Calcific tendinopathy of the rotator cuff

The calcific tendinopathy of the shoulder is characterized by the presence of macroscopic deposits of calcium hydroxyapatite in the tendons of the rotator cuff, spontaneous resorption of those deposits and, consequently, the tendon healing. The evolution of calcification is divided into 4 phases: formation of the calcium deposits, resting phase, resorption phase and post-calcific stage. The incidence of this condition is, in the general population, 8-20% with the peak of incidence at the ages between 30 and 50. The calcific tendinopathy mostly affects the tendon of the supraspinatus. It affects women more often than men and right shoulder more often than left. The bilateral presentation of calcific tendinopathy occurs from 5 to 23% of patients. Different theories about etiopathogenesis of the calcific tendinopathy were described and discussed. In recent years, there have been few publications presenting chondral metaplasia as an important mechanism. Radiological and ultrasound diagnostics are the most widely used diagnostic techniques. Magnetic resonance imaging and computed tomography are rarely used, just in clinically unclear cases. Conservative treatment includes non-steroidal anti-inflammatory drugs (NSAIDs), subacromial administration of the corticosteroids, physical therapeutic intervention, needle aspiration and lavage. In patients refractory to conservative treatment, surgical treatment, primarily arthroscopy, is indicated. Defining the stage (phase) of calcific tendinopathy determines the treatment method and prognoses the course of the disease. Precisely defining the phase enables avoiding unnecessary long-lasting physical therapy and also provides using the most effective treatment