钙化性肌腱炎 资料 In-depth

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

Non-Operative Management

• Conservative treatment is the primary choice for calcific tendinitis, especially in patients with acute calcific tendinitis [22].
• 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 [8].
• Ultrasound treatment helps resolve calcifications and is associated with short-term clinical improvement in patients with symptomatic calcific tendinitis of the shoulder [1].
• Treatment of calcific tendinitis of the shoulder with shock waves has produced a high rate of success in pain relief and functional restoration with negligible associated complications [9].
• 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 [4].

Operative Management

• Surgical treatment of calcific tendinitis gives good results in 88.5% of patients resistant to medical treatment [11].
• Arthroscopic treatment of calcifying tendinitis provides good to excellent clinical results [17].
• Arthroscopic removal of calcification leads to improved clinical outcomes in patients with chronic calcific tendinitis, but at least 6 months of follow-up is needed for these improvements to become statistically significant [13].
• Patients undergoing arthroscopic treatment of a calcific deposit in the shoulder had satisfactory clinical and radiological outcomes at the final follow-up, with functional scores improving slowly and reaching more than 75 percent at six months after surgery [14].
• Endoscopic and open surgery are equally effective in the treatment of chronic calcifying tendinopathy, showing similar clinical and sonographic results [33].
• 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 [19].

Anatomy & Pathophysiology

Epidemiology and Demographics

• Calcific tendon deposits of the shoulder are a frequent occurrence in the general population, although only one third are painful [2].
• In approximately 20% of cases, subjects with rotator cuff calcific tendinopathy are asymptomatic [7].
• Subjects with rotator cuff calcific tendinopathy were often female aged between 30 and 60 [7].
• Women are approximately 1.5 times more often affected than men [71].
• The incidence of calcifying tendinitis in the general population is 2.5-20% [71].
• In about 10% of individuals, calcific deposits are found bilaterally [7].

Anatomical Location

• Calcium deposits are most commonly located at the level of the supraspinatus tendon [7].
• In approximately 80% of patients, calcifying tendinitis occurs in the supraspinatus tendon, 1.5-2 cm from the tendinous insertion at the greater tuberosity [71].
• The greater tuberosity serves as the attachment site for the supraspinatus, infraspinatus, and teres minor tendons of the rotator cuff [43].
• The subacromial bursa and subdeltoid bursa pass underneath the coracoacromial arch [43].

Pathogenesis and Staging

• The pathogenesis of rotator cuff calcific tendinopathy remains unclear [7, 23].
• Endocrine and metabolic disorders were often described as comorbidity in subjects with rotator cuff calcific tendinopathy [7].
• Endocrine disorders probably play an important role in the development of rotator cuff calcific tendinopathy, but the effect of this process is still unknown [7].
• The reactive calcification theory proposed by Uthoff in 1997 consists of a three-stages process: pre-calcific, calcific, and post-calcific stage [7].
• During the pre-calcific stage, tenocytes undergo a metaplastic transformation into chondrocytes within the site where the calcium deposits will subsequently form [7].
• The calcific stage is divided into three phases: the formative phase, the resting phase, and the resorptive phase [7].
• In the formative phase, calcium deposits increase in size [7].
• The resting phase is characterized by the presence of calcium deposits in the rotator cuff [7].
• The resorptive phase is associated with acute, sudden onset of extremely severe pain [29, 30].
• Uhthoff and Loehr described cartilage metaplasia as a reactionary process in an active biologic environment [23].
• The precalcific stage consists of predominantly fibrocartilaginous metaplasia presumably within less vascular areas of the tendon [23].
• In the formative phase of the calcific stage, matrix vesicles unite to become calcific deposits that are separated by fibrocartilage [23].
• Calcific deposits consist of two different forms of hydroxyapatite: A type and B type [23].
• The composition of an individual deposit can have a mixture of the two types of hydroxyapatite, but each individual phase has a different composition [23].
• Calcium is deposited in the fibrocartilaginous matrix of the tendon as calcium carbonate apatite [29, 30].
• Shorter length of the infraspinatus tendon and specific subacromial bursa anatomy may explain the intramuscular migration of calcium deposits leading to infraspinatus myotendinous junction tears [5].

Clinical Presentation

• Subjects with rotator cuff calcific tendinopathy often reported nightly, acute, unilateral and severe pain with spontaneous onset [7].
• Subjects with rotator cuff calcific tendinopathy often reported deficit in active and passive range of motion, mainly in abduction and flexion [7].
• Calcific tendinitis of the supraspinatus does not typically cause loss of external rotation but is frequently associated with mild isolated restriction of abduction [12].

