Tendinite Calcificante Folheto

O que você está sentindo

Você pode experimentar dor aguda ou crônica no ombro causada por inflamação ao redor dos depósitos de cálcio nos tendões do manguito rotador. Essa condição de desgaste pode impactar significativamente sua qualidade de vida e levar a afastamentos do trabalho. A dor frequentemente parece profunda e persistente, tornando os movimentos do dia a dia difíceis.

Tarefas simples, como alcançar as costas para fechar um sutiã ou guardar uma camisa, podem se tornar desafiadoras. Você pode achar difícil levantar objetos acima da cabeça ou dormir confortavelmente do lado afetado. A dor noturna é comum, frequentemente perturbando seu descanso e deixando você com sensação de fadiga no dia seguinte. Acordar com rigidez também é uma queixa frequente, especialmente se a condição estiver presente há algum tempo.

Em alguns casos, a dor pode se apresentar de forma atípica. Você pode sentir desconforto na parte de trás do ombro ou notar que mover o braço acima da cabeça é particularmente doloroso devido ao envolvimento de músculos menores, como o redondo menor. Embora esses sintomas possam ser angustiantes, a tendinite calcificada sintomática tem uma boa probabilidade de resolução completa a longo prazo. A maioria dos pacientes encontra alívio por meio de tratamentos conservadores, que são frequentemente a escolha principal, especialmente nos estágios iniciais.

Se você está experimentando esses sintomas, seu cirurgião avaliará sua situação específica para determinar o melhor caminho a seguir. Seja a dor nova ou de longa data, tratamentos eficazes estão disponíveis para ajudar a restaurar sua função e reduzir o desconforto. Você não precisa aceitar essa dor como permanente. Com o cuidado adequado, você pode esperar melhorias significativas na dor e na função do ombro ao longo do tempo.

O que está realmente acontecendo

A tendinite calcificada ocorre quando depósitos de cálcio se acumulam dentro dos tendões do ombro. Esses tendões são faixas fortes de tecido que conectam seus músculos aos seus ossos. Pense neles como as cordas de uma ponte suspensa. Quando os cristais de cálcio se formam dentro dessas cordas, eles criam um nódulo duro. Esse nódulo irrita o tecido circundante, causando dor e rigidez significativas.

O manguito rotador é um grupo de músculos e tendões que mantêm a articulação do ombro no lugar. Ele atua como uma manga estabilizadora ao redor da cabeça do úmero. Em muitos casos, esses depósitos de cálcio se formam dentro dos tendões do manguito rotador. O corpo às vezes tenta se curar quebrando esses depósitos, mas esse processo pode ser doloroso. A inflamação resultante dessa quebra causa a dor aguda que você sente.

Sua articulação do ombro é uma conexão complexa do tipo bola e soquete. A cabeça longa do tendão do bíceps passa por essa articulação e ajuda a mantê-la estável. Quando você tem tendinite calcificada, a dor pode afetar a forma como essas estruturas trabalham juntas. O depósito em si nem sempre causa sintomas, mas quando se torna ativo, ele interrompe o movimento suave do seu ombro.

Frequentemente observamos que a forma dos ossos do seu ombro ou a espessura dos seus tendões podem influenciar esse processo. No entanto, o problema principal é o próprio depósito de cálcio. Ele cria um bloqueio mecânico e uma resposta inflamatória. É por isso que você pode sentir dor mesmo quando não está movendo o braço intensamente. O depósito pressiona nervos e tecidos sensíveis em um espaço apertado.

Entender isso ajuda a explicar por que o repouso sozinho pode não ser suficiente. O corpo precisa de tempo para reabsorver o cálcio, ou podemos precisar ajudar a removê-lo. Para a maioria das pessoas, tratamentos conservadores, como fisioterapia ou terapia por ondas de choque, podem ajudar a controlar a dor e restaurar a função. Esses tratamentos apoiam o processo natural de cura do seu corpo. Se o depósito for grande ou persistente, podemos discutir a remoção cirúrgica. Isso envolve a limpeza cuidadosa do cálcio para aliviar a pressão sobre seus tendões.

