Rotator cuff calcific tendinopathy: an educational review on diagnosis and treatment

Rotator cuff calcific tendinopathy (RCCT) is a common condition characterized by the pathological deposition of calcium hydroxyapatite crystals over fibrocartilaginous metaplasia of tenocytes, most commonly affecting the supraspinatus tendon. RCCT is one of the most frequent causes of chronic shoulder painful and is more common in patients aged between 30 and 60 years, particularly premenopausal women, and seems not to be correlated to physical activity. Although the pathogenetic mechanism of RCCT is still unclear, it is probably a multifactorial disease with multiple stages: pre-calcific, calcific (including formative and resorptive phases) and post-calcific; pain occurs during the resorptive phase. It is easily identified using conventional radiography or ultrasound. RCCT is a self-limiting condition that may be asymptomatic, thus non requiring any treatment. When painful, the initial management strategy consists of conservative treatment, including rest, oral non-steroidal anti-inflammatory drugs, and physical therapy. If symptoms persist, non-operative treatment may be considered, such as ultrasound-guided percutaneous irrigation, corticosteroid injection into the subacromial-subdeltoid bursa, extracorporeal shockwave therapy, and platelet-rich plasma injection. Surgery is reserved for chronic cases that are refractory to these less invasive therapeutic modalities.