Treament of Calcific Tendinitis of the Rotator Cuff

Abstract

The term “calcific tendinitis” refers to the intratendinous deposition of calcium, predominantly hydroxyapatite, that can affect every tendon in the body and especially the rotator cuff. This pathological condition is a dynamic process that evolves through four stages: pre-calcific, calcific, resorptive, and post-calcific. In the precalcific stage, microtraumatic factors associated with a local decrease in blood supply can lead to intratendinous fibrocartilaginous metaplasia, with resulting calcification. The subsequent calcific phase is considered as a resting period. Eventually, triggered by unknown factors, there is resorption of the deposit, accompanied by vascular invasion, the migration of phagocytic cells with dissolution of the calcific focus (resulting in a “toothpaste” appearance of the calcific deposit), and edema from intratendinous pressure, such that the condition becomes symptomatic. After resorption, in the post-calcific or reparative phase, fibroblasts restore the normal tendinous collagen pattern.