Calcified tendonitis of the rotator cuff. A review of this common shoulder pathology
Keywords:
Calcified Tendonitis, Shoulder Stiffness, Shoulder Treatment, Rotator Cuff, Shoulder Pain.Abstract
Calcified tendonitis is an acute or chronic painful condition due to the presence of calcium phosphate crystals within or around the tendons that form the rotator cuff.
The precise mechanism leading to the deposition of calcium crystals remains unclear. Factors that appear to contribute to this pathology are metabolic diseases (diabetes, thyroid hormone abnormalities), medication factors (e.g., corticosteroids), genetic predisposition of the individual, and overuse injuries.
Clinically, calcified tendonitis is usually asymptomatic. However, in some cases it is characterized by severe pain, which is more addressed in the morning. Many times, the intensity of the pain is so high that it inhibits movements, resulting in stiff shoulder joints. A simple x-ray is the most appropriate imaging method to diagnose the disease. As far as concerns the course of the disease, in many cases, an automatic resorption of calcium is observed while the symptoms recede. The precise mechanisms associated with absorption are unknown.
Numerous treatment options have been reported in the literature that are applied on a case-by-case basis and vary in efficacy.
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References
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Codman EA. The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or about the Subacromial Bursa. Boston: Thomas Todd Co; 1934.
Speed CA, Hazleman BL. Calcific tendinitis of the shoulder. N Engl J Med. 1999; 340:1582–1584.
Loew M, Jurgowski W, Mau HC, et al. Treatment of calcifying tendinitis of rotator cuff by extracorporeal shock waves: A preliminary report. J Shoulder Elbow Surg. 1995;4:101–106.
Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br. 1970; 52:540–553.
Booth RE, Jr, Marvel JP., Jr Differential diagnosis of shoulder pain. Orthop Clin North Am. 1975; 6:353–379.
Gosens T, Hofstee DJ. Calcifying tendinitis of the shoulder: advances in imaging and management. Curr Rheum Rep. 2009; 11:129–134.
Farin PU, Räsänen H, Jaroma H, et al. Rotator cuff calcifications: treatment with ultrasound-guided percutaneous needle aspiration and lavage. Skeletal Radiol. 1996; 25:551–554.
Serafini G, Sconfienza LM, Lacelli F, et al. Rotator cuff calcific tendinitis: short-term and 10-year outcomes after two-needle US-guided percutaneous treatment. Non randomized controlled trial. Radiology. 2009; 252:157–164.
del Cura JL, Torre I, Zabala R, et al. Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results. AJR Am J Roentgenol. 2007;189:W128–134.
Uhthoff HK, Sarkar K, Maynard JA. Calcifying tendinits: a new concept of its pathogenesis. Clin Orthop Relat Res. 1976; 118:164–168.
Oliva F, Via AG, Maffulli N. Physiopathology of intratendinous calcific deposition. BMC Med. 2012; 10:95.
Hamada J, Tamai K, Ono W, Saotome K. Does the nature of deposited basic calcium phosphate crystals determine clinical course in calcific periarthritis of the shoulder? J Rheumathol. 2006; 33:326– 332.
Penel G, Leroy G, Rey C, Bres E. MicroRaman spectral study of the PO4 and CO3 vibrational modes in synthetic and biological apatites. Calcif Tissue Int. 1998; 63:475–481.
Chiou HJ, Hung SC, Lin SY, Wei YS, Li MJ. Correlations among mineral components, progressive calcification process and clinical symptoms of calcific tendonitis. Rheumatology. 2010;49:548–555.
Archer R, Bayley J, Archer C, Ali S. Cell and matrix changes associated with pathological calcification of the human rotator cuff tendons. J Anat. 1993;182:1–12.
Gohr CM, Fahey M, Rosenthal AK. Calcific tendonitis: a model. Connect Tissue Res. 2007;48:286–291.
Merolla G, Dave AC, Paladini P, Campi F, Porcellini G (2014) Ossifying tendinitis of the rotator cuff after arthroscopic excision of calcium deposits: two case reports and literature review. J Orthop Traumatol 15 [Epub ahead of print]
Bayam L, Ahmad MA, Naqui SZ, Chouhan A, Funk L. Pain mapping for common shoulder disorders. Am J Orthop. 2011;40(7):353–358.