O que podemos fazer a respeito

O Dr. Kieran Hirpara, cirurgião de membro superior do Mater Private Hospital Rockhampton, aborda esta condição começando com as opções menos invasivas. A maioria dos pacientes melhora sem cirurgia. Iniciamos com automaneio e fisioterapia. Você pode tentar alterações na atividade para evitar movimentos dolorosos. A fisioterapia visa restaurar a amplitude de movimento e a força do seu ombro. Geralmente, recomendamos dar uma tentativa justa a esta abordagem antes de considerar outros passos.

Se a dor persistir, passamos para o manejo médico. Medicamentos anti-inflamatórios orais ajudam a reduzir o inchaço e a dor. Injeções de corticosteroides podem proporcionar alívio significativo para muitos pacientes. A terapia por ondas de choque extracorpóreas é outra opção segura e não invasiva. Ela utiliza ondas sonoras para quebrar depósitos de cálcio e melhorar a função. Este tratamento tem uma alta taxa de sucesso no alívio da dor, com complicações negligenciáveis. Tanto a agulhagem guiada por ultrassom quanto a terapia por ondas de choque demonstraram eliminar depósitos de cálcio e melhorar os resultados clínicos.

A cirurgia é considerada apenas quando o tratamento conservador não proporcionou melhora suficiente. Procuramos sinais específicos que sugerem que a cirurgia pode ajudar. Por exemplo, pacientes com lesões calcificadas maiores que 1 cm têm 2,8 vezes mais probabilidade de precisar de tratamento cirúrgico. A remoção artroscópica da calcificação leva a melhores resultados clínicos em casos crônicos. As pontuações funcionais nesses pacientes melhoram lentamente, atingindo mais de 75 por cento aos seis meses após a cirurgia. A maioria dos pacientes que passam por manejo cirúrgico para remoção do depósito calcificado precisará de uma reparação concomitante do manguito rotador. Esta cirurgia proporciona melhorias significativas na dor e na função do ombro. Discutimos essas opções com você para decidir o melhor caminho a seguir.

O que esperar

A tendinite calcificada é uma condição na qual o cálcio se acumula nos tendões do ombro. Esse acúmulo causa inflamação e dor. A evolução dessa condição varia de pessoa para pessoa. Para muitos, os sintomas resolvem-se completamente a longo prazo. No entanto, o processo pode ser prolongado. Você pode experimentar dores que aparecem e desaparecem ao longo de vários meses. Essa persistência pode levar a afastamentos do trabalho e a uma menor qualidade de vida.

Se você optar pelo manejo não cirúrgico, seu ombro pode melhorar espontaneamente. O tratamento conservador é frequentemente a escolha primária, especialmente nos estágios iniciais. Alguns pacientes encontram alívio por meio de terapia de ondas de choque ou procedimentos com agulha. Esses tratamentos visam desintegrar os depósitos de cálcio ou eliminá-los. Eles oferecem altas taxas de sucesso no alívio da dor, com muito poucas complicações. Se o seu depósito de cálcio for pequeno ou estiver presente há menos de dez meses, é mais provável que ele se resolva com esses métodos.

Se os sintomas não melhorarem, a remoção cirúrgica do depósito de cálcio é uma opção. A cirurgia artroscópica permite que o seu cirurgião remova a calcificação por meio de pequenas incisões. A maioria dos pacientes que se submetem a esse procedimento também precisa de uma reparação do manguito rotador no mesmo ato cirúrgico. Isso ocorre porque o tendão frequentemente está enfraquecido pelo acúmulo de cálcio. Você pode esperar melhorias significativas na dor e na função do ombro após a cirurgia.

A recuperação é um processo gradual. As pontuações funcionais melhoram lentamente ao longo do tempo. Tipicamente, leva-se pelo menos seis meses para que essas melhorias se tornem plenamente aparentes. Aos seis meses após a cirurgia, mais de 75% dos pacientes relatam bons resultados funcionais. A maioria dos pacientes alcança resultados satisfatórios no acompanhamento final. Embora algumas pessoas se recuperem rapidamente, outras precisam de mais tempo. O seu cirurgião irá orientá-lo ao longo desse cronograma com base no seu progresso específico.

