Skip to main content

Incidence of rotator cuff tears in the setting of calcific tendinopathy on MRI: a case controlled comparison



To compare the incidence of rotator cuff tears on shoulder MRI in patients who have rotator cuff calcific tendinopathy with that in patients without calcific tendinopathy in a frequency-matched case–control study.

Materials and methods

Retrospective review shoulder MRIs of 86 patients with rotator cuff calcific tendinopathy and an 86-patient age-, gender-, and laterality-matched control group using frequency matching.


No statistically significant difference (odds ratio: 0.72, 95% confidence interval: 0.38–1.38, p = 0.32) was found in the incidence of rotator cuff tear in the calcific tendinopathy (27.9%) and control groups (34.9%). A significant (p < 0.001) difference in the size of rotator cuff tear was seen between the two groups, with 12.5% of tears being full-thickness in the calcific tendinopathy group and 63.3% of tears being full-thickness in the control group. Only 3 of the 24 (12.5%) rotator cuff tears present in the calcific tendinopathy group occurred at the site of tendon calcification.


Patients presenting with indeterminate shoulder pain and rotator cuff calcific tendinopathy are not at increased risk for having a rotator cuff tear compared with similar demographic patients without calcific tendinopathy presenting with shoulder pain. Calcific tendinopathy and rotator cuff tears likely arise from different pathological processes.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Friedman MS. Calcified tendinitis of the shoulder. Am J Surg. 1957;94(1):56–61.

    Article  CAS  Google Scholar 

  2. Louwerens JKG, Siervevelt IN, van Hove RP, van den Bekerom MPJ, van Noort A. Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. J Shoulder Elbow Surg. 2015;24(10):1588–93.

    Article  Google Scholar 

  3. Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12,122 shoulders. J Am Med Assoc. 1941;116:2477–82.

    Article  Google Scholar 

  4. Harmon PH, Francisco S. Methods and results in the treatment of 2580 painful shoulders with special reference to calcific tendinitis and the frozen shoulder. Am J Surg. 1958;95:527–44.

    Article  CAS  Google Scholar 

  5. Clavert P, Sirveaux F, Societe francaise d’arthroscopie. “Shoulder calcifying tendinitis”. Rev Chir Orthop Reparatrice Appar Mot. 2008;94(8):336–55.

  6. ElShewy MT. Calcific tendinitis of the rotator cuff. World J Orthop. 2016;7(1):55–60.

    Article  Google Scholar 

  7. Greis AC, Derrington SM, McAuliffe M. Evaluation and nonsurgical management of rotator cuff calcific tendinopathy. Orthop Clin North Am. 2015;46(2):293–302.

    Article  Google Scholar 

  8. Jim YF, Hsu HC, Chang CY, Wu JJ, Chang T. Coexistence of calcific tendinitis and rotator cuff tear: an arthrographic study. Skeletal Radiol. 1993;22:183–5.

    Article  CAS  Google Scholar 

  9. Wolfgang GL. Surgical repair of tears of the rotator cuff of the shoulder: factors influencing the result. J Bone Joint Surg Am. 1974;56(1):14–26.

    Article  CAS  Google Scholar 

  10. McLaughlin HL, Asherman EG. Lesions of the musculotendinous cuff of the shoulder. IV. Some observations based upon the results of surgical repair. J Bone Joint Surg Am. 1951;33(1):76–86.

    Article  Google Scholar 

  11. Chiou HJ, Chou YH, Wu JJ, Hsu CC. Evaluation of calcific tendonitis of the rotator cuff: role of color doppler ultrasonography. J Ultrasound Med. 2002;21(3):289–95.

    Article  Google Scholar 

  12. McLaughlin HL. Lesions of the musculotendinous cuff of the shoulder. III. Observations on the pathology, course and treatment of calcific deposits. Ann Surg. 1946;124(2):354–62.

    Article  Google Scholar 

  13. Codman EA. The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Boston: Thomas Todd. 1934.

  14. Lippmann RK. Observations concerning the calcific cuff deposit. Clin Orthop. 1961;20:49–60.

    CAS  PubMed  Google Scholar 

  15. Uhthoff HK, Sarkar K, Maynard JA. Calcifying tendinitis: a new concept of its pathogenesis. Clin Orthop Relat Res. 1976;118:164–8.

    Google Scholar 

  16. Uhthoff HK. Calcifying tendinitis, an active cell-mediated calcification. Virchows Arch A Pathol Anat Histol. 1975;366:51–8.

    Article  CAS  Google Scholar 

  17. Archer RS, Bayley JI, Archer CW, Ali SY. Cell and matrix changes associated with pathological calcification of the human rotator cuff tendons. J Anat. 1993;182:1–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Kannus P, Józsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am. 1991;73(10):1507–25.

    Article  CAS  Google Scholar 

  19. Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br. 1970;52(3):540–53.

    Article  CAS  Google Scholar 

  20. Moseley HF, Goldie I. The arterial pattern of the rotator cuff of the shoulder. J Bone Joint Surg. 1963;48:780.

    Article  Google Scholar 

  21. Sakamoto K, Kozuki K. Calcific tendinitis at the biceps brachii insertion of a child: a case report. J Shoulder Elbow Surg. 2002;11(1):88–91.

    Article  Google Scholar 

  22. Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77(1):10–5.

    Article  CAS  Google Scholar 

  23. Jozsa L, Balint BJ, Reffy A. Calcifying tendinopathy. Arch Orthop Trauma Surg. 1980;97:305–7.

    Article  CAS  Google Scholar 

  24. Kernwein GA. Roentgenographic diagnosis of shoulder dysfunction. JAMA. 1965;194(10):179–83.

    Article  Google Scholar 

  25. Riley GP, Harrall RL, Constant CR, Cawston TE, Hazleman BL. Prevalence and possible pathological significance of calcium phosphate salt accumulation in tendon matrix degeneration. Ann Rheum Dis. 1996;55(2):109–15.

    Article  CAS  Google Scholar 

  26. Magee T. 3-T MRI of the shoulder: is MR arthrography necessary? AJR Am J Roentgenol. 2009;192(1):86–92.

    Article  Google Scholar 

Download references


1. Memorial Hospital System in Houston.

2. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design (BERD) component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by a grant (UL1 TR000371) from the National Center for Advancing Translational Sciences (NCATS), awarded to the University of Texas Health Science Center at Houston. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCATS.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Nicholas M. Beckmann.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beckmann, N.M., Tran, M.Q. & Cai, C. Incidence of rotator cuff tears in the setting of calcific tendinopathy on MRI: a case controlled comparison. Skeletal Radiol 48, 245–250 (2019).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: