Calcific Tendinitis Lowe

Question 1

What is calcified tendonitis:

Answer 1

-tendon condition produced by the deposit of calcium hydroxyapatite crystals

-occurs most often in the supraspinatus tendon

Question 2

Characteristics:

Answer 2

• deposits do not appear to be caused by trauma or systemic disease (seldom related to rotator cuff tears); calcium deposits disappear and reabsorb as readily as they appear; found in healthy tissue and in people younger than expected with degenerative calcification; between 30-60 years; affect women more; identified with x-ray

-deposits usually located 1-2 cm proximal to supraspinatus insertion; can be mistaken for supraspinatus tendinitis/tendinosis

-four phases:

1. formative: deposit develops and enlarges
2. resting: deposit may or may not produce pain, can produce mechanical dysfunction
3. resorptive: inflammation that works to break deposit down
4. postcalcific phase: deposit fully reabsorbed, tendon heals

-pain varies from no to severe; found in asymptomatic patients and those with shoulder pain not related to calcification; when there is pain, resembles shoulder impingement syndrome; if pain comes on rapidly, it can help distinguish it from impingement pain, rotator cuff disorders and frozen shoulder; night pain common; rest may or may not provide relief; may increase when arm is raised above shoulder; may be unable to find pain-free position even when motionless

Question 3

History:

Answer 3

sharp, sudden pain in shoulder; similar to toothache, deep, throbbing; limited shoulder motion; pain during activity and rest; ask about positions that produce or relieve pain; failure to identify consistent positions that decrease pain is indicative

Question 4

Observation:

Answer 4

no specific findings; apprehension and movement guarding common due to pain avoidance; abduction/flexion motion are irregular due to pain or altered biomechanics; reflex muscular inhibition can cause weakness, uncoordinated movements

Question 5

Palpation:

Answer 5

severe pain at the greater tuberosity of the humerus likely; residual tenderness and hypertonicity in surrounding muscles; swelling rarely evident

Question 6

Range of Motion and Resistance Testing

Answer 6

AROM: pain with compression of irritated tissues possible with abduction/flexion; painful arc during abduction possible; erratic motion due to pain possible; lack of pain does not indicate absence of condition

PROM: as with AROM

MRT: abduction may/may not produce pain as affected tendon is recruited; may be pain in other
resisted actions where affected tendon is not recruited

Question 7

Differential Evaluation:

Answer 7

rotator cuff tears, tendinosis, shoulder impingement syndrome, frozen shoulder/adhesive capsulitis, labral damage, bicipital tendinosis, cervical disc pathology, thoracic outlet syndrome

Question 8

Suggestions for Treatment:

Answer 8

clear protocol has not been established; conservative measures including stretching, rest, shoulder slings, anti-inflammatory medications; relieve stress on supraspinatus tendon; extracorporeal shock wave therapy to break up calcification; massage could be contraindicated with damage fibres; may be possible in final resorptive phase to break up calcification