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 Repeat until all accessible material withdrawn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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