Assessment of calcific tendonitis of rotator cuff by ultrasonography: comparison between symptomatic and asymptomatic shoulders.
OBJECTIVE
Calcific tendonitis of rotator cuff is observed on plain radiographs in 10% of adults, but remains asymptomatic in half these cases. We looked for differences on ultrasound (US) and power Doppler findings between symptomatic and asymptomatic cases of shoulder calcific tendonitis.


METHODS
US was performed in 62 patients (81 shoulders) with symptomatic (n=57) or asymptomatic (n=24) calcific tendonitis. Calcific plaque morphology, power Doppler signaling, and widening of the subacromial-subdeltoid bursa (SSB) were recorded. US-guided steroid injection into the SSB (n=21) or needle puncture of calcific deposits (n=29) was performed at the end of US evaluation in 50 of the 57 patients, and a questionnaire was sent to each patient after 11+/-6 months.


RESULTS
Larger (p=0.0015) and fragmented (p=0.01) calcifications were associated with pain. A power Doppler signal and a widening of the SSB was identified in 21 and 17 of the 57 symptomatic calcification respectively, but in none of the cases of asymptomatic calcification (p<0,005). At least one of these signs was present in 31 of the 57 (54%) symptomatic shoulders (p<0.001). Long-term outcome was favourable for 60% of our patients after steroid injection. The presence of a SSB widening before bursal steroid injection was associated with an improvement of the symptoms (p=0.06).


CONCLUSIONS
Positive power Doppler signal within the calcific deposit and SSB widening are US features strongly associated with pain. Moreover, larger calcifications are also more symptomatic. According to these results, US can help physicians to confirm that calcification is responsible for shoulder pain.
Le Goff
Benoit
B
Rheumatology Unit, Hôtel-Dieu, Nantes University Hospital, Nantes, France. benoit.legoff@chu-nantes.fr
Berthelot
Jean-Marie
JM
Guillot
Pascale
P
Glémarec
Joëlle
J
Maugars
Yves
Y
D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002061:Bursa, Synovial / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000000981:diagnostic imaging* / Q000188:drug therapy; D017006:Rotator Cuff / Q000000981:diagnostic imaging*; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging* / Q000188:drug therapy; D012785:Shoulder Joint / Q000000981:diagnostic imaging; D013256:Steroids / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D052256:Tendinopathy / Q000000981:diagnostic imaging* / Q000188:drug therapy; D018608:Ultrasonography, Doppler / Q000379:methods*
D013256:Steroids