Case Diagnosis: Calcific Tendonitis of the Right Supraspinatus Tendon
A 73-year-old male with hypertension and type 2 diabetes presented to clinic for six months of right shoulder pain. He reported the pain was over the superior lateral aspect of the right shoulder. Physical exam revealed positive impingement signs and empty can. Right shoulder X-ray showed a large calcific deposit near the supraspinatus tendon. The patient failed conservative measures and wanted a different treatment. With sterile technique and ultrasound guidance, we injected 3cc of 1% lidocaine into the supraspinatus tendon and performed tenotomy with a 22-guage needle. Thereafter, 3cc of 1% lidocaine and 40mg of depomedrol was placed into the subacromial bursa. Three more treatments were performed with resolution of symptoms.
Calcific tendonitis is a relatively common disorder that can be asymptomatic in some people but for others it can result in debilitating shoulder pain. Impingement syndrome of the shoulder is often implicated in calcific tendonitis. The diagnosis can be made with a thorough history, physical exam, and imaging. Initial management involves non-steroidal anti-inflammatory medications, physical therapy, and modalities such as extracorporeal shock wave therapy. Refractory cases can be treated with interventions including ultrasound guided needle lavage or barbotage. Arthroscopic surgical decompression may also be considered. For this patient, we offered a referral to orthopedic surgery, but he declined and preferred trial of ultrasound guided barbotage. We provided a total of four treatments over the span of two years. After each treatment, the patient’s pain, symptoms and function improved significantly. Follow-up imaging revealed resolution of the calcific deposit.
Calcific tendonitis is a common etiology of shoulder pain. Initial management involves medications, physical therapy, and extracorporeal shock wave therapy. When conservative management fails, ultrasound guided needle barbotage is an excellent treatment option.