Spivey JL, Carrell TM. Severe pain in the shoulder with no history of trauma. Calcific tendinitis. JAAPA. 2009;22(4):59–60.
Hurt G, Baker CL., Jr Calcific tendinitis of the shoulder. Orthop Clin North Am. 2003;34:567–575.
Neer CS., II. Less frequent procedures. In: Neer CS II, editor. Shoulder reconstruction. Philadelphia: WB Saunders; 1990. pp. 421–485.
Gotoh M, Hamada K, Yamakawa H, Inoue A, Fukuda H. Increased substance P in subacromial bursa and shoulder pain in rotator cuff diseases. J Orthop Res. 1998;16(5):618–621.
Gosens T, Hofstee DJ. Calcifying tendinitis of the shoulder: advances in imaging and management. Curr Rheumatol Rep. 2009;11(2):129–134.
Le Goff B, Berthelot JM, Guillot P, Glémarec J, Maugars Y. Assessment of calcific tendonitis of rotator cuff by ultrasonography: comparison between symptomatic and asymptomatic shoulders. Joint Bone Spine. 2010;77:258–263.
Martinoli C, Bianchi S, Prato N, Pugliese F, Zamorani MP, Valle M, Derchi LE. US of the shoulder: non-rotator cuff disorders. RadioGraphics. 2003;23:381–401.
Flemming DJ, Murphey MD, Shekitka KM, Temple HT, Jelinek JJ, Kransdorf MJ. Osseous involvement in calcific tendinitis: a retrospective review of 50 cases. AJR Am J Roentgenol. 2003;181:965–972.
Ogon P, Suedkamp NP, Jaeger M, Izadpanah K, Koestler W, Maier D. Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulder. Arthritis Rheum. 2009;60(10):2978–2984. doi: 10.1002/art.24845. [PubMed] [CrossRef]
Brown KM, Saunders MM, Kirsch T, Donahue HJ, Reid JS. Effect of COX-2-specific inhibition on fracture-healing in the rat femur. J Bone Joint Surg Am. 2004;86-a:116–123.
Connizzo BK, Yannascoli SM, Tucker JJ, et al. The detrimental effects of systemic Ibuprofen delivery on tendon healing are time-dependent. Clin Orthop Relat Res. 2014;472:2433–2439.
Gerstenfeld LC, Al-Ghawas M, Alkhiary YM, et al. Selective and nonselective cyclooxygenase-2 inhibitors and experimental fracture-healing. Reversibility of effects after short-term treatment. J Bone Joint Surg Am. 2007;89:114–125. [PubMed] [Google Scholar]
Uhthoff H, Sarkar K, Maynard J. Calcifying tendinitis: a new concept of its pathogenesis. Clin Orthop Relat Res. 1976;118:164–168.
Noel E, Carillon Y, Gaillard T, Bouvier M. Needle aspiration irrigation in calcifying tendinitis of rotator cuff. In: Gazielly DF, Gleyze PT, editors. The cuff. Paris: Elsevier; 1997. pp. 152–157.
Tillander B, Franzen LE, Karlsson MH, Norlin R. Effect of steroid injections on the rotator cuff: an experimental study in rats. J Shoulder Elbow Surg. 1999;8(3):271–274. doi: 10.1016/S1058- 2746(99)90141-6.
G. Fryer, L. Hodgson.The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle. J.Bodyw. Mov. Ther., 9 (4) (2005), pp. 248-255
Haik, M.N.; Alburquerque-Sendin, F.; Moreira, R.F.; Pires, E.D.; Camargo, P.R. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. Br. J. Sports Med. 2016, 50, 1124–1134,
Comfort TH, Arafiles R. Barbotage of the shoulder with image-intensified fluoroscopic control of needle placement for calcified tendinitis. Clin Orthop Relat Res. 1978;135:171–178.
Farin PU, Jaroma H, Soimakallio S. Rotator cuff calcifications: treatment with US-guided technique. Radiology. 1995;195(3):841–843. doi: 10.1148/radiology.195.3.7754018.
Castillo-González FD, Ramos-Álvarez JJ, Rodríguez-Fabián G, González-Pérez J, Calderón- Montero J. Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study. Muscles Ligaments Tendons J. 2014;4(2):220–225.
de Witte PB, Selten JW, Navas A, Nagels J, Visser CP, Nelissen RG, Reijnierse M. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med. 2013;41(7):1665–1673.