Classification

• Calcific deposits in the rotator cuff are most commonly located at the level of the supraspinatus tendon [7].
• In approximately 10% of individuals with rotator cuff calcific tendinopathy, the deposits are found bilaterally [7].
• In 20% of cases of rotator cuff calcific tendinopathy, the subjects are asymptomatic [7].
• The supraspinatus tendon was the most frequently affected tendon in 82.7% of patients with calcific deposits within the rotator cuff [41].
• The infraspinatus tendon was affected in 8.4% of patients with calcific deposits within the rotator cuff [41].
• The subscapularis tendon was affected in 8.9% of patients with calcific deposits within the rotator cuff [41].
• Two or more tendons were affected in 9% of patients with calcific deposits within the rotator cuff [41].
• The median length of calcific deposits in the rotator cuff was 1.16 cm [41].
• Calcific deposits were categorized as Gärtner type I in 38.4% of cases, type II in 47.0% of cases, and type III in 14.6% of cases [41].
• A widely accepted method of classification based on radiographic appearance defines type A as dense, rounded, and sharply delineated deposits [69].
• A widely accepted method of classification based on radiographic appearance defines type B as multilobular in appearance, still radiodense, and sharply outlined deposits [69].
• A widely accepted method of classification based on radiographic appearance defines type C as more radiolucent and heterogeneous with irregular outlines [69].
• A widely accepted method of classification based on radiographic appearance defines type D as dystrophic calcific lesions of the tendon insertion [69].
• Calcium deposition can be characterized as discrete or fragmented and dense or fluffy using the classification scheme developed by Mole et al [63].
• Approximately 76% of calcifications were dense (type A or B) and 24% were fluffy (type C) in a study analyzing subacromial decompression and deposit removal [63].
• 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 [18].

Clinical Presentation

• In 20% of cases, subjects with rotator cuff calcific tendinopathy are asymptomatic [7].
• Calcium deposits in rotator cuff calcific tendinopathy are most commonly located at the level of the supraspinatus tendon [7].
• In about 10% of individuals with rotator cuff calcific tendinopathy, the deposits are found bilaterally [7].
• Subjects with rotator cuff calcific tendinopathy often report nightly, acute, unilateral and severe pain with spontaneous onset [7].
• Subjects complaining of rotator cuff calcific tendinopathy were often female aged between 30 and 60 [7].
• Calcific tendinitis is a poorly understood condition in which symptoms can be protracted, resulting in time off work and impaired quality of life [6].
• Demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in the Korean population were not different from those of Western populations [20].
• Atypical presentations of calcific tendinitis can involve the teres minor and present with isolated posterior shoulder pain affecting overhead movement [27].
• Recognition of atypical presentations of calcific tendinitis with bone erosion may prevent unnecessary biopsy and overtreatment [15].

Investigations

Imaging Modalities and Techniques

• Ultrasound is a simple and accurate test for identifying rotator cuff tears and calcific tendinitis [51].
• Ultrasound can be useful in guiding injections or barbotage, which involves aspirating calcific deposits in the rotator cuff [51].
• At least two X-ray views should be obtained for shoulder imaging: an anteroposterior view in the plane of the glenoid and an axillary projection with the arm in abduction [51].
• The axillary projection with the arm in abduction shows the relationship of the humeral head to the glenoid [51].
• Magnetic resonance imaging (MRI) can identify rotator cuff tears, although accuracy for these is enhanced by combining the scan with arthrography [51].
• MRI is useful to identify osteonecrosis of the humeral head or a bone tumour [51].
• Computed tomography (CT) is helpful for planning fracture surgery and shoulder joint replacement [51].
• The purpose of shoulder imaging is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [26].
• Standardized plain films are almost always sufficient to garner the information needed for shoulder care [26].
• The first key radiographic view is the anteroposterior (AP) view in the plane of the scapula, taken so that the x-ray beam passes through the glenohumeral joint [26].
• The AP view shows the superoinferior position of the humeral head relative to the glenoid, presence of osteophytes, narrowing of the joint space, degree of medial displacement of the humerus, quality of bone, presence of loose bodies, and whether there is humeral head collapse or deformity [26].
• The second key radiographic view is the axillary view taken with the arm in the functional position of elevation in the plane of the scapula [26].
• The axillary view is referred to as the “truth view” because it demonstrates glenohumeral relationships in the functional position of elevation [26].
• CT scans have the disadvantage of being taken with the arm in the adducted position, unlike the axillary truth view [26].
• The standardized axillary view enables measurement of posterior subluxation or “functional decentering” that is not evident in images taken with the arm at the side [26].
• The degree of posterior subluxation can be measured by the position of the center of the humeral head in relation to the plane of the scapula, the position of the center of the humeral head in relation to the glenoid face, or the point of contact of the humeral articular surface on the glenoid articular surface [26].
• The point of contact of the humeral articular surface on the glenoid articular surface reflects the degree of centering of the net humeral joint reaction force on the glenoid [26].
• A robust approach to imaging the shoulder must recognize that the shoulder is a three-dimensional structure that cannot be represented by a single planar view [53].
• Critical relationships, such as the degree of centering of the humeral head, change with the position of the arm [53].
• Shoulder pathology may be found in a large number of different bones and soft tissues [53].
• Overlying and superimposed structures as well as metallic implants may complicate imaging the structures of interest [53].
• Surgeons need to develop a judicious approach to imaging that yields necessary information while avoiding the tendency to "over-image" [53].

