What does mild calcific deposition on the left rotator cuff indicate?

Mild Calcific Deposition on Left Rotator Cuff: Significance and Management

Mild calcific deposition on the left rotator cuff indicates calcium hydroxyapatite crystal accumulation within the rotator cuff tendons, most commonly affecting the supraspinatus tendon, which can cause shoulder pain and dysfunction but may also be asymptomatic depending on the phase of the condition.

Understanding Calcific Tendinitis

Calcific tendinitis is characterized by calcium hydroxyapatite crystal deposits in the rotator cuff tendons. This condition:

• Affects approximately 10% of adults, with half remaining asymptomatic 1
• Most commonly involves the supraspinatus tendon, though other rotator cuff tendons can be affected
• Progresses through formative, resting, and resorptive phases

Clinical Significance of Calcifications

The clinical significance of calcific deposits depends on several factors:

• Size and fragmentation: Larger and fragmented calcifications are more likely to be symptomatic (p=0.0015 and p=0.01, respectively) 1
• Inflammatory status: Presence of inflammation around the deposit correlates with pain
• Phase of disease: Resorptive phase is typically more painful than formative or resting phases
• Location: Calcifications that migrate into surrounding tissues (such as the subacromial-subdeltoid bursa or muscles) can cause increased pain 2

Diagnostic Features

Ultrasound and MRI are the preferred imaging modalities for evaluating calcific tendinitis:

• Ultrasound findings associated with symptomatic calcifications 1:

  • Positive power Doppler signal around the calcification (indicating inflammation)
  • Widening of the subacromial-subdeltoid bursa
  • Fragmented appearance of calcifications
  • At least one of these signs was present in 54% of symptomatic shoulders

• MRI findings 3:

  • Can detect osseous and soft tissue abnormalities
  • Shows tendinous enlargement and heterogeneous signal pattern
  • Demonstrates diffuse increased signal intensity on T1-weighted images
  • May show slight increase in signal intensity on T2-weighted images

Management Approach

Non-operative Treatment (First-line)

Approximately 90% of patients can be treated non-operatively 4:

1. Pain management:

   • NSAIDs for pain and inflammation control
   • Rest and activity modification to prevent further irritation

2. Physical therapy:

   • Range of motion exercises
   • Pendulum exercises
   • Strengthening of rotator cuff and scapular stabilizers

3. Interventional options for persistent symptoms:

   • Ultrasound-guided steroid injection into the subacromial-subdeltoid bursa (60% favorable long-term outcome) 1
   • Ultrasound-guided needle lavage (aspiration) of calcific deposits 5

Surgical Management

Consider for patients who fail conservative treatment:

• Arthroscopic removal of calcific deposits
• Subacromial decompression if impingement is present

Monitoring and Prognosis

• Most cases resolve spontaneously over time
• Presence of subacromial-subdeltoid bursa widening before steroid injection is associated with better symptom improvement (p=0.06) 1
• Regular follow-up imaging can help monitor the evolution of deposits

Key Points for Clinicians

• Not all calcific deposits are symptomatic - correlation with clinical presentation is essential
• Ultrasound features (power Doppler signal, bursal widening) can help determine if the calcification is the source of pain
• The condition often resolves spontaneously, but persistent symptoms may require intervention
• Rare complications include migration of calcifications into surrounding tissues, which can cause increased pain and functional limitation 2