Calcifying Shoulder

Psaki, C. and Carroll, J. Acetic acid ionization A study to determine the absorptive effects upon calcified tendonitis of the shoulder. Phys. Ther. Rev. 55 84, 1955. 

Rotator cuff calcifications are a common finding (occurring in as many as 3% of adults with a prevalence in females in their fourth to sixth decades of life) when examining the shoulder with US. Generally speaking, calcifying tendinitis refers to deposition of calcium, predominantly hydroxyapatite, in the rotator cuff tendons the most commonly affected tendon... 

Some general considerations merit attention. First, only painful calcifications must be treated finding calcification within a rotator cuff tendon does not automatically mean that shoulder pain is related to it. A typical mistake is to treat calcifying tendinitis in patients with shoulder pain derived from other causes, including cervical spine disease. Remember that most calcifications are asymptomatic. Second, the best results are achieved on large calcifications. Treatment of clusters of smaller calcifications is almost invariably unsuccessful. Third, the goal of the procedure is to disrupt the calcification and to remove some but not all calcific material (Fig. 18.14f). Too many needle insertions to remove as much as possible of the calcification should be avoided to prevent tendon tears. Once ruptured, calcification almost invariably evolves toward resorption, and shoulder pain and disability improve in most cases (Fig. 18.16). 

Fig. 18.16a-c. US-guided treatment of calcifying tendinitis radiographic results. Series of anteroposterior standard radiographs of the shoulder obtained a before, b soon after the procedure and c 2 months later in a patient with a painful calcification (arrow) in the supraspinatus tendon. Although partial removal of the calcification is observed initially, most of the calcification then dissolves with time. (Courtesy of Dr. Giovanni Serafini, Pietra Ligure, Italy)... 

The tendons and sheaths can become inflamed from repetitive use. When the tendons are overstretched or constricted, the chance of pain and injury increases. With further exertion, some of the fibers that make up the tendon can actually fray or tear apart. The tendon becomes thickened, bumpy, or irregular in certain parts of the body, such as the shoulder. The injured area may calcify. Without rest and sufficient time for the tissues to heal, the tendon may be permanently weakened. 

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