Diagnostic Findings and Clinical Correlations

• Restriction of passive glenohumeral abduction combined with normal passive external rotation is a diagnostic feature of calcific tendinitis [12].
• The incidence of rotator cuff tears in cases of calcific tendonitis is higher than previously reported in cohorts undergoing MRI [36].
• 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 [24].
• 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 [18].
• This case highlights the importance of considering atypical presentations of calcific tendinitis, particularly in the context of isolated posterior shoulder pain [27].
• Shorter length of the infraspinatus tendon and specific subacromial bursa anatomy may explain the intramuscular migration of calcium deposits leading to the lesion [5].
• 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 [21].

Ultrasound-Specific Assessment and Management

• US elastography is recommended for all patients with calcific tendinosis, except for those with the arc morphological type, before making management decisions [37].
• A complex case report illustrates the value of the surgeon performing ultrasound of the shoulder to diagnose an intraosseous calcifying tendinitis [34].
• Accuracy of rotator cuff ultrasonography depends on the skill of the scanner operator and an awareness of pitfalls that are encountered [49].
• Introducing 10 common pitfalls of rotator cuff ultrasonography helps reduce overdiagnosis or underdiagnosis of rotator cuff pathology [49].
• In 70% of shoulders treated with ultrasonography-guided lavage for rotator cuff calcific tendinitis, the treatment resulted in significant reduction of symptoms [49].
• Calcifications that were softer and middle-sized (12 to 17 mm) had more significant improvement after ultrasonography-guided lavage [49].
• Better results from ultrasonography-guided lavage occurred in patients aged 30 to 40 years [49].

Treatment

Non-Operative Management

• Nonoperative treatment consists of physical therapy, therapeutic modalities, and injections [29].
• Initial conservative treatment includes rest in a sling, non-steroidal anti-inflammatory drugs (NSAIDs), and injection of corticosteroid into the subacromial bursa [61].
• In most cases of calcific tendinitis, clinical symptoms resolve spontaneously in seven to ten days, while the calcium deposit may persist on radiographs [61].
• Symptomatic calcific tendinitis of the shoulder has a good likelihood to completely resolve in the long-term [3].
• Extracorporeal shock wave therapy (ESWT) effectively reduced painful symptomatology and increased shoulder function in patients with chronic calcific tendinitis of the shoulder [39].
• Shock wave therapy is a safe and effective noninvasive treatment for patients with calcific tendinitis of the shoulder, producing a high rate of success in pain relief and functional restoration with negligible complications [16].
• Shock wave therapy is a heterogeneous but effective treatment for calcifying tendinitis of the shoulder [57].
• Both ultrasound-guided needling and extracorporeal shock wave therapy improved clinical outcomes and eliminated calcium deposits in patients with calcific tendinitis [31].
• Ultrasound-guided needling showed a higher decrease in calcium deposits compared to radial shockwave therapy at 6 weeks [62].
• Ultrasound-guided needling showed a significantly higher improvement in the Oxford Score pre- and post-treatment compared to radial shockwave therapy [62].
• After one year, there was no significant difference in NRS and Oxford Score between ultrasound-guided needling and radial shockwave therapy groups [62].
• Approximately 40% of patients were free of complaints after one year in both the ultrasound-guided needling and radial shockwave therapy groups [62].
• Only 44% of patients in the radial shockwave therapy group would choose this treatment again, compared to almost every patient in the ultrasound-guided needling group [62].
• "Needling and lavage" of the lesion under image guidance has been described and is often successful [29].
• Percutaneous needle barbotage of calcium deposits has been demonstrated to provide pain relief and improved symptoms in patients suffering from calcific tendonitis [40].
• Unsatisfactory results were found in 20% to 30% of cases treated with extracorporeal shockwave therapy [61].