De Witte, P. B., Kolk, A., Overes, F., Nelissen, R. G. H. H., & Reijnierse, M. (2017). Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Needling and Lavage Versus Subacromial Corticosteroids: Five-Year Outcomes of a Randomized Controlled Trial. The American Journal of Sports Medicine, 45(14), 3305–3314.
Vignesh KN, McDowall A, Simunovic N, Bhandari M, Choudur HN. Efficacy of ultrasound- guided percutaneous needle treatment of calcific tendinitis. AJR Am J Roentgenol. 2015;204(1):148– 152.
Yi-Cheng Wu, Wen-Chung Tsai, Yu-Kung Tu, Tung-Yang Yu. Comparative Effectiveness of Nonoperative Treatments for Chronic Calcific Tendinitis of the Shoulder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Archives of Physical Medicine and Rehabilitation 2017;98:1678-92.
Rompe JD, Kirkpatrick CJ, Kullmer K, Schwitalle M, Krischek O. Dose-related effects of shock waves on rabbit tendo Achillis: a sonographic and histological study. J Bone Jt Surg Br. 1998;80(3):546–552.
Farr S, Sevelda F, Mader P, Graf A, Petje G, Sabeti-Aschraf M. Extracorporeal shockwave therapy in calcifying tendinitis of the shoulder. Knee Surg Sports Traumatol Arthrosc. 2011;19(12):2085–2089.
Ioppolo F, Tattoli M, Di Sante L, Attanasi C, Venditto T, Servidio M, Cacchio A, Santilli V. Extracorporeal shock-wave therapy for supraspinatus calcifying tendinitis: a randomized clinical trial comparing two different energy levels. Phys Ther. 2012;92(11):1376–1385.
Albert JD, Meadeb J, Guggenbuhl P, Marin F, Benkalfate T, Thomazeau H, Chalès G. High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial. J Bone Jt Surg Br. 2007;89(3):335–341.
Hsu CJ, Wang DY, Tseng KF, Fong YC, Hsu HC, Jim YF. Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. J Shoulder Elbow Surg Br. 2008;17(1):55–59.
Daecke W, Kusnierczak D, Loew M. Long-term effects of extracorporeal shockwave therapy in chronic calcific tendinitis of the shoulder. J Shoulder Elbow Surg. 2002;11(5):476–480
Kim YS, Lee HJ, Kim YV, Kong CG. Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. J Shoulder Elbow Surg. 2014;23(11):1640–1646.
Verhaegen, F., Brys, P., & Debeer, P. (2016). Rotator cuff healing after needling of a calcific deposit using platelet-rich plasma augmentation: a randomized, prospective clinical trial. Journal of Shoulder and Elbow Surgery, 25(2), 169–173.
Pakos, E., Gkiatas, I., Rakkas, G., Papadopoulos, D., Gelalis, I., Vekris, M., & Korompilias, A. (2018). Calcific deposit needling in combination with extracorporeal shock wave therapy (ESWT): A proposed treatment for supraspinatus calcified tendinopathy. SICOT-J, 4, 45.
El Shewy MT. Arthroscopic removal of calcium deposits of the rotator cuff: a 7-year follow-up. Am J Sports Med. 2011; 39:1302–1305.
Jacobs R, Debeer P. Calcifying tendinitis of the rotator cuff: functional outcome after arthroscopic treatment. Acta Orthop Belg. 2006; 72:276–281.
Oliva F, Via AG, Maffulli N. Physiopathology of intratendinous calcific deposition. BMC Med. 2012; 10:95.
Seil R, Litzenburger H, Kohn D, Rupp S. Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy. 2006; 22:521–527. [PubMed]Hurt G, Baker CL. Calcific tendinitis of the shoulder. Orthop Clin North Am. 2003; 34:567–575.
Jerosch J, Strauss JM, Schmiel S. Arthroscopic treatment of calcific tendinitis of the shoulder. J Shoulder Elbow Surg. 1998; 7:30–37.
Rizzello G, Franceschi F, Longo UG, et al. Arthroscopic management of calcific tendinopathy of the shoulder—do we need to remove all the deposit? Bull NYU Hosp Joint Dis. 2009; 67:330–333.
DE Witte PB, Selten JW, Navas A, et al. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med. 2013;41:1665–1673.
