Evaluation of Calcific Tendonitis of the Rotator Cuff

Abstract

Objective. To use color Doppler ultrasonography to evaluate the morphology and vascularity of calcific tendonitis and to predict the formative and resorptive phases of the calcification. Methods. Ninetyfour patients with shoulder calcification on plain radiographs were enrolled in this study. Ultrasonography of the shoulder was focused on the rotator cuff. Color Doppler ultrasonography was applied in the calcific region. Patient symptoms were graded as painless, mild, moderate, and severe. The calcific plaques were classified as arc-shaped, fragmented or punctate, nodular, and cystic types. Color Doppler ultrasonographic signals were graded 0 to 3. The formative and resorptive phases of calcification were categorized by patient symptoms; acute onset of moderate or severe pain indicated the resorptive phase. Results. The calcific plaques appeared arc shaped in 59 patients (20 painless, 19 mild, and 20 moderate), fragmented or punctate in 27 (2 painless, 3 mild, 20 moderate, and 2 severe), nodular in 6 (1 moderate and 5 severe), and cystic in 2 (severe). There was a significant difference between the morphology of the calcific plaques and clinical symptoms (P < .01). On color Doppler ultrasonography, grade 0 signals were found in 28 patients (22 painless and 6 with mild pain); grade 1 in 18 (16 mild and 2 severe); grade 2 in 41 (all moderate); and grade 3 in 7 (all severe). The correspondence between color Doppler ultrasonographic findings and clinical symptoms was excellent (P < .01). Conclusions. High-resolution ultrasonography with color Doppler imaging could differentiate the formative and resorptive phases of the calcification and could be used as a follow-up modality in calcific tendonitis of the shoulder. Key words: shoulder; calcification; ultrasonography; color Doppler ultrasonography. General Hospital-Taipei, School of Medicine, National Yang Ming University, Taipei, Taiwan, Republic of China; and Section of Radiology, Taipei Municipal Ho-Ping Hospital, Taipei, Taiwan, Republic of China (D.-Y.H.)

What Imaging‐Detected Pathologies Are Associated With Shoulder Symptoms and Their Persistence? A Systematic Literature Review

“…In total, 56 articles were included (41 cross‐sectional, 11 cohort, 4 case–control). Imaging modalities included 25 ultrasound 16, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 24 MRI 15, 16, 41, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 12 radiographs 27, 30, 49, 53, 55, 62, 65, 66, 67, 68, 69, 70, 3 bone scintigraphy 65, 71, 72, 2 PET 73, 74, and no computed tomography. Of these studies, 10 assessed associations with 2 imaging modalities (16, 27, 30, 41, …”

“…The mean (range) score was 48% 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67 for cohort, 41% 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41...…”

“…Three studies evaluated the association between calcification and pain 21, 22, 31, and 2 studies evaluated the association with pain and function 49, 68 (Tables 1, 2, and 3). Two ultrasound studies of mixed quality 22, 31 showed that calcification was associated with pain, and 1 low‐quality study found no association 21.…”

Comprehensive Shoulder US Examination: A Standardized Approach with Multimodality Correlation for Common Shoulder Disease

“…Uhthoff et al (61) proposed that calcific tendinitis occurs in multiple stages-namely, the precalcific, calcific (including formative and resorptive phases), and postcalcific stages-and that pain primarily occurs during the resorptive phase. The SST is the most commonly affected tendon of the RC, and associated with the resorptive phase (64). At MR imaging, the calcium deposits are hypointense, and they may show associated blooming and surrounding intratendinous high signal intensity, representing edema, on T2-weighted images (Fig 19b).…”

Extracorporeal Shock Wave Therapy for the Treatment of Chronic Calcifying Tendonitis of the Rotator Cuff

“…7 Several authors have found no correlation between the presence of a tendon tear and calcific tendonitis. 4,[7][8][9][10] The treatment of patients with calcific tendonitis typically is conservative, including use of subacromial cortisone injections, physical therapy, and systemic nonsteroidal antiinflammatory drugs, although evidence of efficacy is limited. 11,12 For patients with chronic calcification, surgical removal of the deposits, either with an open procedure or endoscopically, has been reported to relieve symptoms.…”