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Calcifying Tendonitis Workup

  • Author: Anthony H Woodward, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Nov 21, 2015
 

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.[13, 14]

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.[13, 14]

Magnetic resonance imaging (MRI)

  • The calcific deposit causes decreased signal intensity on T1-weighted images.[15, 16]
  • 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.[15] 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.[13, 14]
 
 
Contributor Information and Disclosures
Author

Anthony H Woodward, MD Orthopedic Surgeon, Private Practice

Anthony H Woodward, MD is a member of the following medical societies: American Association of Orthopaedic Medicine, Oregon Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Paul E Di Cesare, MD 

Paul E Di Cesare, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, 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, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern 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, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Jegan Krishnan, MBBS, FRACS, PhD Professor, Chair, Department of Orthopedic Surgery, Flinders University of South Australia; Senior Clinical Director of Orthopedic Surgery, Repatriation General Hospital; Private Practice, Orthopaedics SA, Flinders Private Hospital

Jegan Krishnan, MBBS, FRACS, PhD is a member of the following medical societies: Australian Medical Association, Australian Orthopaedic Association, Royal Australasian College of Surgeons

Disclosure: Nothing to disclose.

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