Calcific Tendinopathy of the Shoulder: Difference between revisions

No edit summary
No edit summary
 
(163 intermediate revisions by 15 users not shown)
Line 1: Line 1:
<div class="noeditbox">Welcome to [[Texas State University Evidence-based Practice Project|Texas State University's Evidence-based Practice project space]]. This is a wiki created by and for the students in the Doctor of Physical Therapy program at Texas State University - San Marcos. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox">
<div class="editorbox">
'''Original Editors'''  
'''Original Editors''' [[User:Mary Harris|Mary Harris]], [[User:Thomas Lawlor|Tom Lawlor]], [[User:Patrick Bales|Patrick Bales]], [[User:Misty Hillin|Misty Hillin]], [[User:Rick Wetherald|Rick Wetherald]]&nbsp;as part of the Texas Evidence Based Practice Project.


'''Lead Editors''' - Your name will be added here if you are a lead editor on this page.&nbsp; [[Physiopedia:Editors|Read more.]]
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
</div>  
</div>  
== Search Strategy  ==
&nbsp;


add text here related to databases searched, keywords, and search timeline <br>  
== Introduction ==
[[File:Dense calcification of the supraspinatus.jpeg|thumb|Calcification of the supraspinatus]]
Calcific tendinopathy (CT) of the shoulder is a common, painful condition identified by the existence of calcium deposits in the rotator cuff tendons.<ref name=":2">Sansone V, Maiorano E, Galluzzo A, Pascale V. Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment. Orthopedic research and reviews. 2018;10:63.Available:https://www.dovepress.com/calcific-tendinopathy-of-the-shoulder-clinical-perspectives-into-the-m-peer-reviewed-fulltext-article-ORR (accessed 12.1.2023)</ref> It usually results in shoulder pain with decreased range of motion. Diagnosis is made by shoulder x-rays, with visible signs of calcium deposits overlying the rotator cuff insertion.Treatment consists of NSAIDs, physical therapy, corticosteroid injections and ultrasound-guided needle lavage. Those who fail conservative treatment may choose to have arthroscopic decompression of the calcium deposits.<ref name=":1">Orthobullets [https://www.orthobullets.com/shoulder-and-elbow/3042/calcific-tendonitis Calcific Tendonitis]Available:https://www.orthobullets.com/shoulder-and-elbow/3042/calcific-tendonitis (accessed 12.1.2023)</ref>


== Definition/Description  ==
== Epidemiology ==
Usually occurs in middle-aged patients between the ages of 30 and 60, with a slight preference for females.<ref name=":0">Radiopedia [https://radiopaedia.org/articles/calcific-tendinitis?lang=gb Calcific Tendinitis] Available: https://radiopaedia.org/articles/calcific-tendinitis?lang=gb<nowiki/>(accessed 12.1.2023)</ref>


Calcific tendonitis refers to the deposition of calcium—predominantly hydroxyapatite—in a tendon, most often in those of the rotator cuff. May be secondary to a local decrease in oxygen tension resulting in fibrocartilaginous metaplasia and resulting calcification.<ref name="Serafini">Serafini G, Sconfienza L, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F. Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial. Radiology [serial online]. July 2009;252(1):157-164. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 20, 2011.</ref><br>
== Pathogenesis ==
Current theories indicate that CT may be the result of a cell-mediated process in which calcium deposition occur followed by their spontaneous resorption. However, in a few cases, this self-healing process is disrupted, causing symptoms. Literature now is showing that biological and genetic factors may underlie CTs genesis.. These new finding may explain why most of the therapies currently in use provide partially satisfactory outcomes.<ref name=":2" />


== Epidemiology/Etiology ==
== Localisation ==
<sup></sup>
*Supraspinatus tendon (80% of cases): critical zone -&nbsp;''Most Common''
*Infraspinatus tendon (15% of cases): lower 1/3
*Subscapularis tendon (5%of cases): pre-insertional fibers<ref name="Serafini">Serafini G, Sconfienza L, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F. Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial. Radiology [serial online]. July 2009;252(1):157-164. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 20, 2011.</ref>
{{#ev:youtube|ycphj08OJt0}}
== Characteristics/Clinical Presentation ==


'''Etiology is still unclear.'''
The chief patient complaints to expect in calcific tendinopathy are:


