Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2016; 7(1): 55-60
Published online Jan 18, 2016. doi: 10.5312/wjo.v7.i1.55
Calcific tendinitis of the rotator cuff
Mohamed Taha ElShewy
Mohamed Taha ElShewy, Orthopedic Department, Cairo University, Cairo 11412, Egypt
Author contributions: ElShewy MT solely contributed to this work.
Conflict-of-interest statement: There is no conflict of interest associated with the sole author or others who contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mohamed Taha ElShewy, MD, Orthopedic Department, Cairo University, 51 Demascus street, Dokki, Cairo 11412, Egypt.
Telephone: +20-12-22281698 Fax: +20-2-37496759
Received: May 26, 2015
Peer-review started: May 28, 2015
First decision: August 22, 2015
Revised: September 5, 2015
Accepted: November 17, 2015
Article in press: November 25, 2015
Published online: January 18, 2016

Calcific tendinitis within the rotator cuff tendon is a common shoulder disorder that should be differentiated from dystrophic calcification as the pathogenesis and natural history of both is totally different. Calcific tendinitis usually occurs in the fifth and sixth decades of life among sedentary workers. It is classified into formative and resorptive phases. The chronic formative phase results from transient hypoxia that is commonly associated with repeated microtrauma causing calcium deposition into the matrix vesicles within the chondrocytes forming bone foci that later coalesce. This phase may extend from 1 to 6 years, and is usually asymptomatic. The resorptive phase extends from 3 wk up to 6 mo with vascularization at the periphery of the calcium deposits causing macrophage and mononuclear giant cell infiltration, together with fibroblast formation leading to an aggressive inflammatory reaction with inflammatory cell accumulation, excessive edema and rise of the intra-tendineous pressure. This results in a severely painful shoulder. Radiological investigations confirm the diagnosis and suggest the phase of the condition and are used to follow its progression. Although routine conventional X-ray allows detection of the deposits, magnetic resonance imaging studies allow better evaluation of any coexisting pathology. Various methods of treatment have been suggested. The appropriate method should be individualized for each patient. Conservative treatment includes pain killers and physiotherapy, or “minimally invasive” techniques as needling or puncture and aspiration. It is almost always successful since the natural history of the condition ends with resorption of the deposits and complete relief of pain. Due to the intolerable pain of the acute and severely painful resorptive stage, the patient often demands any sort of operative intervention. In such case arthroscopic removal is the best option as complete removal of the deposits is unnecessary.

Keywords: Rotator cuff, Calcific tendenitis, Prevalence, Pathogenesis, Natural history, Classification, Clinical picture, Imaging, Treatment

Core tip: This review article discuss calcific tendinitis of the rotator cuff regarding the definition, prevalence, pathology, pathogenesis, natural history, clinical presentation, classification, diagnosis and various treatment modalities.