eMedicine Specialties > Orthopedic Surgery > Systemic Diseases

Calcifying Tendonitis: Workup

Author: Anthony H Woodward, MD, Consulting Surgeon, Department of Orthopedic Surgery, Private Practice
Contributor Information and Disclosures

Updated: Oct 23, 2007

Workup

Imaging Studies

  • Plain x-rays
    • Plain x-rays demonstrate calcific deposits. Routine shoulder views, true anteroposterior (AP) and lateral views, AP views with the shoulder in internal and external rotation, axillary views, and supraspinatus outlet views should be sufficient to demonstrate calcification in any rotator cuff tendon. The sensitivity of plain x-rays for detecting calcific deposits is 0.90 (when using ultrasonography as the standard).
    • The calcific deposit can be characterized by its location (ie, which tendon is affected) and by its size. Symptoms usually occur if the deposit is larger than 1.5 cm, although one study found no correlation between the size of the deposit and the severity of the symptoms.
    • Many authors have noted the varying appearances of the calcific deposits. Two types of deposits have been recognized: a localized, homogeneous deposit with well-defined limits, which has been identified with the formative or resting phases, and a more diffuse, heterogeneous, amorphous, fluffy deposit that has a poorly defined periphery, which has been identified with acute symptoms and with the resorptive phase. However, poor correlation exists between the appearance of a calcific deposit on plain x-rays and its consistency on needling.6
  • Arthrograms with radiopaque dye are not required to diagnose calcifying tendinitis, but if a rotator cuff tear is suspected, an arthrogram will demonstrate it.
  • Computed tomography (CT) scanning may be used to accurately localize the calcific deposit, but this modality is probably unnecessary.6
  • Magnetic resonance imaging (MRI)
    • The calcific deposit causes decreased signal intensity on T1-weighted images.7,8
    • If edema is present around the calcific deposit, as might occur in the resorptive phase, increased signal intensity around the calcific deposits may be present on T2-weighted images.7 Do not misinterpret this increased area of signal intensity that is due to edema as a rotator cuff tear.
    • MRI is not necessary to detect calcifying tendinitis, although its accuracy for finding calcification is more than 95%.
  • Ultrasonography
    • Ultrasonography depends heavily on the skill of the technologists and the interpreting radiologist.
    • In experienced hands, ultrasonography is more sensitive than plain x-rays are.
    • Ultrasonography does not expose the patient to radiation.
    • Identification of soft, fluffy calcific deposits with ultrasonography is more accurate than with plain x-rays.6

More on Calcifying Tendonitis

Overview: Calcifying Tendonitis
Workup: Calcifying Tendonitis
Treatment: Calcifying Tendonitis
Follow-up: Calcifying Tendonitis
References
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References

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Further Reading

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Keywords

calcifying tendinitis, calcific tendinitis, calcified tendinitis, calcareous tendinitis, tendinosis calcarea, calcific tendinopathy

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Contributor Information and Disclosures

Author

Anthony H Woodward, MD, Consulting Surgeon, Department of Orthopedic Surgery, Private Practice
Anthony H Woodward, MD is a member of the following medical societies: American Association of Orthopaedic Medicine and Oregon Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jegan Krishnan, MBBS, FRACS, PhD, Chair, Senior Clinical Director, Department of Orthopedic Surgery, Flinders Medical Centre and Repatriation General Hospital, Flinders University of South Australia
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Paul E Di Cesare, MD, Chair and Professor, Department of Orthopedic Surgery, University of California Davis School of Medicine
Paul E Di Cesare, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and Sigma Xi
Disclosure: stryker Consulting fee Consulting; smith and nephew Consulting fee Speaking and teaching

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center, Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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