II. Pathophysiology
- Degenerative changes at rupture site (Supraspinatus)
- Calcification enlarges to irritate overlying bursa
- Results in impingement under coracoacromial arch
III. Symptoms
- Similar to strains and Rotator Cuff Tendonitis
- Night pain
- Unable to sleep on Shoulder
IV. Signs
- Marked decreased range of motion
- Tenderness to palpation over bursa or calcific deposit
V. Radiology: Shoulder XRay
- Views
- Internal or external rotation
- Transaxillary
- Findings
- Calcium deposition
VI. Differential Diagnosis
VII. Management
- Subacromial Corticosteroid Injection
- Moist warm packs
- Diathermy or local Ultrasound
- Arm in sling for acute pain
- Shoulder Range of Motion Exercises
- Surgical excision of calcific deposits
- Reserved for resistant cases
- High energy extracorporeal shock wave therapy (ESWT)
VIII. Management: Aspiration or needling of calcific deposits
- Precautions
- Procedure should be performed by experienced clinician
- Indications
- May be effective if deposit is soft, fluffy, or irregular
- Technique
- Draw Lidocaine into syringe with 18 gauge needle
- Inject and aspirate multiple areas at deposits
- Repeat until all accessible material withdrawn
- Consider 2 needle approach
- First needle injects
- Second needle aspirates
- Complete procedure with local Corticosteroid
- Inject Corticosteroid at subacromial bursa