During the formative phase, X-ray images typically reveal calcium deposits with uniform density and a clear margin. In the more painful resorptive phase, deposits instead appear cloudy and with unclear margins. By arthroscopy, formative stage deposits appear crystalline and chalk-like, while resorptive stage deposits appear smooth resembling toothpaste. Ultrasound is also used to locate and assess calcium deposits. In the formative stage, deposits are hyperechoic and arc-shaped; in the resorptive stage deposits are less echogenic and appear fragmented. Treatment
The first line of treatment for calcific tendinitis is typically nonsteroidal anti-inflammatory drugs to relieve pain, rest for the affected joint, and sometimes physical therapy to avoid joint stiffness. For those with severe pain direct injections of steroids to the affected site are often effective for pain relief, but may interfere with reabsorption of the calcium deposit. For those whose pain doesnt improve with medication and rest, the deposit can be dissolved and removed with techniques called "ultrasound-guided needling", "barbotage", and "US-PICT" (for "ultrasound percutaneous injection in calcific tenditis"). In each, ultrasound is used to locate the deposit and guide a needle to the affected site. There saline and lidocaine are injected to dissolve the deposit, then removed to wash it away. Another common treatment is extracorporeal shockwave therapy, where pulses of sound are used to break up the deposit and promote healing. There is little standardization of energy levels, duration, and time interval of treatment; though most studies report positive outcomes with low- to medium-energy waves (below 0.28 mJ/mm2).
History
Calcifications in the rotator cuff tendon were first described by Ernest Codman in his 1934 book The Shoulder. In 1952, in his study on x-ray therapy for people with such calcifications, Henry Plenk coined the term "calcifying tendinitis". References
External links
eMedicine on Calcific Tendonitis
Extracorporeal shock wave therapy (subscription required)