Channel: nabil ebraheim

Category: Education

Tags: treatmentorthopaedicsdr. nabil ebraheimutmcdiagnosiscalcific tendonitissymptomsnathan elkinssignsrotator cuffsupraspinatusmanagmentcalcificationshoulderut

Description: Dr. Ebraheim’s educational animated video describes the condition of calcific tendonitis. Follow me on twitter: twitter.com/#!/DrEbraheim_UTMC Find me on Instagram @OrthoInitiative Calcific Tendonitis of the shoulder - Everything You Need To Know - Dr. Nabil Ebraheim youtube.com/watch?v=3gnyGXpj4sg Calcific tendinitis of the shoulder Calcific tendinitis is calcium deposits in the supraspinatus tendon. It is a condition that usually occurs in adults around the fourth decade of life and there is a higher incidence in diabetic patients. Calcific deposits cause severe pain in the shoulder and that pain is increased by elevation of the arm above the shoulder and it also leads to decreased range of motion of the shoulder. It is actually deposited calcium carbonate apatite crystals into the rotator cuff tendon. This condition is more common in females and the clinical symptoms and presentation is similar to impingement syndrome of the shoulder. Some of the patients will have diabetes or hypothyroidism. There is no history of trauma and the etiology is clearly not known. The calcific tendinitis has many phases and the most painful time is during the reabsorptive phase. These deposits affect the function of the rotator cuff causing chemical irritation and shoulder impingement. It reduces the space between the rotator cuff and the acromion and that will lead to shoulder impingement. X-rays are the gold standard for the diagnosis. The x-ray will show calcium deposits about 1 to 2 cm from the supraspinatus insertion (this is the tendon most commonly affected). The appearance of the lesion on x-ray varies from a fluffy, cloudy appearance with a poorly defined periphery and the patient will have more pain in this type than the other type, which is a well-circumscribed, dense calcification. The MRI may be difficult to interpret, however we can see a small, black signal in the supraspinatus of the MRI. There will be a low signal intensity in all sequences. The MRI is not necessary for the diagnosis. The x-ray is more helpful, however we get the MRI to see any associated pathology such as a rotator cuff tear. Treatment Conservative • Physiotherapy (for stretching and strengthening the rotator cuff) • Anti-inflammatory medication • Subacromial injection o Conservative treatment results in improving the symptoms and about 60 to 70% of patients after 6 months. Surgery • Involves removal of the lesion and possible repair of the rotator cuff tendon. • Done in larger lesions are when conservative treatment fails.