Operative Management

• In athletes with calcifying tendinitis of the supraspinatus tendon with failed nonoperative treatment, complete arthroscopic removal of calcific deposits and tendon repair without acromioplasty results in significant pain relief and improvement in functional outcomes [60].
• Arthroscopic excision has been successful in between 50% and 82% of cases [61].
• Open or arthroscopic surgery are only considered after failure of other noninvasive treatments due to concerns about their invasiveness [61].
• The rotator cuff should be repaired if it is significantly involved during surgical treatment [29].

Complications

• Recurrence and persistent symptoms are not rare in patients with peritendinous calcific deposits in the hand and wrist [10].
• The incidence of rotator cuff tears in cases of calcific tendonitis is higher than previously reported in a cohort of patients who underwent MRI [36].

Recovery

Natural History and Prognosis

• Periarticular calcific deposits are self-limiting and respond to conservative treatment, whereas recurrence and persistent symptoms are not rare in patients with peritendinous calcific deposits in the hand and wrist [10].

Non-Operative Recovery

• 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 [38].
• A symptom duration of ≤10 months or calcification size of ≤10.82 mm represented the clinical scenarios most likely to show resorption after ESWT [81].
• Calcific deposits disappeared in the same percentage of patients in both groups of a randomized clinical trial comparing two different energy levels for extracorporeal shock-wave therapy [83].

Operative Recovery

• 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 [35].

