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Figure. Anteroposterior radiograph of the right shoulder.
A 45-year-old woman presents to the office with severe pain in the right shoulder that has persisted for 4 days. She denies trauma or a precipitating event, reporting that the pain came on suddenly. The shoulder pain is made worse with any movement of the arm. Anteroposterior radiograph of the right shoulder (Figure) shows calcific tendinitis of the rotator cuff.
Which phase of calcific tendinitis does this case most likely represent?
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Calcific tendinitis is a disorder of unknown etiology in which calcium deposits form in one or more tendons of the rotator cuff. This causes severe pain often associated with subacromial impingement. The 3 main phases of calcific tendinitis include the precalcific, calcific, and postcalcific. The calcific phase is further categorized into the formative, resting, and resorptive phases. Pain is the most intense during the resorptive phase when vascular infiltration promotes spontaneous resorption. Symptom duration and severity vary and may be influenced by the size of the calcium deposit. The majority (>70%) of symptomatic cases of rotator cuff calcific tendinitis resolve with conservative treatment within 6 months, and most calcific deposits decrease in size or disappear on radiograph. Patients should be educated that the most painful period is during the resorptive phase, and symptoms should resolve within 3 to 6 months. A subacromial steroid injection and physical therapy can offer pain relief until healing has ocurred.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
References
1. Suzuki K, Potts A, Anakwenze O, Singh A. Calcific tendinitis of the rotator cuff: management options. J Am Acad Orthop Surg. 2014;22(11):707-717.
2. De Carli A, Ferdinando P, Giacomo D, Pitino D, Ferretti A. Calcific tendinitis of the shoulder.Joints. 2014;2(3):130-136.
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