Calcific tendinitis

Changed by Bruno Di Muzio, 23 May 2016

Updates to Article Attributes

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Calcific tendinitis is a self limiting-limiting condition due to deposition of calcium hydroxyapatite within tendons, usually of the rotator cuff. It is a common presentation of the hydroxyapatite crystal deposition disease (HADD)

Epidemiology

Typically this condition affects middle aged-aged patients between the ages of 30 and 60, with a slight predilection for women 2.

Clinical presentation

The condition passes through four stages 2:

  1. pre-calcific
    • asymptomatic
    • fibrocartilaginous metaplasia (see below)
  2. calcific or formative
    • symptoms are variable from none to pain on movement
  3. resorptive
    • most symptomatic
    • pain due to extravasation of calcium hydroxyapatite into adjacent tissues, especially subacromial bursa, causing calcific bursitis
    • pain typically lasts 2 weeks
  4. post-calcific
    • variable symptomatology
    • some restriction of movement common
    • may last months

Pathology

Calcific tendonitis results from the deposition of calcium hydroxyapatite within the substance of a tendon, and is thought to be due to decreased oxygen tension, leading to fibrocartilagenousfibrocartilaginous metaplasia and secondary mineralizationmineralisation 1.

Location

This condition most frequently affects the rotator cuff of the shoulder 1.

Radiographic features

Plain radiograph

Calcific deposits are usually visualised as homogeneous hyperdensity with variable morphology, but typically globular/amorphous with poor margins.

MRI
  • T1
    • hypointense homogeneous signal
    • adjacent tendon may be thickened
    • some enhancement surrounding deposit may be seen
  • T2
    • hypointense calcium deposits
    • hyperintense signal may be present peripherally due to oedema
    • hyperintense subacromial-subdeltoid bursal fluid
  • T2*: calcifications may bloom

Treatment and prognosis

Controversial and difficult to measure due to the inherent variability of the symptoms and the self limiting-limiting nature of the disease. Potential treatments include 2:

  • oral analgesiaanalgesic/anti-inflammatory medication
  • subacromial local anestheticanaesthetic/steroid injection
  • aspiration of mineralised material
  • ultrasound therapy

Differential diagnosis

In the shoulder consider:

  • incidental calcification: seen in 2.5-20% of 'normal' healthy shoulders 1-2
  • degenerative calcification
    • seen in previously torn tendons
    • generally smaller
    • slightly older individuals
  • loose bodies
    • associated chondral defect
    • associated secondary osteoarthritis
  • -<p><strong>Calcific tendinitis</strong> is a self limiting condition due to deposition of calcium hydroxyapatite within tendons, usually of the <a href="/articles/rotator-cuff">rotator cuff</a>.</p><h4>Epidemiology</h4><p>Typically this condition affects middle aged patients between the ages of 30 and 60, with a slight predilection for women <sup>2</sup>.</p><h4>Clinical presentation</h4><p>The condition passes through four stages <sup>2</sup>:</p><ol>
  • +<p><strong>Calcific tendinitis</strong> is a self-limiting condition due to deposition of calcium hydroxyapatite within tendons, usually of the <a href="/articles/rotator-cuff">rotator cuff</a>. It is a common presentation of the <a title="Hydroxyapatite deposition disease" href="/articles/hydroxyapatite-deposition-disease">hydroxyapatite crystal deposition disease (HADD)</a>. </p><h4>Epidemiology</h4><p>Typically this condition affects middle-aged patients between the ages of 30 and 60, with a slight predilection for women <sup>2</sup>.</p><h4>Clinical presentation</h4><p>The condition passes through four stages <sup>2</sup>:</p><ol>
  • -</ol><h4>Pathology</h4><p>Calcific tendonitis results from the deposition of calcium hydroxyapatite within the substance of a tendon, and is thought to be due to decreased oxygen tension, leading to fibrocartilagenous metaplasia and secondary mineralization <sup>1</sup>.</p><h5>Location</h5><p>This condition most frequently affects the <a href="/articles/rotator-cuff">rotator cuff</a> of the shoulder <sup>1</sup>.</p><ul>
  • +</ol><h4>Pathology</h4><p>Calcific tendonitis results from the deposition of calcium hydroxyapatite within the substance of a tendon, and is thought to be due to decreased oxygen tension, leading to fibrocartilaginous metaplasia and secondary mineralisation <sup>1</sup>.</p><h5>Location</h5><p>This condition most frequently affects the <a href="/articles/rotator-cuff">rotator cuff</a> of the shoulder <sup>1</sup>.</p><ul>
  • -</ul><h4>Treatment and prognosis</h4><p>Controversial and difficult to measure due to the inherent variability of the symptoms and the self limiting nature of the disease. Potential treatments include <sup>2</sup>:</p><ul>
  • -<li>oral analgesia/anti-inflammatory medication</li>
  • -<li>subacromial local anesthetic/steroid injection</li>
  • +</ul><h4>Treatment and prognosis</h4><p>Controversial and difficult to measure due to the inherent variability of the symptoms and the self-limiting nature of the disease. Potential treatments include <sup>2</sup>:</p><ul>
  • +<li>oral analgesic/anti-inflammatory medication</li>
  • +<li>subacromial local anaesthetic/steroid injection</li>

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