Key Evidence

• [L1] In patients with symptomatic calcific tendinitis of the shoulder, ultrasound treatment helps resolve calcifications and is associated with short-term clinical improvement. [1] (10.1056/nejm199905203402002)
• [L3] Calcific tendon deposits of the shoulder are a frequent occurrence in the general population, although only one third are painful. [2] (10.1007/s00256-015-2240-3)
• [L1] Symptomatic calcific tendinitis of the shoulder has a good likelihood to completely resolve in the long-term. [3] (10.1097/phm.0000000000000939)
• [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. [4] (10.1016/j.jseint.2021.01.013)
• [L4] Shorter length of the infraspinatus tendon and specific subacromial bursa anatomy may explain the intramuscular migration of calcium deposits leading to the lesion. [5] (10.1016/j.jse.2022.01.092)
• [L3] Calcific tendinitis is a poorly understood condition in which symptoms can be protracted, resulting in time off work and impaired quality of life. [6] (10.1016/j.jse.2006.06.007)
• [L3] [7] (10.1177/17585732241244515)
• [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. [8] (10.1016/j.jse.2009.07.008)
• [L2] Treatment of calcific tendinitis of the shoulder with shock waves has produced a high rate of success in pain relief and functional restoration with negligible associated complications. [9] (10.1016/j.jse.2007.03.023)
• [L3] Periarticular calcific deposits are self-limiting and respond to conservative treatment, whereas recurrence and persistent symptoms are not rare in patients with peritendinous calcific deposits in the hand and wrist. [10] (10.1177/1753193413478393)
• [L4] Surgical treatment of calcific tendinitis gives good results in 88.5% of patients resistant to medical treatment. [11] (10.1007/s100670050108)
• [L3] Calcific tendinitis of the supraspinatus does not typically cause loss of external rotation but is frequently associated with mild isolated restriction of abduction. [12] (10.1177/2325967117752907)
• [L4] Arthroscopic removal of calcification leads to improved clinical outcomes in patients with chronic calcific tendinitis, but at least 6 months of follow-up is needed for these improvements to become statistically significant. [13] (10.5397/cise.2018.21.2.75)
• [Paper] Patients undergoing arthroscopic treatment of a calcific deposit in the shoulder had satisfactory clinical and radiological outcomes at the final follow-up, with functional scores improving slowly and reaching more than 75 percent at six months after surgery. [14] (10.1016/j.otsr.2020.03.005)
• [L5] Recognition of atypical presentations of calcific tendinitis with bone erosion may prevent unnecessary biopsy and overtreatment. [15] (10.1016/j.jse.2009.02.009)
• [L3] Shock wave therapy is a safe and effective noninvasive treatment for patients with calcific tendinitis of the shoulder, producing a high rate of success in pain relief and functional restoration with negligible complications. [16] (10.1177/03635465030310031701)
• [L3] Arthroscopic treatment of calcifying tendinitis provides good to excellent clinical results. [17] (10.1177/03635465211037690)
• [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. [18] (10.1016/j.jse.2008.09.016)
• [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. [19] (10.1186/s12891-017-1839-z)
• [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. [20] (10.5397/cise.2020.00010)
• [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. [21] (10.3390/diagnostics12123097)
• [L5] The primary choice of treatment for calcific tendinitis is conservative, especially in patients with acute calcific tendinitis. [22] (10.5397/cise.2020.00318)
• [L5] [23] (10.5435/jaaos-22-11-707)
• [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. [24] (10.5397/cise.2021.00094)
• [Case_report] This case highlights the importance of considering atypical presentations of calcific tendinitis, particularly in the context of isolated posterior shoulder pain. [27] (10.1016/j.jisako.2025.101055)
• [L2] Both treatment modalities for calcific tendinitis improved clinical outcomes and eliminated calcium deposits. [31] (10.1016/j.jse.2014.06.036)
• [L1] Endoscopic and open surgery are equally effective in the treatment of chronic calcifying tendinopathy, showing similar clinical and sonographic results. [33] (10.1097/01.blo.0000063786.32430.22)
• [L4] This complex case report illustrates the value of the surgeon performing ultrasound of the shoulder to diagnose an intraosseous calcifying tendinitis. [34] (10.1016/j.xrrt.2023.09.012)
• [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. [35] (10.1016/j.arthro.2015.05.015)
• [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. [36] (10.1016/j.arthro.2019.11.127)
• [L4] We recommend that US elastography be performed for all patients with calcific tendinosis, except for those with the arc morphological type, before making management decisions. [37] (10.1016/j.jcma.2015.05.006)
• [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. [38] (10.2214/ajr.07.2254)
• [L2] ESWT effectively reduced painful symptomatology and increased shoulder function in patients with chronic calcific tendinitis of the shoulder. [39] (10.1136/ard.62.3.248)
• [L4] [40] (10.1177/2325967121s00655)
• [L3] [41] (10.1016/j.jse.2015.02.024)
• [L1] Shock wave therapy is a heterogeneous but effective treatment for calcifying tendinitis of the shoulder. [57] (10.1177/1941738108331197)
• [L4] In athletes with calcifying tendinitis of the supraspinatus tendon with failed nonoperative treatment, complete arthroscopic removal of calcific deposits and tendon repair without acromioplasty results in significant pain relief and improvement in functional outcomes. [60] (10.1177/2325967116669310)
• [L3] [61] (10.1302/0301-620x.99b12.bjj-2016-1178.r1)
• [L2] [62] (10.1016/j.jor.2017.07.011)
• [L3] [63] (10.1016/j.jse.2010.10.038)
• [L4] [69] (10.1016/j.jse.2004.04.001)
• [L2] [71] (10.1177/0269215510396740)
• [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. [81] (10.1177/23259671241231609)
• [L2] Calcific deposits disappeared in the same percentage of patients in both groups. [83] (10.2522/ptj.20110252)

References

[1] Ultrasound Therapy for Calcific Tendinitis of the Shoulder. New England Journal of Medicine. 1999. DOI: 10.1056/nejm199905203402002

[2] 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

[3] Long-Term Course of Shoulders After Ultrasound Therapy for Calcific Tendinitis. American Journal of Physical Medicine & Rehabilitation. 2018. DOI: 10.1097/phm.0000000000000939

[4] 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

[5] Infraspinatus Myotendinous Junction Tears: Analysis Of A Consecutive Series And Their Relationship With Calcifying Tendonitis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.092

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

[7] Clinical features in rotator cuff calcific tendinopathy: A scoping review. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241244515

[8] 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

[9] Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.03.023

[10] Acute calcium deposits in the hand and wrist; comparison of acute calcium peritendinitis and acute calcium periarthritis. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413478393

[11] Surgical Management of Calcific Tendinitis of the Shoulder: An Analysis of 26 Cases. Clinical Rheumatology. 1999. DOI: 10.1007/s100670050108

