Keywords:
Musculoskeletal soft tissue, Ultrasound, Diagnostic procedure, Inflammation
Authors:
S. Ahmed1, M. Ho2, R. Singh2, S. Morgan3, G. Constantinescu2; 1London/UK, 2Dartford/UK, 3Kent/UK
DOI:
10.26044/essr2019/P-0159
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 of the humeral head (2).
Whilst not all calcifications manifest clinically with shoulder pain,
the early identification and removal of such calcific deposits is favoured in order to prevent or remedy chronic debilitating shoulder pain (3).
Calcific tendinosis is commonly detected on radiographs performed as an initial investigation for shoulder pain.
Radiographs remain a useful first line investigation for detecting calcium deposits within the rotator cuff tendons given their ease of acquisition,
inexpensiveness and ability to clearly delineate calcium deposits as radiopaque densities (Fig 1).
High-resolution,
sonographic evaluation of the calcific deposits is rapid,
accurate and avoids radiation.
It allows a dynamic,
tri-dimensional estimation of the rotator cuff calcific deposits and helps with treatment planning-barbotage and /or fenestration(Fig 2 and Fig 3).
In the acute setting of calcific tendinosis an ultrasound guided steroid injectionin the subacromial bursa is usually performed to reduce pain and increase the range of movement,
prior to subsequent barbotage/fenestration (4).
Rotator cuff tendons calcific deposits can also be identified on MRI and CT studies (Fig 4 and Fig 5),
more often in the setting of diagnostic work-up for various shoulder pathologies.
On MRI,
in particular,
some small cacific deposits can be dificult to detect or may be overlooked on fluid sensitive gradients due to their similar signal characteristics to the rotator cuff tendons.
CT scanning,
although very sensitive in detecting calcific deposits,
is more likely to be used as a problem solving tool,
when the other,
more sensitive modalities have limitations. It also involves significant radiation.
The aim of this study was to assess the corellation and potential benefits of sonography versus plain film evaluation of rotator cuff calcific deposits.