HSS Ultrasound of the Month Case 83

Clinical History 51-year-old female with shoulder pain and limited range of motion for one year.

X-ray showed a calcified focus in the region of the supraspinatus tendon insertion consistent with calcium hydroxyapatite deposition (calcific tendonitis).

Ultrasound was requested for percutaneous treatment.

Ultrasound of the Month – Case 83

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Ultrasound of the Month – Case 83

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Ultrasound of the Month – Case 83

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Ultrasound of the Month – Case 83

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Diagnosis: Rotator cuff calcific tendonitis Discussion Calcium hydroxyapatite deposition into a tendon, “calcific tendonitis”, most commonly occurs in the rotator cuff of the shoulder.

Calcific tendonitis progresses through various phases; within the calcific stage, the formative phase is followed by the resting phase and then the resorptive phase. The resorptive phase is the most painful phase.

Diagnosis can be made using either x-ray, MRI, or ultrasound.

Ultrasound has the advantage of allowing for a guided barbotage and cortisone injection during the same visit.

Barbotage can break up the calcium and may speed up the resorption of the calcium hydroxyapatite deposit.

Cortisone is injected into the subacromial-subdeltoid bursa to address the bursitis.

If ultrasound-guided barbotage fails to provide pain relief, surgical debridement and repair of the affected rotator cuff may be indicated.

Ultrasound of the Month – Case 83

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