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calcific tendonitis
Also see supraspinatus tendonitis
Pathology:
1) deposition of calcium salts, primarily hydroxyapatite, within a tendon
2) may be initiated by ischemia or degeneration of tendon
3) supraspinatus tendon is most frequently affected
a) it is frequently impinged upon
b) it has a reduced blood supply when the arm is abducted
4) calcification within the tendon may evoke acute inflammation
Epidemiology:
- generally develops after age 40
Clinical manifestations:
1) chronic shoulder pain puctuated by acute attacks may occur secondary to inflammation
2) may be asymptomatic
3) range of motion may be limited by pain
Radiology:
- X-ray of shoulder (calcific tenodonitis of the supraspinatus tendon)*
a) calcification in the subacromial space
b) calcification of the supraspinatus, generally near insertion on the humerus
c) small & scattered homogeneous, amorphous densities in soft tissue near the greater tuberosity of the humerus [5]
Management:
1) non-steroidal anti-inflammatory drugs (NSAIDs)
2) local glucocorticoid injections
3) surgery in selected cases
4) extracorporeal shock wave therapy [4]
5) ultrasound-guided lavage [5]
- of no benefit [6]
Related
supraspinatus tendonitis
tendon
General
tendonitis (tendon injury)
ectopic/dystrophic calcification
References
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1961
- Scientific American Medicine
- Cecil Textbook of Medicine 20th edition, Bennet JC & Plum F
(eds), WB Saunders, Philadelphia, 1996, pg 1521
- Journal Watch 24(2):16-17, 2004
Gerdesmeyer L, JAMA 290:2573, 2003
PMID: 14625334
- NEJM knowledge+ Rheumatology
- Moosmayer S et al.
Ultrasound guided lavage with corticosteroid injection versus sham lavage
with and without corticosteroid injection for calcific tendinopathy of shoulder:
Randomised double blinded multi-arm study.
BMJ 2023 Oct 11; 383:e076447.
PMID: 37821122 PMCID: PMC10565688 Free PMC article
https://www.bmj.com/content/383/bmj-2023-076447