<u>Possible Causes</u>:<ref name="Cacchio">Cacchio A, Paoloni M, Spacca G, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Physical Therapy [serial online]. May 2006;86(5):672-682. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 25, 2011.</ref>  
* Night pain, causing loss of sleep.<sup><ref name="Ebenbichler">Ebenbichler G R. et. al. Ultrasound therapy for calcific tendinitis of the shoulder. New England Journal of Medicine. 1999; Vol 340 (20): 1533-1538.</ref>,&nbsp;<ref name="Gimblett">Gimblett P, Saville J, Ebrall P. A conservative management protocol for calcific tendinitis of the shoulder. Journal Of Manipulative And Physiological Therapeutics [serial online]. November 1999;22(9):622-627.</ref>,&nbsp;<ref name="Alexander">Alexander L D., et. al. Exposure to Low Amounts of Ultrasound Energy Does Not Improve Soft Tissue Shoulder Pathology: A Systematic Review. Physical Therapy.  2010; vol 90 (1): 14-25.</ref>,&nbsp;<ref name="Wainner" />.</sup>
* Constant dull ache<sup><ref name="Wainner" /></sup>.
* Pain increases considerably with AROM<sup><ref name="Wainner" /></sup>.
* Decrease in ROM, or complaint of stiffness&nbsp;<sup><ref name="Fusaro">Fusaro I, et. al. Functional results in calcific tendinitis of the shoulder treated with rehabilitation after ultrasonic-guided approach. Musculoskeletal Surgery. 2011 (95): S31–S36.</ref>,&nbsp;<ref name="Alexander" />,&nbsp;<ref name="Wainner" /></sup>.  
* Radiating pain up into the suboccipital region, or down into the fingers<ref name="Ebenbichler" />,&nbsp;<ref name="Gimblett" />,&nbsp;<ref name="Wainner" />.<br>The condition goes through 4 stage, see table below.


*Hypovasculariation
{| width="400" cellspacing="1" cellpadding="1" border="1"
*Local degenerative and proliferative changes
|-
! colspan="2" scope="col" bgcolor="#33cc00" | Stages<ref name="Wainner">Wainner R, Hasz M. Management of acute calcific tendinitis of the shoulder. Journal Of Orthopaedic &amp; Sports Physical Therapy [serial online]. March 1998;27(3):231-237. ( LOE 4 )</ref>
|-
| bgcolor="#66ff66" align="center" | Stage Name
| bgcolor="#66ff66" align="center" | Presentation
|-
|&nbsp;Chronic (Silent)<br>&nbsp;Phase
|
*Presence of the calcific deposit&nbsp;<br>is asymptomatic and may be so for years.


<br>Calcific tendonitis occurs in 2.5%–7.5% of healthy shoulders in adults. It's more commonly seen in women (70% of cases) and most frequently during the 5th decade of life.<ref name="Serafini" />
|-
|
Acute Painful Phase


<u>Common locations</u>:&nbsp;<ref name="Serafini" />  
|
*Severe pain, disability, and<br>frequently nocturnal discomfort.<br>


*The supraspinatus tendon (80% of cases): Critical Zone -'''''Most Common'''''
|-
*Infraspinatus tendon (15% of cases): lower 1/3
|
*subscapularis tendon (5%of cases): pre-insertional fibers<br><br>
Mechanical Phase&nbsp;


== Characteristics/Clinical Presentation  ==
|
*Tendon impingement being a prominent finding
*Pain of less severe nature than the acute phase


add text here <br>
|}


== Differential Diagnosis  ==
== Differential Diagnosis  ==


add text here<br>  
* Incidental calcification: found in 2.5-20% of 'normal' healthy shoulders.
* Degenerative calcification: found tendons with tear history; generally smaller; slightly older individuals
* Loose bodies: associated chondral defect; associated secondary osteoarthritis<ref name=":0" />


== Outcome Measures  ==
== Outcome Measures  ==
*[https://www.physio-pedia.com/Visual_Analogue_Scale VAS Pain scale]<ref name="Cacchio">Cacchio A, Paoloni M, Spacca G, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Physical Therapy [serial online]. May 2006;86(5):672-682.( LOE 1b )</ref><br>
*[[DASH Outcome Measure]]


add links to outcome measures here (also see [[Outcome Measures|Outcome Measures Database]])
== Medical Management    ==
Nonoperative


== Examination  ==
# NSAIDs, physical therapy, stretching & strengthening, steroid injections
# [[Tendinopathy Treatment Adjuncts|Extracorporeal shock-wave therapy as an adjunct treatment]]. Most useful in refractory calcific tendonitis in the formative and resting phases
# Ultrasound-guided needle lavage vs. needle barbotage (needle to break up calcium deposit)


add text here related to physical examination and assessment <br>  
Operative: surgical decompression of calcium deposit.<ref name=":1" />


== Medical Management <br>  ==
== Physiotherapy ==
Physiotherapy techniques include


add text here <br>  
* Range of motion exercises to avoid articular stiffness
* Strength exercises to restore normal shoulder/scapular mechanics.
* [[Scapular Dyskinesia|Scapular dyskinesia]] can cause subacromial impingement and a rehabilitation program that addresses this issue has been shown to reduce shoulder pain<ref name=":2" />. See link for detail.


