Calcific Shoulder Tendinitis. The Arthroscopic Management

Which is the Pathology of calcific tendinitis?
Deposition of calcium hydroxyapatite within the substance of a tendon, due to decreased oxygen tension, leading to fibrocartilagenous metaplasia and secondary mineralization

Where is it located?
This condition most frequently affects the rotator cuff of the shoulder supraspinatus : 80%,infraspinatus : 15%,subscapularis : 5%,periarticular soft tissues in addition to tendons, ligaments,
capsule, bursae.

Typically this condition affects middle aged patients between the ages of 30 and 60, with a slight predilection in women

The condition passes through four stages
fibrocartilagenous metaplasia

calcific or formative
symptoms are variable from none to pain on movement

most symptomatic
pain due to extravasation of calcium hydroxyapatite into adjacent tissues, especially subacromial bursa
pain typically lasts 2 weeks

variable symptomatology
some restriction of movement common
may last months

o «τόφος» του ασβεστίου

Radiographic features?
Calcific deposits visualized as homogeneous hyperdensity with variable morphology, but typically globular / amorphous with poor margins

Treatment and prognosis
Controversial and difficult to measure due to the inherent variability of the symptoms and the self limiting nature of the disease.
• Oral analgesia / anti-inflammatory medication
• Subacromial local anesthetic / steroid injection
• Aspiration of mineralised material
• Ultrasound therapy
• Extracorporeal schock wave therapy

Extracorporeal shockwave therapy
Acoustic waves (sound waves) induce fragmentation of the calcium crystals. It is the same technology used to break up kidney stones. 

Aspiration of mineralised material under U/S control

The arthroscopic removal of calcified tissues ( please see VIDEOS)