Quando procurar ajuda médica

Consulte o seu médico de família se tiver dor no ombro que não melhora com o repouso. Solicite uma avaliação especializada se os sintomas interferirem no seu sono ou no trabalho. A tendinite calcificante é uma condição aguda ou crônica causada por inflamação em torno de depósitos de cálcio nos tendões do manguito rotador. Os sintomas podem persistir por muito tempo. Procure atendimento se notar fraqueza, instabilidade ou bloqueio. O piora súbita da dor também é motivo para agendar uma consulta. A avaliação precoce ajuda a evitar exames desnecessários. A maioria dos pacientes apresenta melhora significativa com o tratamento conservador. O seu cirurgião pode orientá-lo sobre os passos adequados para restaurar a função e reduzir a dor.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Calcific tendon deposits of the shoulder are a frequent occurrence in the general population [1].
Only one third of calcific tendon deposits are painful [1].
The primary choice of treatment for calcific tendinitis is conservative, especially in patients with acute calcific tendinitis [7].
Conservative treatment for calcific tendinitis of the shoulder showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits [3].
Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment in the setting of calcific tendinitis of the shoulder [2].
Extracorporeal shock wave therapy (ESWT) can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder due to its good tolerance, safety, and clinical radiological response [6].
Patients with calcific tendinitis of the shoulder who have factors identified for a poor outcome after ESWT should undergo a different procedure [38].
Utilization of barbotage as a treatment for calcific tendonitis of the shoulder appears to produce notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation [9].
The incidence of rotator cuff tears in cases of calcific tendonitis is higher than previously reported [10].
Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of calcific tendinitis due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment [8].
The short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression [14].

Anatomy & Pathophysiology

Only one third of calcific tendon deposits in the general population are painful [1].
Calcific tendinitis of the shoulder in the Korean population has demographic, radiographic, and clinical features that are not different from those of Western populations [5].
Imaging and functional data indicate that calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis [11].
The acromion index is not different between shoulders with calcifying tendinitis, partial-thickness rotator cuff tears, or full-thickness rotator cuff tears [17].
The acromion index of shoulders with calcific tendinitis is comparable to that of shoulders with subacromial impingement [27].
The theoretical concept that a high acromion index results in increased upward force against the subacromial space, influencing pain and function in calcifying tendinitis, was not supported [40].
A rotator cuff tear was the only factor affecting the complete recovery of shoulder function in patients treated for calcific tendinitis [35].

Classification

Symptoms of calcific tendinitis can be protracted, resulting in time off work and impaired quality of life [4].
The demographic, radiographic, and clinical features of calcific tendinitis in the Korean population are not different from those of Western populations [5].
The acromion index is not different between shoulders with calcifying tendinitis, partial- or full-thickness rotator cuff tears [17].
Calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis [11].
Calcification in medial epicondylitis was more commonly identified than previously reported and was distributed over a relatively broad area [13].
Conservative treatment for calcific tendinitis showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits [3].
Shock wave therapy is a heterogeneous but effective treatment for calcifying tendinitis of the shoulder [18].

Clinical Presentation

Only one third of calcific tendon deposits in the shoulder are painful [1].
The prevalence of calcific deposits within the rotator cuff tendons is 7.8% in asymptomatic patients [21].
The prevalence of calcific deposits within the rotator cuff tendons is 42.5% in patients with subacromial pain syndrome [21].
Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment [2].
The demographic, radiographic, and clinical features of calcific tendinitis in the Korean population were not different from those of Western populations [5].
Acute calcific deposition of the hand and wrist is a benign self-limiting disease [15].
Clinical criteria predictive for shoulder rotator cuff calcific tendinopathy can help clinicians suspect this musculoskeletal disease early and with certainty [22].

