2. INTRODUCTION
■ It is largely a self limiting disorder of rotator cuff in which the tendons are infiltrated
with calcium deposits.
■ Most common age group is usually above 30.
■ Female are affected more than males.
■ Around 10 percent cases are bilateral.
■ The most common site of occurrence is within the supraspinatus tendon and at a
location 1.5 to 2 cm away from the tendon insertion on greater tuberosity.
■ Most patients with calcific deposits are asymptomatic ,but pain can be intense in
symptomatic patients.
3. ETIOLOGY
■ The correct etiology still remain unknown.
■ Suggested causes have included a vascular etiology, with degeneration of tendon
fibres preceding the calcification and aging of tendon with a general diminishing of
vascularity to supraspinatus as a normal course of events.
■ Microangiographic studies showed an area of hypovascularity near codman’s critical
zone just proximal to supraspinatus insertion into greater tuberosity.
4. CHRONOLOGICAL PROGRESSION (by
Sarkar and Uthoff)
■ PHASE 1 – Precalcification stage – Possibly a site of diminished blood supply undergoes
fibrocartilaginous metaplasia.No symptoms.
■ PHASE 2 — Calcification stage — Calcium is deposited into matrix vesicles.
— smaller vesicles coalesce to form larger vesicles.
— Fibrocartilage is gradually replaces and eroded but pain is minimal.
— X-rays show well marginated deposits called as resting phase.
—Resorptive phase starts when vascular channels appear at periphery of deposits and
calcium resorption starts.This is extremely painful and patient seeks help.
— Calcium gets replaced with granulation tissue.
5. Contd..
■ PHASE 3 — Postcalcification phase —During this phase , the granulation tissue matures into
collagen and pain subsides.
8. Investigations
■ X-rays – most practical and feasible.
■ USG – hyperechoic focus,can’t classify the stages
■ CT – best for assessing bony erosions and consistency.
■ MRI –T1- hypointense homogenous
T2-hypointense calcium deposits with hyperintense edema.
9.
10.
11. TREATMENT
■ Essentially almost all patients eventually recover from calcific tendinitis .
■ Non operative – Exercises
— Anti inflammatory medications
—Corticosteroid injections- can cause recurrence as they abort the
resorptive phase returning the lesion to dormancy.
■ Operative – Gschwend et al. listed following indications
(1)symptoms progression
(2)pain affecting activities of daily life even after a long time.
(3)absence of improvement after conservative therapy.
12. Techniques
1. Ultrasound guided percutaneous needling with corticosteroid injection showed 70
percent improvement in a 2 year follow up study.
2. Extracorporeal shoch wave therapy -10 to 30 mins with >0.28mj/mm square
3. Currently the best technique being arthroscopic removal with shaver.Acromioplasty is
needed in patients with subacromial stenosis.
