II. Pathophysiology

  1. Degenerative changes at rupture site (Supraspinatus)
  2. Calcification enlarges to irritate overlying bursa
  3. Results in impingement under coracoacromial arch

III. Symptoms

  1. Similar to strains and Rotator Cuff Tendonitis
  2. Night pain
    1. Unable to sleep on Shoulder

IV. Signs

  1. Marked decreased range of motion
  2. Tenderness to palpation over bursa or calcific deposit

V. Radiology: Shoulder XRay

    1. Internal or external rotation
    2. Transaxillary
  2. Findings
    1. Calcium deposition

VI. Differential Diagnosis

VII. Management

  1. Subacromial Corticosteroid Injection
  2. Moist warm packs
  3. Diathermy or local Ultrasound
  4. Arm in sling for acute pain
  5. Shoulder Range of Motion Exercises
  6. Surgical excision of calcific deposits
    1. Reserved for resistant cases
  7. High energy extracorporeal shock wave therapy (ESWT)
    1. Gerdesmeyer (2003) JAMA 290:2573-80 [PubMed]

VIII. Management: Aspiration or needling of calcific deposits

  1. Precautions
    1. Procedure should be performed by experienced clinician
  2. Indications
    1. May be effective if deposit is soft, fluffy, or irregular
  3. Technique
    1. Draw Lidocaine into syringe with 18 gauge needle
    2. Inject and aspirate multiple areas at deposits
      1. Repeat until all accessible material withdrawn
    3. Consider 2 needle approach
      1. First needle injects
      2. Second needle aspirates
    4. Complete procedure with local Corticosteroid
      1. Inject Corticosteroid at subacromial bursa

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Related Studies

Ontology: Calcific tendinitis of shoulder (C0158303)

Concepts Disease or Syndrome (T047)
ICD9 726.11
ICD10 M75.3
SnomedCT 27741009, 239957000, 699942000
English Calcifying tendinitis shoulder, Calcific tendinitis of should, calcific tendonitis of shoulder, calcific tendonitis of shoulder (diagnosis), Calcif tendinitis shlder, calcific tendonitis shoulder, calcific shoulder tendonitis, calcifying shoulder tendinitis, calcific shoulder tendinitis, calcific tendinitis shoulder, shoulder calcific tendinitis, calcifying tendinitis shoulder, shoulder calcific tendonitis, Calcific tendonitis of shoulder, Apatite-associated destructive arthritis of shoulder (disorder), Milwaukee shoulder, Apatite-associated destructive arthritis of shoulder, Calcifying tendinitis of shoulder, Calcifying tendinitis of the shoulder, Calcific tendinitis of shoulder (disorder), tendinitis; calcific, shoulder, Calcific tendinitis of shoulder
Dutch verkalkende tendinitis van schouder, tendinitis; calcificans, schouder, Verkalkte tendinitis van schouder
French Tendinite calcifiante de l'épaule
German Tendinitis calcificans, Tendinitis calcarea im Schulterbereich
Italian Tendinite calcifica della spalla
Portuguese Tendinite calcificante do ombro
Spanish Tendinitis calcificante del hombro, tendinitis calcificante de hombro, tendinitis calcificante de hombro (trastorno), tendinitis calcificante del hombro (trastorno), tendinitis calcificante del hombro, artritis destructiva de hombro asociada con apatita (trastorno), artritis destructiva de hombro asociada con apatita, hombro de Milwaukee
Japanese 肩の石灰化腱炎, カタノセッカイカケンエン
Czech Kalcifikující tendinitida ramene
Korean 어깨의 석회성 힘줄염
Hungarian Váll kalcifikáló tendinitise