On the impact of calcified deposits within the rotator cuff tendons in shoulders of patients with shoulder pain and dysfunction

Relationship between calcific tendinopathy and rotator cuff tear on shoulder magnetic resonance imaging: case-controlled comparison

Purpose

To determine the frequency of rotator cuff tear on the shoulder magnetic resonance imaging (MRI) of patients with rotator cuff calcific tendinopathy and the relationship between rotator cuff tear and calcific tendinopathy.

Material and methods

In this retrospective case control study, 137 patients with calcific tendinopathy and 137 control group patients without calcific tendinopathy with shoulder pain, whose age, sex, and shoulder laterality values were matched, were compared in terms of rotator cuff tears on their shoulder MRI images.

Results

The frequency of rotator cuff tear was found to be significantly higher in the control group (37.2%) compared to the calcific tendinopathy group (23.4%) (p < 0.01). Partial thickness was 81.3% in the calcific tendinopathy group and 70.6% in the control group, and no significant difference was observed between the two groups in terms of the size of the rotator cuff tear (p > 0.05). In the calcific tendinopathy group, there was no significant relationship between the localisation of calcification and the rotator cuff tear, and only in 4.4% of the participants were calcification and tear at the same location on the same tendon (p > 0.05, r = 0.04).

Conclusions

The patients with calcific tendinopathy, who had been admitted with shoulder pain, did not demonstrate an increased risk of rotator cuff tear based on their MRI compared to patients with shoulder pain without calcific tendinopathy. No significant relationship was determined between calcific tendinopathy and rotator cuff tear.

Calcium hydroxyapatite deposition disease: Imaging features and presentations mimicking other pathologies

OBJECTIVE

Calcium hydroxyapatite depositional disease (HADD) is usually asymptomatic and self-limiting; however, when there is an associated inflammatory process or HADD occurs in an unusual location, it may mimic trauma, infection, or neoplasm. The purpose of this article is to review the imaging features of HADD and how to distinguish it from more worrisome entities that can have similar appearances.

CONCLUSION

An understanding of the presentations of HADD is important to allow early and confident diagnosis. In particular, familiarity with presentations that resemble more ominous pathologies is essential to avoid costly and time-consuming workup or intervention.

Alarming increase in the registration of degenerative rotator cuff-related lesions a nationwide epidemiological study investigating 244,519 patients

PURPOSE AND HYPOTHESIS

Shoulder lesions are common and a challenge to diagnose. They often result in significant disability for the patient and are an economic burden to society. From recent studies, an increasing incidence has been reported. The purpose of this study was to investigate and map the incidence of shoulder lesions in Denmark from 1996 to 2013 with focus on sex, age and geographical area.

METHODS

The Danish National Patient Registry was searched retrospectively to find the number of shoulder lesions in Denmark during the period 1996-2013. Regional population data were retrieved from the services of Statistics Denmark. Incidence rates were analysed using Poisson regression models, and all analyses were done in R 3.2.2, and p values less than 0.05 were considered statistically significant.

RESULTS

During the 18-year period, 244,519 patients with a DM 75 diagnosis were registered. Male-to-female ratio was 51:49, and median age was 51. Most frequent were rotator cuff syndrome with a mean incidence rate of 313.3 (confidence interval 241.8-384.8) per 10⁵ person-years at risk (PYRS). A statistically significant increase in overall incidence rate from 149.4 per 10⁵ PYRS in 1996 to 715.3 per 10⁵ PYRS in 2013 was found (p < 0.01). Incidence was highest for men aged 51-70 (1085.1 per 10⁵ PYRS in 2013). There was no significant difference in incidence between sexes. Rural areas had a 1.4-fold higher mean incidence rate than urban areas.

CONCLUSION

The incidence of shoulder lesions rapidly increased mainly due to an increase among people of working age (31-70 years). There were no significant differences in incidence between sexes. Rural areas had a 1.4-fold higher incidence rate than urban areas. As shoulder lesions impose a huge socioeconomic burden on society, not to mention a great distress to the patient, the present findings is highly relevant for political decision-making regarding preventive and health promoting initiatives.

Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment

Calcific tendinitis is a painful shoulder disorder characterised by either single or multiple deposits in the rotator cuff tendon. Although the disease subsides spontaneously in most cases, a subpopulation of patients continue to complain of pain and shoulder dysfunction and the deposits do not show any signs of resolution. Although several treatment options have been proposed, clinical results are controversial and often the indication for a given therapy remains a matter of clinician choice. Herein, we report on the current state of the art in the pathogenesis, diagnosis and treatment of calcific tendinitis of the rotator cuff.

Extracorporeal shockwave treatment is effective in calcific tendonitis of the shoulder. A randomized controlled trial

BACKGROUND

Calcific tendonitis of the shoulder is often associated with chronic pain and impairment of function. Extracorporeal shockwave therapy (ESWT) is considered to be a treatment option. We compared the effects of two different ESWT regimens.

METHODS

43 patients (57 shoulders) with symptomatic calcific tendonitis of the shoulder for more than six months were included in a double-blinded study. Thirty-one shoulders were treated at the area of maximum pain with application of 2 x 2000 impulses of 0.28 mJ/mm2 at an interval of two weeks (treatment group) and 26 shoulders with 2 x 2000 impulses of < 0.07 mJ/mm2 at an interval of two weeks (control group), without pretreatment analgesia. Shoulder function (Constant score) and pain (visual analogue scale, VAS) were assessed before treatment and at one week, three months and seven months after treatment. Shoulder X-rays were performed at the 3- and 7-month follow-up visits.

RESULTS

Improvement in Constant score was significantly higher in the treatment group at all follow-up visits (p < 0.05). Seven months post-treatment, calcifications dissolved completely in 19% of the treatment group and 8% of the control group, and a > 50% reduction was observed in 19% and 8% respectively. With regard to reduction of pain, there was significant improvement in the treatment group compared with the control group at the 1-week follow-up (p < 0.05). However, at the 3-month and 7-month visits, no significant between-group difference in pain could be detected.

CONCLUSION

As applied, ESWT with an energy flux density of 0.28 mJ/mm2 led to a significantly greater improvement in shoulder function and a slightly higher, nonsignificant, rate of > 50% disintegration of calcific deposits compared with the control group. However, this did not result in reduction of pain.