Investigations

Calcific tendinitis symptoms can be protracted, resulting in time off work and impaired quality of life [4].
Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis [16].
Sonographic or MRI evaluation has accuracy limitations when assessing for rotator cuff tears in the context of calcific tendinitis [16].
The condition of articular chondrocalcinosis is characterized by multiple calcific deposits in the articular cartilage, primarily in the deeper and mid-portions of the cartilage above the tidemark [41].
The dynamic pathological process of calcific tendinopathy includes migration patterns of calcium deposits [12].

Treatment

Calcific tendon deposits are a frequent occurrence in the general population, although only one third are painful [1].
Nonsurgical management remains the mainstay of treatment for calcific tendinitis of the rotator cuff, with most patients improving with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections [19].
Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain, and thus it is reasonable to trial ultrasound-guided needling (barbotage) and extracorporeal shock wave therapy (ESWT) as first-line treatment [36].
ESWT can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder due to its good tolerance, safety, and clinical radiological response [6].
ESWT in calcific tendinitis of the shoulder is very effective [20].
ESWT has a therapeutic effect on tendinosis calcarea [29].
Radial extracorporeal shock wave therapy (rESWT) showed a 14.28% reduction in pain, a 43% improvement in shoulder functional status, and significant increases in shoulder flexion, abduction, extension, and external rotation compared to traditional physiotherapy [26].
Needle aspiration of calcific deposits (NACD) is safe and effective for calcific tendinitis of the rotator cuff [30].
Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement [31].

Complications

Calcific tendon deposits of the shoulder are a frequent occurrence in the general population, although only one third are painful [1].
Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis and aware of the accuracy limitations of sonographic or MRI evaluation [16].
The prevalence rate of calcific deposits in the rotator cuff is 7.8% in asymptomatic patients and 42.5% in patients with subacromial pain syndrome [21].

Recovery

The dynamic pathological process of calcific tendinopathy includes migration patterns of calcium deposits, which are relevant to functional recovery [12].
Arthroscopic bursectomy and debridement of the calcific deposit provides short-term functional outcomes that are not influenced by whether subacromial decompression is performed in combination [14].
Outcome after arthroscopic treatment seems to correlate strongly only with the presence of residual calcium deposits in the tendon, with complete removal recommended [48].
Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques [23].
There was no significant difference in short- and long-term clinical outcomes between single- and double-needle US-guided percutaneous irrigation of calcific tendinopathy [24].
Utilization of barbotage produces notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation [9].
Only with one-time needling, radiologic changes in size and/or density were seen in 76.6% of the calcific tendinitis patients at 4 weeks after the index procedure [28].
A symptom duration of ≤10 months or calcification size of ≤10.82 mm represented the clinical scenarios most likely to show resorption after ESWT [44].
In ESWT studies, Type III calcifications and shorter symptom duration were associated with better outcomes [46].
The onset of calcium resorption in acute calcific tendinitis occurs most frequently in the summer in Japan [47].
The minimal and substantial clinical benefit (MCID, SCB) and responsiveness for patients with long-lasting rotator cuff calcific tendinitis treated with minimally invasive treatment options have been established for the Constant-Murley score and Disabilities of the Arm, Shoulder and Hand score [32].