[12] Restriction of Passive Glenohumeral Abduction Combined With Normal Passive External Rotation Is a Diagnostic Feature of Calcific Tendinitis. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967117752907

[13] Functional Recovery of the Shoulder after Arthroscopic Treatment for Chronic Calcific Tendinitis. Clinics in Shoulder and Elbow. 2018. DOI: 10.5397/cise.2018.21.2.75

[14] Recovery pattern after arthroscopic treatment for calcific tendinitis of the shoulder. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2020.03.005

[15] Calcific tendinitis of the rotator cuff associated with intraosseous loculation: Two case reports. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.02.009

[16] Shock Wave Therapy for Calcific Tendinitis of the Shoulder. The American Journal of Sports Medicine. 2003. DOI: 10.1177/03635465030310031701

[17] Clinical and Structural Results of Rotator Cuff Repair Compared With Rotator Cuff Debridement in Arthroscopic Treatment of Calcifying Tendinitis of the Shoulder. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211037690

[18] 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

[19] 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

[20] 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

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

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

[23] Calcific Tendinitis of the Rotator Cuff. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-11-707

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

[26] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Radiographic Evaluation.

[27] Atypical calcific tendinitis involving teres minor which affects overhead movement: A case report. Journal of ISAKOS. 2026. DOI: 10.1016/j.jisako.2025.101055

[29] Miller S Review Of Orthopaedics. ACROMIOCLAVICULAR AND STERNOCLAVICULAR INJURIES > 5. Calcific tendinitis.

[30] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > ACROMIOCLAVICULAR AND STERNOCLAVICULAR INJURIES > 5. Calcific tendinitis.

[31] Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.06.036

[33] Prospective Randomized Surgical Treatments for Calcifying Tendinopathy. Clinical Orthopaedics & Related Research. 2003. DOI: 10.1097/01.blo.0000063786.32430.22

[34] Intraosseous migration of supraspinatus calcification: benefits of intraoperative ultrasound technique. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2023.09.012

[35] 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

[36] 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

[37] Management of rotator cuff calcific tendinosis guided by ultrasound elastography. Journal of the Chinese Medical Association. 2015. DOI: 10.1016/j.jcma.2015.05.006

[38] Sonographically Guided Percutaneous Needle Lavage in Calcific Tendinitis of the Shoulder: Short- and Long-Term Results. American Journal of Roentgenology. 2007. DOI: 10.2214/ajr.07.2254

[39] 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

[40] Paper 92: Outcomes of Percutaneous Barbotage for Calcific Tendonitis of the Shoulder. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00655

[41] Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.02.024

[43] Rockwood And Matsen S The Shoulder. Shoulder and Elbow Specialty Clinic Workers’ Survey > ANATOMY.

[49] Orthopaedic Knowledge Update Sports Medicine 6. Diagnostic Ultrasonography and Ultrasonography-­Guided Procedures > Annotated References.

[51] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INVESTIGATION.

[53] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > SENIOR EDITOR COMMENTARY.

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

[60] Return to Sports After Arthroscopic Treatment of Rotator Cuff Calcifications in Athletes. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116669310

[61] Prognostic factors for the outcome of extracorporeal shockwave therapy for calcific tendinitis of the shoulder. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b12.bjj-2016-1178.r1

[62] Ultrasound guided Needling vs Radial Shockwave Therapy in calcific tendinitis of the shoulder: A prospective randomized trial. Journal of Orthopaedics. 2017. DOI: 10.1016/j.jor.2017.07.011

[63] Calcific tendonitis of the shoulder: is subacromial decompression in combination with removal of the calcific deposit beneficial?. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.10.038

[69] Arthroscopic treatment of calcifying tendinitis of the shoulder: Clinical and ultrasonographic follow-up findings at two to five years. Journal of Shoulder and Elbow Surgery. 2004. DOI: 10.1016/j.jse.2004.04.001

[71] Arm position during extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: a randomized study. Clinical Rehabilitation. 2011. DOI: 10.1177/0269215510396740

[81] Treatment Algorithm for the Resorption of Calcific Tendinitis Using Extracorporeal Shockwave Therapy: A Data Mining Study. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671241231609

[83] Extracorporeal Shock-Wave Therapy for Supraspinatus Calcifying Tendinitis: A Randomized Clinical Trial Comparing Two Different Energy Levels. Physical Therapy. 2012. DOI: 10.2522/ptj.20110252