Purpose
Rotator cuff calcific tendonitis is a common clinical entity reported to occur in up to 20% of painful shoulders (1).
There is a preponderance for the condition within the 3rd to 5th decades and more commonly in females.
It is characterised by the intratendinous deposition of calcium hydroxyapatite crystals with a predilection for the supraspinatus tendon.
The most common site for deposition within the supraspinatus tendon is the critical zone,
an area approximately 8-15 mm from the insertion of the tendon onto the greater tubercle...
Methods and Materials
31 patients (n=31) with radiographic evidence of calcific tendonitis underwent subsequent ultrasound for further evaluation and possible therapeutic intervention by barbotage and/or fenestration.
The study cohort comprised of 23 (n=23) female patients and 8(n=8) male patients.
The age range was 33 to 71 years with a median age of 52.
Using sonography,
3 dedicated Musculoskeletal Radiologists estimated the rotator cuff volume of calcific burden in each patient which was compared retrospectively with previous plain film findings.
3 patients in the study cohort proceeded to MR...
Results
Within our cohort of patients,
sonographic evaluation of calcific tendonitis revealed a near constant underestimation of calcific deposit size on initial radiographs.
2 patients from our study cohort of 31 subjects showed good correlation of deposit size on plain film and ultrasound.
The measured difference in two-axis determination of the calcium deposits varied from 3 mm to 5 mm (mean value of 4 mm),
with a projected volume underestimation differential of at least 3.9 mm3.
Study limitations include:
-small cohort size
-variable interval between plain...
Conclusion
Our study highlights the relative under-estimation of the rotator cuff calcific deposits dimensions on plain films as compared to sonographic evaluation.
It further highlightsthe advantages of sonographic evaluation in terms of accuracy,
rapidity and lack of radiation penalty,
whilst facilitating treatment by barbotage /fenestration in the same setting.
In certain cases,
plain film and ultrasound examinations may be inconclusive/limited in evaluating calcific foci in the rotator cuff tendons(ambiguity in cases of calcification from high grade rotator cuff tears,
greater tuberosity fractures,
cortical erosions at muscle...
References
1.Speed CA,
Hazleman BL.
Calcific tendinitis of the shoulder.
N Engl J Med 1999;340(20):1582–1584.
2.
Siegal DS et.
al.
Calcific tendonitis: A pictorial review.
Canadian Association of Radiologists Journal 2009; 60(5) 263-272.
3.Merolla G,
Singh S,
Paladini P,
Porcellini G.
Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment.J Orthop Traumatol.
2015;17(1):7–14.
4.
Serafini G,
Sconfienza LM,
Lacelli F,
Silvestri E,
Aliprandi A,
Sardanelli F.
Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guidedpercutaneous treatment--nonrandomized controlled trial.
Radiology....
Personal Information
Dr S Ahmed is a Consultant Musculoskeletal Radiologist at Barts Health NHS Trust
Dr M Ho is a Radiology Research Fellow at Darent Valley Hospital.
Mr R Singh is a Consultant Orthopaedic Surgeon at Darent Valley Hospital NHS Trust,
Dartford Kent.
Dr S Morgan is a Consultant Musculoseketal Radiologist at Darent Valley Hospital NHS Trust,
Dartford,
Kent
Dr G Constantinescu is a Consultant Musculoskeletal Radiologist at Kings College Hospital NHS Trust