Key Evidence

[L3] Calcific tendon deposits of the shoulder are a frequent occurrence in the general population, although only one third are painful. [1] (10.1007/s00256-015-2240-3)
[L3] Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment in the setting of calcific tendinitis of the shoulder. [2] (10.1016/j.jseint.2021.01.013)
[L2] Conservative treatment for calcific tendinitis of the shoulder showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits. [3] (10.1016/j.jse.2009.07.008)
[L3] Calcific tendinitis is a poorly understood condition in which symptoms can be protracted, resulting in time off work and impaired quality of life. [4] (10.1016/j.jse.2006.06.007)
[L4] This study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in the Korean population, which were not different from those of Western populations. [5] (10.5397/cise.2020.00010)
[L2] Because of its good tolerance, safety, and clinical radiological response, ESWT can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder. [6] (10.1136/ard.62.3.248)
[L5] The primary choice of treatment for calcific tendinitis is conservative, especially in patients with acute calcific tendinitis. [7] (10.5397/cise.2020.00318)
[L3] Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of calcific tendinitis due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment. [8] (10.1186/s12891-017-1839-z)
[L4] Utilization of barbotage as a treatment for calcific tendonitis of the shoulder appears to produce notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation. [9] (10.1016/j.jseint.2024.06.005)
[L4] The incidence of rotator cuff tears in cases of calcific tendonitis in this cohort of patients who underwent MRI is higher than previously reported. [10] (10.1016/j.arthro.2019.11.127)
[L2] Imaging and functional data indicate that calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis that should be considered in clinical and surgical practice. [11] (10.1016/j.jse.2008.09.016)
[L5] The paper illustrates the dynamic pathological process of calcific tendinopathy, including migration patterns of calcium deposits, and discusses clinical and sonographic assessment to optimize diagnosis, rehabilitation, and interventional management for functional recovery. [12] (10.3390/diagnostics12123097)
[L3] Calcification in medial epicondylitis was more commonly identified than previously reported and was distributed over a relatively broad area. [13] (10.1016/j.jse.2021.08.031)
[L1] This study has demonstrated that the short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression. [14] (10.1016/j.arthro.2015.05.015)
[L5] Acute calcific deposition of the hand and wrist is a benign self-limiting disease. [15] (10.1016/j.jhsa.2014.06.011)
[L3] Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis and aware of the accuracy limitations of sonographic or MRI evaluation. [16] (10.5397/cise.2021.00094)
[L3] The acromion index is not different between shoulders with calcifying tendinitis, partial- or full-thickness rotator cuff tears. [17] (10.1007/s00402-011-1263-z)
[L1] Shock wave therapy is a heterogeneous but effective treatment for calcifying tendinitis of the shoulder. [18] (10.1177/1941738108331197)
[L5] Nonsurgical management remains the mainstay of treatment for calcific tendinitis of the rotator cuff, with most patients improving with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. [19] (10.5435/jaaos-22-11-707)
[L1] ESWT in calcific tendinitis of the shoulder is very effective. [20] (10.1007/s00256-004-0849-8)
[L3] The prevalence rates of 7.8% in asymptomatic patients and 42.5% in patients with subacromial pain syndrome provide a current view on the epidemiology of calcific deposits in the rotator cuff. [21] (10.1016/j.jse.2015.02.024)
[L3] These clinical criteria, predictive for shoulder RCCT, can be crucial to help all clinicians suspect this musculoskeletal disease early and with certainty, thus allowing for an appropriate and prompt diagnosis path. [22] (10.1177/17585732241244515)
[L4] Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques, and it is only slightly invasive and painful. [23] (10.2214/ajr.07.2254)
[L1] There was no significant difference in short- and long-term clinical outcomes between single- and double-needle US-guided percutaneous irrigation of calcific tendinopathy. [24] (10.1148/radiol.2017162888)
[L2] Specifically, the rESWT group showed a 14.28% reduction in pain, a 43% improvement in shoulder functional status, and significant increases in shoulder flexion, abduction, extension, and external rotation. [26] (10.5606/archrheumatol.2019.7081)
[L4] The AI of shoulders with calcific tendinitis is comparable to that of shoulders with subacromial impingement. [27] (10.1007/s00167-012-2327-5)
[L4] Only with one-time needling, radiologic changes in size and/or density were seen in 76.6% of the calcific tendinitis patients at 4 weeks after the index procedure. [28] (10.1016/j.arthro.2013.03.033)
[L2] ESWT has a therapeutic effect on tendinosis calcarea. [29] (10.1007/s00776-003-0720-0)
[L4] Needle aspiration of calcific deposits (NACD) is safe and effective for calcific tendinitis of the rotator cuff. [30] (10.1016/j.ejrad.2016.01.018)
[L3] Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement. [31] (10.1007/s00167-022-06870-2)
[L2] This study established the MCID, SCB, and responsiveness for patients with long-lasting rotator cuff calci fi c tendinitis who were treated with minimally invasive treatment options. [32] (10.1016/j.jseint.2020.05.001)
[L3] A rotator cuff tear was the only factor affecting the complete recovery of shoulder function. [35] (10.1177/03635465231217733)
[L1] Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain, and thus it is reasonable to trial UGN and ESWT as first-line treatment. [36] (10.1016/j.jse.2023.03.017)
[L3] Patients with calcific tendinitis of the shoulder who have the factors identified for a poor outcome after ESWT should undergo a different procedure. [38] (10.1302/0301-620x.99b12.bjj-2016-1178.r1)
[L2] The theoretical concept of a high acromion index resulting in an increased upward force against the subacromial space, which influences pain and function in calcifying tendinitis of the shoulder, was not supported. [40] (10.1007/s00167-011-1563-4)
[L5] The condition is characterized by multiple calcific deposits in the articular cartilage, primarily in the deeper and mid-portions of the cartilage above the tidemark. [41] (10.2106/00004623-197254040-00015)
[L3] A symptom duration of ≤10 months or calcification size of ≤10.82 mm represented the clinical scenarios most likely to show resorption after ESWT. [44] (10.1177/23259671241231609)
[L3] In SWT studies, Type III calcifications and shorter symptom duration were associated with better outcomes. [46] (10.1177/17585732251414964)
[L3] The onset of calcium resorption in acute calcific tendinitis occurs most frequently in the summer in Japan; however, the reasons for seasonal variation remain unclear, and further studies will be needed. [47] (10.1186/s12891-020-03773-6)
[L4] Outcome seems to correlate strongly only with the presence of residual calcium deposits in the tendon; complete removal is recommended. [48] (10.1016/j.jse.2004.04.001)