== Physical Therapy Management <br>  ==
See [[Therapeutic Exercise for the Shoulder]]


add text here <br>  
There is evidence supporting the use of extracorporeal shock wave therapy (ESWT) as a potentially effective treatment of calcific tendinopathy.  See above link.<ref>Lee SY<sup>1</sup>, Cheng B, Grimmer-Somers K.
The midterm effectiveness of extracorporeal shockwave therapy in the management of chronic calcific shoulder tendinitis. ( LOE 2a )
</ref> But ECSW is not free from complications, that included transient bone marrow edema and even reported cases of humeral head necrosis.<ref>Humeral head osteonecrosis after extracorporeal shock-wave treatment for rotator cuff tendinopathy. A case report.
Liu HM, Chao CM, Hsieh JY, Jiang CC
J Bone Joint Surg Am. 2006 Jun; 88(6):1353-6. ( LOE 4 )
</ref><ref>Osteonecrosis of the humeral head after extracorporeal shock-wave lithotripsy.
Durst HB, Blatter G, Kuster MS
J Bone Joint Surg Br. 2002 Jul; 84(5):744-6. ( LOE 4 )
</ref>See [[Tendinopathy Treatment Adjuncts]]


== Key Research ==
== References ==


add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>  
<references />  


== Resources <br>  ==
&nbsp;


add appropriate resources here <br>
[[Category:Texas_State_University_EBP_Project]]
 
[[Category:Musculoskeletal/Orthopaedics|Orthopaedics]]  
== Clinical Bottom Line  ==
[[Category:Shoulder]]
 
[[Category:Conditions]]  
add text here <br>
[[Category:Conditions]]
 
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
 
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]  
<div class="researchbox">
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>
</div>
== References  ==
 
see [[Adding References|adding references tutorial]].
 
<references />


[[Category:Texas_State_University_EBP_Project]]
[[Category:Shoulder - Conditions]]
[[Category:Sports Medicine]]
[[Category:Tendinopathy]]

Latest revision as of 09:53, 12 January 2023

Original Editors Mary Harris, Tom Lawlor, Patrick Bales, Misty Hillin, Rick Wetherald as part of the Texas Evidence Based Practice Project.

Top Contributors - Mary Harris, Thomas Lawlor, Karina Leahy, Rick Wetherald, Patrick Bales, Admin, Lucinda hampton, Fasuba Ayobami, Kim Jackson, Tony Lowe, 127.0.0.1, Anthony Mertens, Wanda van Niekerk, Naomi O'Reilly and WikiSysop

 

Introduction[edit | edit source]

Calcification of the supraspinatus

Calcific tendinopathy (CT) of the shoulder is a common, painful condition identified by the existence of calcium deposits in the rotator cuff tendons.[1] It usually results in shoulder pain with decreased range of motion. Diagnosis is made by shoulder x-rays, with visible signs of calcium deposits overlying the rotator cuff insertion.Treatment consists of NSAIDs, physical therapy, corticosteroid injections and ultrasound-guided needle lavage. Those who fail conservative treatment may choose to have arthroscopic decompression of the calcium deposits.[2]

Epidemiology[edit | edit source]

Usually occurs in middle-aged patients between the ages of 30 and 60, with a slight preference for females.[3]

Pathogenesis[edit | edit source]

Current theories indicate that CT may be the result of a cell-mediated process in which calcium deposition occur followed by their spontaneous resorption. However, in a few cases, this self-healing process is disrupted, causing symptoms. Literature now is showing that biological and genetic factors may underlie CTs genesis.. These new finding may explain why most of the therapies currently in use provide partially satisfactory outcomes.[1]

Localisation[edit | edit source]

  • Supraspinatus tendon (80% of cases): critical zone - Most Common
  • Infraspinatus tendon (15% of cases): lower 1/3
  • Subscapularis tendon (5%of cases): pre-insertional fibers[4]

Characteristics/Clinical Presentation[edit | edit source]

The chief patient complaints to expect in calcific tendinopathy are:

  • Night pain, causing loss of sleep.[5], [6], [7], [8].
  • Constant dull ache[8].
  • Pain increases considerably with AROM[8].
  • Decrease in ROM, or complaint of stiffness [9], [7], [8].
  • Radiating pain up into the suboccipital region, or down into the fingers[5], [6], [8].
    The condition goes through 4 stage, see table below.
Stages[8]
Stage Name Presentation
 Chronic (Silent)
 Phase
  • Presence of the calcific deposit 
    is asymptomatic and may be so for years.

Acute Painful Phase

  • Severe pain, disability, and
    frequently nocturnal discomfort.

