of the localization, size, and morphology of the deposit [10]. Cesarec classified dividing deposits into three types using ultrasound: arch-shaped (1), cloudy (2), and fragmented and nodular (3).…”

“…Monitoring the development of calcified deposits by Power Doppler as an indicator the inflammatory process in the tendon and an indicator of spontaneous resorption helps to predict the duration of the symptoms and to make a decision on the way of the treatment. Cesarec et al [10] postulated that by defining the stage of the calcific tendinopathy, we would be able to determine the mode of treatment and prognosis of the further course of the disease.…”

“…Cases of calcifying tendinitis were classified according to Cesarec et al [10] by dividing deposits into three types, using ultrasound: arch-shaped (1), cloudy (2), and fragmented and nodular (3). One surgeon performed all surgery.…”

Efficacy of ultrasound in diagnosis and treatment of the shoulder – A systematic review

“…Measurements of distance, thickness or perimeter of a given structure were prevalent. In the study by Kim et www.fizjoterapiapolska.pl Some studies used the "Power Doppler" and "B" elastography modes [41,46]. In addition, other studies included measurements of thickness of the deltoid and pectoral muscles, as well as the coracoacromial ligament and the rotator cuff interval [27,33,39,48].…”