Seyahi A, Demirhan M. Arthroscopic removal of intraosseous and intratendinous deposits in calcifying tendinitis of the rotator cuff. Arthroscopy. 2009;25:590–596.
Maier D, Jaeger M, Izadpanah K, Bornebusch L, Suedkamp NP, Ogon P. Rotator cuff preservation in arthroscopic treatment of calcific tendinitis. Arthroscopy. 2013; 29:824–831.
Marder RA, Heiden EA, Kim S. Calcific tendonitis of the shoulder: is subacromial decompression in combination with removal of the calcific deposit beneficial? J Shoulder Elbow Surg. 2011; 20:955– 960.
Codman EA. The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or about the Subacromial Bursa. Boston: Thomas Todd Co; 1934.
Speed CA, Hazleman BL. Calcific tendinitis of the shoulder. N Engl J Med. 1999; 340:1582–1584.
Loew M, Jurgowski W, Mau HC, et al. Treatment of calcifying tendinitis of rotator cuff by extracorporeal shock waves: A preliminary report. J Shoulder Elbow Surg. 1995;4:101–106.
Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br. 1970; 52:540–553.
Booth RE, Jr, Marvel JP., Jr Differential diagnosis of shoulder pain. Orthop Clin North Am. 1975; 6:353–379.
Gosens T, Hofstee DJ. Calcifying tendinitis of the shoulder: advances in imaging and management. Curr Rheum Rep. 2009; 11:129–134.
Farin PU, Räsänen H, Jaroma H, et al. Rotator cuff calcifications: treatment with ultrasound-guided percutaneous needle aspiration and lavage. Skeletal Radiol. 1996; 25:551–554.
Serafini G, Sconfienza LM, Lacelli F, et al. Rotator cuff calcific tendinitis: short-term and 10-year outcomes after two-needle US-guided percutaneous treatment. Non randomized controlled trial. Radiology. 2009; 252:157–164.
del Cura JL, Torre I, Zabala R, et al. Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results. AJR Am J Roentgenol. 2007;189:W128–134.
Uhthoff HK, Sarkar K, Maynard JA. Calcifying tendinits: a new concept of its pathogenesis. Clin Orthop Relat Res. 1976; 118:164–168.
Oliva F, Via AG, Maffulli N. Physiopathology of intratendinous calcific deposition. BMC Med. 2012; 10:95.
Hamada J, Tamai K, Ono W, Saotome K. Does the nature of deposited basic calcium phosphate crystals determine clinical course in calcific periarthritis of the shoulder? J Rheumathol. 2006; 33:326– 332.
Penel G, Leroy G, Rey C, Bres E. MicroRaman spectral study of the PO4 and CO3 vibrational modes in synthetic and biological apatites. Calcif Tissue Int. 1998; 63:475–481.
Chiou HJ, Hung SC, Lin SY, Wei YS, Li MJ. Correlations among mineral components, progressive calcification process and clinical symptoms of calcific tendonitis. Rheumatology. 2010;49:548–555.
Archer R, Bayley J, Archer C, Ali S. Cell and matrix changes associated with pathological calcification of the human rotator cuff tendons. J Anat. 1993;182:1–12.
Gohr CM, Fahey M, Rosenthal AK. Calcific tendonitis: a model. Connect Tissue Res. 2007;48:286–291.
Merolla G, Dave AC, Paladini P, Campi F, Porcellini G (2014) Ossifying tendinitis of the rotator cuff after arthroscopic excision of calcium deposits: two case reports and literature review. J Orthop Traumatol 15 [Epub ahead of print]
Bayam L, Ahmad MA, Naqui SZ, Chouhan A, Funk L. Pain mapping for common shoulder disorders. Am J Orthop. 2011;40(7):353–358.
Spivey JL, Carrell TM. Severe pain in the shoulder with no history of trauma. Calcific tendinitis. JAAPA. 2009;22(4):59–60.
Hurt G, Baker CL., Jr Calcific tendinitis of the shoulder. Orthop Clin North Am. 2003;34:567–575.
Neer CS., II. Less frequent procedures. In: Neer CS II, editor. Shoulder reconstruction. Philadelphia: WB Saunders; 1990. pp. 421–485.
Gotoh M, Hamada K, Yamakawa H, Inoue A, Fukuda H. Increased substance P in subacromial bursa and shoulder pain in rotator cuff diseases. J Orthop Res. 1998;16(5):618–621.