Mechanical Phase 

  • Tendon impingement being a prominent finding
  • Pain of less severe nature than the acute phase

Differential Diagnosis[edit | edit source]

  • Incidental calcification: found in 2.5-20% of 'normal' healthy shoulders.
  • Degenerative calcification: found tendons with tear history; generally smaller; slightly older individuals
  • Loose bodies: associated chondral defect; associated secondary osteoarthritis[3]

Outcome Measures[edit | edit source]

Medical Management[edit | edit source]

Nonoperative

  1. NSAIDs, physical therapy, stretching & strengthening, steroid injections
  2. Extracorporeal shock-wave therapy as an adjunct treatment. Most useful in refractory calcific tendonitis in the formative and resting phases
  3. Ultrasound-guided needle lavage vs. needle barbotage (needle to break up calcium deposit)

Operative: surgical decompression of calcium deposit.[2]

Physiotherapy[edit | edit source]

Physiotherapy techniques include

  • Range of motion exercises to avoid articular stiffness
  • Strength exercises to restore normal shoulder/scapular mechanics.
  • Scapular dyskinesia can cause subacromial impingement and a rehabilitation program that addresses this issue has been shown to reduce shoulder pain[1]. See link for detail.

See Therapeutic Exercise for the Shoulder

There is evidence supporting the use of extracorporeal shock wave therapy (ESWT) as a potentially effective treatment of calcific tendinopathy. See above link.[11] But ECSW is not free from complications, that included transient bone marrow edema and even reported cases of humeral head necrosis.[12][13]See Tendinopathy Treatment Adjuncts

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Sansone V, Maiorano E, Galluzzo A, Pascale V. Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment. Orthopedic research and reviews. 2018;10:63.Available:https://www.dovepress.com/calcific-tendinopathy-of-the-shoulder-clinical-perspectives-into-the-m-peer-reviewed-fulltext-article-ORR (accessed 12.1.2023)
  2. ↑ 2.0 2.1 Orthobullets Calcific TendonitisAvailable:https://www.orthobullets.com/shoulder-and-elbow/3042/calcific-tendonitis (accessed 12.1.2023)
  3. ↑ 3.0 3.1 Radiopedia Calcific Tendinitis Available: https://radiopaedia.org/articles/calcific-tendinitis?lang=gb(accessed 12.1.2023)
  4. ↑ Serafini G, Sconfienza L, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F. Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial. Radiology [serial online]. July 2009;252(1):157-164. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 20, 2011.
  5. ↑ 5.0 5.1 Ebenbichler G R. et. al. Ultrasound therapy for calcific tendinitis of the shoulder. New England Journal of Medicine. 1999; Vol 340 (20): 1533-1538.
  6. ↑ 6.0 6.1 Gimblett P, Saville J, Ebrall P. A conservative management protocol for calcific tendinitis of the shoulder. Journal Of Manipulative And Physiological Therapeutics [serial online]. November 1999;22(9):622-627.
  7. ↑ 7.0 7.1 Alexander L D., et. al. Exposure to Low Amounts of Ultrasound Energy Does Not Improve Soft Tissue Shoulder Pathology: A Systematic Review. Physical Therapy. 2010; vol 90 (1): 14-25.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Wainner R, Hasz M. Management of acute calcific tendinitis of the shoulder. Journal Of Orthopaedic & Sports Physical Therapy [serial online]. March 1998;27(3):231-237. ( LOE 4 )
  9. ↑ Fusaro I, et. al. Functional results in calcific tendinitis of the shoulder treated with rehabilitation after ultrasonic-guided approach. Musculoskeletal Surgery. 2011 (95): S31–S36.
  10. ↑ Cacchio A, Paoloni M, Spacca G, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Physical Therapy [serial online]. May 2006;86(5):672-682.( LOE 1b )
  11. ↑ Lee SY1, Cheng B, Grimmer-Somers K. The midterm effectiveness of extracorporeal shockwave therapy in the management of chronic calcific shoulder tendinitis. ( LOE 2a )
  12. ↑ Humeral head osteonecrosis after extracorporeal shock-wave treatment for rotator cuff tendinopathy. A case report. Liu HM, Chao CM, Hsieh JY, Jiang CC J Bone Joint Surg Am. 2006 Jun; 88(6):1353-6. ( LOE 4 )
  13. ↑ Osteonecrosis of the humeral head after extracorporeal shock-wave lithotripsy. Durst HB, Blatter G, Kuster MS J Bone Joint Surg Br. 2002 Jul; 84(5):744-6. ( LOE 4 )

 

Retrieved from "https://www.physio-pedia.com/index.php?title=Calcific_Tendinopathy_of_the_Shoulder&oldid=325052"