Review Question - QID 216901

The patient is presenting with suspected calcific tendonitis of the right shoulder. The next best step in management would be arthroscopic debridement of the calcification.

Calcific tendonitis of the shoulder is a painful condition that results in calcium hydroxyapatite deposition into the tendons of the rotator cuff. It typically affects patients between 30-60 years of age and is associated with diabetes and hypothyroidism. Initial treatment consists of physical therapy with anti-inflammatory medications and corticosteroid injections as needed. A needle aspiration and barbotage is another nonoperative treatment option. Refractory cases are treated surgical decompression with or without subacromial decompression.

Balke et al. performed a case series of 70 shoulders that underwent arthroscopic treatment consisting of calcium deposit excision with or without subacromial decompression. The authors reported at 6 years follow-up there was a significant improvement in shoulder pain and function compared to preoperative scores, but still diminished compared to the healthy shoulder. The authors concluded mid-term results of arthroscopic treatment are good but there is a higher incidence of rotator cuff tears in the operative shoulder and no apparent benefit of subacromial decompression.

Marder et al. performed a retrospective study of patients undergoing arthroscopic treatment of calcific tendonitis. They reported a long time to resumption of activity without pain in patients undergoing debridement with subacromial decompression compared to debridement alone. They concluded debridement alone for calcific tendonitis is effective and permits quicker return to baseline activity.

Ark et al. performed a retrospective study of 23 patients with calcific tendonitis treated with arthroscopic debridement and subacromial decompression. They reported complete calcium removal in 9 patients and 91% of patients experiencing either good or satisfactory results at 26 months follow-up. They concluded arthroscopic debridement with subacromial decompression is a good treatment option for calcific tendonitis.

Zubler et al. performed a retrospective study of 22 patients evaluated for calcific tendonitis with MR arthrography. They reported a poor inter-rater agreement or poor sensitivity of detecting calcific tendonitis alone. They concluded calcific tendonitis should not be evaluated with corresponding radiographs.

Figure A is a coronal T2 MRI with a hypointense signal in the supraspinatus tendon, which is concerning for calcific tendonitis.

Incorrect answers
Answer 1: Performing an isolated rotator cuff repair without debridement of the calcium deposit will not resolve the patient's symptoms.
Answer 2: A bone scan would provide no additional diagnostic utility in this case.
Answer 3: An MRI arthrogram would provide no added diagnostic benefit in this case.
Answer 4: An EMG would not provide any additional diagnostic utility in this case.