Gosens T, Hofstee DJ. Calcifying tendinitis of the shoulder: advances in imaging and management. Curr Rheumatol Rep. 2009;11(2):129–134.
Le Goff B, Berthelot JM, Guillot P, Glémarec J, Maugars Y. Assessment of calcific tendonitis of rotator cuff by ultrasonography: comparison between symptomatic and asymptomatic shoulders. Joint Bone Spine. 2010;77:258–263.
Martinoli C, Bianchi S, Prato N, Pugliese F, Zamorani MP, Valle M, Derchi LE. US of the shoulder: non-rotator cuff disorders. RadioGraphics. 2003;23:381–401.
Flemming DJ, Murphey MD, Shekitka KM, Temple HT, Jelinek JJ, Kransdorf MJ. Osseous involvement in calcific tendinitis: a retrospective review of 50 cases. AJR Am J Roentgenol. 2003;181:965–972.
Ogon P, Suedkamp NP, Jaeger M, Izadpanah K, Koestler W, Maier D. Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulder. Arthritis Rheum. 2009;60(10):2978–2984. doi: 10.1002/art.24845. [PubMed] [CrossRef]
Brown KM, Saunders MM, Kirsch T, Donahue HJ, Reid JS. Effect of COX-2-specific inhibition on fracture-healing in the rat femur. J Bone Joint Surg Am. 2004;86-a:116–123.
Connizzo BK, Yannascoli SM, Tucker JJ, et al. The detrimental effects of systemic Ibuprofen delivery on tendon healing are time-dependent. Clin Orthop Relat Res. 2014;472:2433–2439.
Gerstenfeld LC, Al-Ghawas M, Alkhiary YM, et al. Selective and nonselective cyclooxygenase-2 inhibitors and experimental fracture-healing. Reversibility of effects after short-term treatment. J Bone Joint Surg Am. 2007;89:114–125. [PubMed] [Google Scholar]
Uhthoff H, Sarkar K, Maynard J. Calcifying tendinitis: a new concept of its pathogenesis. Clin Orthop Relat Res. 1976;118:164–168.
Noel E, Carillon Y, Gaillard T, Bouvier M. Needle aspiration irrigation in calcifying tendinitis of rotator cuff. In: Gazielly DF, Gleyze PT, editors. The cuff. Paris: Elsevier; 1997. pp. 152–157.
Tillander B, Franzen LE, Karlsson MH, Norlin R. Effect of steroid injections on the rotator cuff: an experimental study in rats. J Shoulder Elbow Surg. 1999;8(3):271–274. doi: 10.1016/S1058- 2746(99)90141-6.
G. Fryer, L. Hodgson.The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle. J.Bodyw. Mov. Ther., 9 (4) (2005), pp. 248-255
Haik, M.N.; Alburquerque-Sendin, F.; Moreira, R.F.; Pires, E.D.; Camargo, P.R. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. Br. J. Sports Med. 2016, 50, 1124–1134,
Comfort TH, Arafiles R. Barbotage of the shoulder with image-intensified fluoroscopic control of needle placement for calcified tendinitis. Clin Orthop Relat Res. 1978;135:171–178.
Farin PU, Jaroma H, Soimakallio S. Rotator cuff calcifications: treatment with US-guided technique. Radiology. 1995;195(3):841–843. doi: 10.1148/radiology.195.3.7754018.
Castillo-González FD, Ramos-Álvarez JJ, Rodríguez-Fabián G, González-Pérez J, Calderón- Montero J. Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study. Muscles Ligaments Tendons J. 2014;4(2):220–225.
de Witte PB, Selten JW, Navas A, Nagels J, Visser CP, Nelissen RG, Reijnierse M. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med. 2013;41(7):1665–1673.
De Witte, P. B., Kolk, A., Overes, F., Nelissen, R. G. H. H., & Reijnierse, M. (2017). Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Needling and Lavage Versus Subacromial Corticosteroids: Five-Year Outcomes of a Randomized Controlled Trial. The American Journal of Sports Medicine, 45(14), 3305–3314.
Vignesh KN, McDowall A, Simunovic N, Bhandari M, Choudur HN. Efficacy of ultrasound- guided percutaneous needle treatment of calcific tendinitis. AJR Am J Roentgenol. 2015;204(1):148– 152.