References

[1] Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders. Skeletal Radiology. 2015. DOI: 10.1007/s00256-015-2240-3

[2] Predictive factors for failure of conservative management in the treatment of calcific tendinitis of the shoulder. JSES International. 2021. DOI: 10.1016/j.jseint.2021.01.013

[3] Radiologic course of the calcific deposits in calcific tendinitis of the shoulder: Does the initial radiologic aspect affect the final results?. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.07.008

[4] Calcific tendinitis: Natural history and association with endocrine disorders. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.06.007

[5] Calcific tendinitis of the shoulder in the Korean population: demographics and its relation with coexisting rotator cuff tear. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2020.00010

[6] Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study. Annals of the Rheumatic Diseases. 2003. DOI: 10.1136/ard.62.3.248

[7] Diagnosis and treatment of calcific tendinitis of the shoulder. Clinics in Shoulder and Elbow. 2020. DOI: 10.5397/cise.2020.00318

[8] Examination of concomitant glenohumeral pathologies in patients treated arthroscopically for calcific tendinitis of the shoulder and implications for routine diagnostic joint exploration. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1839-z

[9] Determining the efficacy of barbotage for pain relief in calcific tendinitis. JSES International. 2024. DOI: 10.1016/j.jseint.2024.06.005

[10] Calcific Tendonitis of the Shoulder: Protector or Predictor of Cuff Pathology? A Magnetic Resonance Imaging–Based Study. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.127

[11] Osteolytic lesion of greater tuberosity in calcific tendinitis of the shoulder. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.09.016

[12] Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review. Diagnostics. 2022. DOI: 10.3390/diagnostics12123097

[13] Radiologic evaluation and clinical effect of calcification in medial epicondylitis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.08.031

[14] Short‐Term Outcome After Arthroscopic Bursectomy Debridement of Rotator Cuff Calcific Tendonopathy With and Without Subacromial Decompression: A Prospective Randomized Controlled Trial. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.05.015

[15] Acute Calcium Deposits in the Hand and Wrist. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.011

[16] Is common the rotator cuff tear in the calcific tendinitis?. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00094

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[18] Focused Extracorporeal Shock Wave Therapy in Calcifying Tendinitis of the Shoulder: A Meta-Analysis. Sports Health: A Multidisciplinary Approach. 2009. DOI: 10.1177/1941738108331197

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