MR Arthrography Shoulder Calcium hydroxyapatite may be difficult to visualize on MRI given the lack of contrast between hypointense calcium and an adjacent normal tendon. However, MR arthrography can be used to identify a concomitant rotator cuff tear. In the setting of calcific tendonitis, 93% of rotator cuff tears are partial thickness [68]. Given the improved ability of MR arthrography to detect partial thickness articular-surface tears of the rotator cuff compared to conventional shoulder MRI [24-26], there may be an advantage to performing MR arthrography in patients with calcific tendinopathy [69]. MRI Shoulder Without and With IV Contrast There is insufficient evidence to support the use of MRI shoulder without and with IV contrast in the evaluation of chronic shoulder pain when radiographs demonstrate calcific tendinopathy or calcific bursitis. MRI Shoulder Without IV Contrast The signal void of calcium hydroxyapatite deposition can be difficult to distinguish from the hypointense signal in normal rotator cuff tendon, thus making identification of calcific tendonitis by MRI alone difficult in some cases. However, MRI can be used in calcific tendonitis cases to evaluate the extent of adjacent soft-tissue and bone abnormalities as well as exclude other causes of shoulder pain. Patients with calcific tendonitis on radiographs have up to a 56% incidence of concomitant rotator cuff tear seen on MRI [68]. Intraosseous migration of calcium hydroxyapatite can produce extensive marrow edema, which can be confused with a neoplastic process [52,70]. Radiography Shoulder Additional Views Calcium hydroxyapatite deposition in tendon or bursa is typically well seen on conventional radiographic projections, without a need for specialized additional views. Chronic Shoulder Pain US Shoulder US is reported to be 98% sensitive and 94% specific for calcium hydroxyapatite in the rotator cuff tendons [71], although identification may be challenging if the area of calcium deposition is small.
Chronic Shoulder Pain PCAs. MR Arthrography Shoulder Calcium hydroxyapatite may be difficult to visualize on MRI given the lack of contrast between hypointense calcium and an adjacent normal tendon. However, MR arthrography can be used to identify a concomitant rotator cuff tear. In the setting of calcific tendonitis, 93% of rotator cuff tears are partial thickness [68]. Given the improved ability of MR arthrography to detect partial thickness articular-surface tears of the rotator cuff compared to conventional shoulder MRI [24-26], there may be an advantage to performing MR arthrography in patients with calcific tendinopathy [69]. MRI Shoulder Without and With IV Contrast There is insufficient evidence to support the use of MRI shoulder without and with IV contrast in the evaluation of chronic shoulder pain when radiographs demonstrate calcific tendinopathy or calcific bursitis. MRI Shoulder Without IV Contrast The signal void of calcium hydroxyapatite deposition can be difficult to distinguish from the hypointense signal in normal rotator cuff tendon, thus making identification of calcific tendonitis by MRI alone difficult in some cases. However, MRI can be used in calcific tendonitis cases to evaluate the extent of adjacent soft-tissue and bone abnormalities as well as exclude other causes of shoulder pain. Patients with calcific tendonitis on radiographs have up to a 56% incidence of concomitant rotator cuff tear seen on MRI [68]. Intraosseous migration of calcium hydroxyapatite can produce extensive marrow edema, which can be confused with a neoplastic process [52,70]. Radiography Shoulder Additional Views Calcium hydroxyapatite deposition in tendon or bursa is typically well seen on conventional radiographic projections, without a need for specialized additional views. Chronic Shoulder Pain US Shoulder US is reported to be 98% sensitive and 94% specific for calcium hydroxyapatite in the rotator cuff tendons [71], although identification may be challenging if the area of calcium deposition is small.