Calcific tendinitis (or calcific tendonitis) is a self-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).
Typically this condition affects middle-aged patients between the ages of 30 and 60, with a slight predilection for women 2.
The condition passes through four stages 2:
- fibrocartilaginous metaplasia (see below)
- calcific or formative
- symptoms are variable from none to pain on movement
- variable symptomatology
- some restriction of movement common
- may last months
Calcific tendinitis 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 mineralization 1.
This condition most frequently affects the rotator cuff of the shoulder 1.
- supraspinatus: 80%
- infraspinatus: 15%
- subscapularis: 5%
- periarticular soft tissues in addition to tendons
Calcific deposits are usually visualized as homogeneous hyperdensity with variable morphology, but typically globular/amorphous with poor margins.
- hypointense homogeneous signal
- adjacent tendon may be thickened
- some enhancement surrounding deposit may be seen
- hypointense calcium deposits
- hyperintense signal may be present peripherally due to edema
- 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 nature of the disease. Potential treatments include 2:
- oral analgesic/anti-inflammatory medication
- subacromial local anesthetic/steroid injection
- aspiration of mineralized material
- ultrasound therapy
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