Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment

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Abstract

Calcific tendinitis is a painful shoulder disorder characterised by either single or multiple deposits in the rotator cuff tendon. Although the disease subsides spontaneously in most cases, a subpopulation of patients continue to complain of pain and shoulder dysfunction and the deposits do not show any signs of resolution. Although several treatment options have been proposed, clinical results are controversial and often the indication for a given therapy remains a matter of clinician choice. Herein, we report on the current state of the art in the pathogenesis, diagnosis and treatment of calcific tendinitis of the rotator cuff.

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Most cited references 65

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Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: a controlled study.

S Kontoyannis, M E Mavrikakis, A Rasidakis … (1989)

Two groups, one of 824 adult diabetics and one of 320 age and sex matched non-diabetics, were examined for abnormal glucose metabolism and calcifications on anteroposterior shoulder x rays. Two hundred and sixty two (31.8%) of the diabetics had shoulder calcification compared with 33 (10.3%) of the control group, with a preponderant localisation in the right shoulder. Diabetes of long duration treated with insulin for a long time was associated with a larger percentage of shoulder calcifications. These data and previous laboratory findings suggest a possible pathogenetic correlation between the prevalence of calcific shoulder tendinitis and diabetes.

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Calcific tendinitis: natural history and association with endocrine disorders.

Paul Harvie, Thomas Pollard, Andrew Carr (2015)

A retrospective, observational cohort study of 102 consecutive patients (125 shoulders) with calcific tendinitis is presented. Of the patients, 73 (71.6%) were women and 29 (28.4%) were men. Compared with population prevalences, significant levels of endocrine disorders were found. We compared 66 patients (62 women [93.9%] and 4 men [6.1%]; mean age, 50.3 years) (81 shoulders) with associated endocrine disease with 36 patients (11 women [30.6%] and 25 men [69.4%]); mean age, 52.4 years) (44 shoulders) without endocrine disease. The endocrine cohort was significantly younger than the non-endocrine cohort when symptoms started (mean, 40.9 years and 46.9 years, respectively), had significantly longer natural histories (mean, 79.7 months compared with 47.1 months), and had a significantly higher proportion who underwent operative treatment (46.9% compared with 22.7%). Disorders of thyroid and estrogen metabolism may contribute to calcific tendinitis etiology. Classifying calcific tendinitis into type I (idiopathic) and type II (secondary or endocrine-related) aids prognosis and management.

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Does erroneous differentiation of tendon-derived stem cells contribute to the pathogenesis of calcifying tendinopathy?

Gang Li, Pauline Lui, Yun-Feng Rui … (2011)

Calcifying tendinopathy is a tendon disorder with calcium deposits in the mid-substance presented with chronic activity-related pain, tenderness, local edema and various degrees of incapacitation. Most of current treatments are neither effective nor evidence-based because its underlying pathogenesis is poorly understood and treatment is usually symptomatic. Understanding the pathogenesis of calcifying tendinopathy is essential for its effective evidence-based management. One of the key histopathological features of calcifying tendinopathy is the presence of chondrocyte phenotype which surrounds the calcific deposits, suggesting that the formation of calcific deposits was cell-mediated. Although the origin of cells participating in the formation of chondrocyte phenotype and ossification is still unknown, many evidences have suggested that erroneous tendon cell differentiation is involved in the process. Recent studies have shown the presence of stem cells with self-renewal and multi-differentiation potential in human, horse, mouse and rat tendon tissues. We hypothesized that the erroneous differentiation of tendon-derived stem cells (TDSCs) to chondrocytes or osteoblasts leads to chondrometaplasia and ossification and hence weaker tendon, failed healing and pain, in calcifying tendinopathy. We present a hypothetical model on the pathogenesis and evidences to support this hypothesis. Understanding the key role of TDSCs in the pathogenesis of calcifying tendinopathy and the mechanisms contributing to their erroneous differentiation would provide new opportunities for the management of calcifying tendinopathy. The re-direction of the differentiation of resident TDSCs to tenogenic or supplementation of MSCs programmed for tenogenic differentiation may be enticing targets for the management of calcifying tendinopathy in the future.

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Author and article information

Contributors

Giovanni Merolla: +390541966382 , giovannimerolla@hotmail.com , giovanni.merolla@auslrn.net

Journal

Journal ID (nlm-ta): J Orthop Traumatol

Journal ID (iso-abbrev): J Orthop Traumatol

Title: Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1590-9921

ISSN (Electronic): 1590-9999

Publication date (Electronic): 12 July 2015

Publication date PMC-release: 12 July 2015

Publication date (Print): March 2016

Volume: 17

Issue: 1

Pages: 7-14

Affiliations

[ ]Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy

[ ]Biomechanics Laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica (RN) - AUSL della Romagna Ambito Territoriale di Rimini, Italy

Article

Publisher ID: 367

DOI: 10.1007/s10195-015-0367-6

PMC ID: 4805635

PubMed ID: 26163832

SO-VID: 4caa110f-c092-4335-9da0-fafeca7c9f4c

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 31 March 2015

Date accepted : 25 June 2015

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ScienceOpen disciplines: Orthopedics

Keywords: calcific tendinitis,shoulder,rotator cuff,diagnosis,treatment options

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ScienceOpen disciplines: Orthopedics

Keywords: calcific tendinitis, shoulder, rotator cuff, diagnosis, treatment options

Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment

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Most cited references 65

Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: a controlled study.

Calcific tendinitis: natural history and association with endocrine disorders.

Does erroneous differentiation of tendon-derived stem cells contribute to the pathogenesis of calcifying tendinopathy?

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