Calcific tendinitis

definition

· inflammation secondary to calcium deposition in rotator cuff

epidemiology

· most common around age 40

· more common sedentary workers

· involves dominant and nondominant shoulder with equal frequency

aetiology

· part of impingement

· deposition occurs in diseased tendon

· usually in critical zone of supraspinatus

· 1-2 cm from bony insertion

pathogenesis

· calcium laid down in degenerate tissues

Degeneration

· degeneration occurs due to

· hypovascularity

· mechanical wear

· repeated microtrauma

· age-related changes

Formative phase

· area undergoes fibrocartilagenous metaplasia

· chondrocytes mediate deposition of calcium

· does not cause pain

Resorptive phase

· ingrowth of capillaries

· deposit phagocytosed by macrophages

· tendon subsequently repaired

· acute symptoms due to increased intratendinous pressure

clinical

Formative phase

· calcification in tendon not painful

· symptoms due to impingement

· x-rays show calcium clearly

Resorptive phase

· severe pain of acute onset

· may be excruciating requiring opiate analgesia

· associated restriction of ROM

· may be confused with septic arthritis

· x-rays show fluffy opacity

treatment

Nonoperative

· rest

· adequate analgesia

· NSAIDs

· HCLA injection into subacromial bursa

Operative

Needle aspiration

· localise area of maximum tenderness

· infiltrate with local anaesthetic

· insert large bore needle into deposit

· inject and withdraw saline until return clear

· puncture area thoroughly

Excision

· deltoid splitting approach

· identify raised white area in cuff

· incise area and thoroughly curette cavity

· if tendon degenerate, excise and repair

· image intensification may be required to localise deposit