Complications of calcific tendinitis of the shoulder: a concise review

Abstract

Calcific tendinitis (CT) of the rotator cuff (RC) muscles in the shoulder is a disorder which remains asymptomatic in a majority of patients. Once manifested, it can present in different ways which can have negative effects both socially and professionally for the patient. The treatment modalities can be either conservative or surgical. There is poor literature evidence on the complications of this condition with little consensus on the treatment of choice. In this review, the literature was extensively searched in order to study and compile together the complications of CT of the shoulder and present it in a clear form to ease the understanding for all the professionals involved in the management of this disorder. Essentially there are five major complications of CT: pain, adhesive capsulitis, RC tears, greater tuberosity osteolysis and ossifying tendinitis. All the above complications have been explained right from their origin to the control measures required for the relief of the patient.

Level of evidence: 5.

Fig. 1

a AP view radiograph shows a big calcium deposit (>1 cm) of the supraspinatus (SS) tendon in a case with acute phase, b image of the same case who underwent ultrasound guided needling and bursal lavage of the subacromial space with leakage of copious amounts of semisolid calcium deposits, c X-ray performed after 2 months from bursal lavage showed almost complete resorption of the calcium deposit

Fig. 2

a–c Active range of motion in a young lady with chronic calcifying tendinitis of the SS. At 2 months from the onset of pain she developed a stiff shoulder that required 6 months of manual physiotherapy for full recovery of shoulder motion

Fig. 3

T1-weighted coronal oblique MRI shows a solid calcium deposit at the insertion of the SS (black arrow) with partial tear of the related tendon on the bursal side (white arrow)

Fig. 4

Arthroscopic steps in a patient with chronic calcific deposit of the SS tendon. a Intraoperative needling to identify the site of deposit and delimit the amount of tendon to be removed, b full thickness insertional SS tear produced after complete removal of calcium deposit, c SS reattached on its footprint using a suture anchor (Cross FT 4.5 mm, Linvatec, Largo, FL—USA)

Fig. 5

T1-weighted coronal oblique MRI highlights a greater tuberosity osteolysis (black arrow) in a case with a calcium deposit of the SS in contact with the bone

Fig. 6

a Arthroscopic finding of recurrence of calcific tendinitis of the rotator cuff in the form of ossifying tendinitis, b histologic examination confirmed the diagnosis showing tendinous tissue mixed with areas of chondroid and bone metaplasia