Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment

Abstract

Calcific tendinopathy (CT) of the shoulder is a common, painful condition characterized by the presence of calcium deposits in the rotator cuff tendons. Current theories indicate that CT may be the result of a cell-mediated process in which, after a stage of calcium deposition, calcifications are spontaneously resorbed. However, in a minority of cases, this self-healing process is somehow disrupted, resulting in symptoms. Recent literature shows an emerging role of biological and genetic factors underlying CT. This new evidence could supplement the classic mechanical theory of rotator cuff tendinopathy complicated by calcium precipitation, and it may also explain why the majority of the therapies currently in use are only able to provide partially satisfactory outcomes. This review aims to summarize the current knowledge about the pathological processes underlying CT of the shoulder and thereby justify the quest for advanced biological treatments of this condition when it becomes symptomatic.

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

“…Subjects filled-in the Oxford Shoulder Score (OSS) that consists of 12 questions, with grades ranging from 0 to 48, where 0 represents maximal disability, and score 48 no disability 10 . The Constant Shoulder Score (CSS) consists of 8 questions related to pain, activities of daily living, strength of abduction and range of motion [11][12][13] . The score unifies subjective and objective estimate into one result.…”

Interactive associations of sex and hyperlipidemia with calcific tendinitis of the shoulder in Taiwanese adults

“…[ 3 ] Recent findings have suggested a 2-to-8-fold increase in blood vessel growth, neovascularization (a nerve growth), macrophages, and mast cells among patients with CT. [ 4 ] The disease prevalence ranges from 2.7% to 36%. [ 3 , 5 – 8 ] This has so far been widely reported among Caucasians, especially women between the ages of 30 and 50. [ 9 ] The aetiopathogenesis of the disease is yet to be fully understood even though different theories have been suggested.…”

“…[ 9 , 10 ] Treatment of this disorder usually involves physiotherapy and anti-inflammatory medications. [ 11 ] Nevertheless, the treatment options have not been proven to be satisfactory enough [ 5 ] even though several cases are believed to resolve spontaneously . [ 1 ]…”

Association Between Rotator Cuff Tears and Calcific Tendinopathy

“…One theory is that it is caused because of failed cell-mediated healing and another theory hypothesizes that excessive mechanical loading is needed for developing calcific tendinopathy. 2 If mechanical loading is significant, it could only mean that the rotator cuff tendon containing a calcification has sufficient strength to withstand this excessive loading without rupturing. This may be an explanation for the relationship between the presence of calcifications and partial cuff tears 1 and the inverse relationship with full thickness cuff tears.…”