Yi-Cheng Wu, Wen-Chung Tsai, Yu-Kung Tu, Tung-Yang Yu. Comparative Effectiveness of Nonoperative Treatments for Chronic Calcific Tendinitis of the Shoulder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Archives of Physical Medicine and Rehabilitation 2017;98:1678-92.
Rompe JD, Kirkpatrick CJ, Kullmer K, Schwitalle M, Krischek O. Dose-related effects of shock waves on rabbit tendo Achillis: a sonographic and histological study. J Bone Jt Surg Br. 1998;80(3):546–552.
Farr S, Sevelda F, Mader P, Graf A, Petje G, Sabeti-Aschraf M. Extracorporeal shockwave therapy in calcifying tendinitis of the shoulder. Knee Surg Sports Traumatol Arthrosc. 2011;19(12):2085–2089.
Ioppolo F, Tattoli M, Di Sante L, Attanasi C, Venditto T, Servidio M, Cacchio A, Santilli V. Extracorporeal shock-wave therapy for supraspinatus calcifying tendinitis: a randomized clinical trial comparing two different energy levels. Phys Ther. 2012;92(11):1376–1385.
Albert JD, Meadeb J, Guggenbuhl P, Marin F, Benkalfate T, Thomazeau H, Chalès G. High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial. J Bone Jt Surg Br. 2007;89(3):335–341.
Hsu CJ, Wang DY, Tseng KF, Fong YC, Hsu HC, Jim YF. Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. J Shoulder Elbow Surg Br. 2008;17(1):55–59.
Daecke W, Kusnierczak D, Loew M. Long-term effects of extracorporeal shockwave therapy in chronic calcific tendinitis of the shoulder. J Shoulder Elbow Surg. 2002;11(5):476–480
Kim YS, Lee HJ, Kim YV, Kong CG. Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. J Shoulder Elbow Surg. 2014;23(11):1640–1646.
Verhaegen, F., Brys, P., & Debeer, P. (2016). Rotator cuff healing after needling of a calcific deposit using platelet-rich plasma augmentation: a randomized, prospective clinical trial. Journal of Shoulder and Elbow Surgery, 25(2), 169–173.
Pakos, E., Gkiatas, I., Rakkas, G., Papadopoulos, D., Gelalis, I., Vekris, M., & Korompilias, A. (2018). Calcific deposit needling in combination with extracorporeal shock wave therapy (ESWT): A proposed treatment for supraspinatus calcified tendinopathy. SICOT-J, 4, 45.
El Shewy MT. Arthroscopic removal of calcium deposits of the rotator cuff: a 7-year follow-up. Am J Sports Med. 2011; 39:1302–1305.
Jacobs R, Debeer P. Calcifying tendinitis of the rotator cuff: functional outcome after arthroscopic treatment. Acta Orthop Belg. 2006; 72:276–281.
Oliva F, Via AG, Maffulli N. Physiopathology of intratendinous calcific deposition. BMC Med. 2012; 10:95.
Seil R, Litzenburger H, Kohn D, Rupp S. Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy. 2006; 22:521–527. [PubMed]Hurt G, Baker CL. Calcific tendinitis of the shoulder. Orthop Clin North Am. 2003; 34:567–575.
Jerosch J, Strauss JM, Schmiel S. Arthroscopic treatment of calcific tendinitis of the shoulder. J Shoulder Elbow Surg. 1998; 7:30–37.
Rizzello G, Franceschi F, Longo UG, et al. Arthroscopic management of calcific tendinopathy of the shoulder—do we need to remove all the deposit? Bull NYU Hosp Joint Dis. 2009; 67:330–333.
DE Witte PB, Selten JW, Navas A, et al. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med. 2013;41:1665–1673.
Seyahi A, Demirhan M. Arthroscopic removal of intraosseous and intratendinous deposits in calcifying tendinitis of the rotator cuff. Arthroscopy. 2009;25:590–596.
Maier D, Jaeger M, Izadpanah K, Bornebusch L, Suedkamp NP, Ogon P. Rotator cuff preservation in arthroscopic treatment of calcific tendinitis. Arthroscopy. 2013; 29:824–831.
Marder RA, Heiden EA, Kim S. Calcific tendonitis of the shoulder: is subacromial decompression in combination with removal of the calcific deposit beneficial? J Shoulder Elbow Surg. 2011; 20:955– 960.
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