Review Question - QID 219474

The resorptive phase of calcific tendonitis is characterized by phagocytic resorption and vascular infiltration of the affected tendon. Clinically, this is the most pain-generating phase of the disease process (Answer 3).

Calcific tendonitis is a process of calcification and degeneration of a rotator cuff tendon near its insertion. This condition can lead to high levels of pain and loss of motion for patients. It typically affects female patients between the ages of 30 and 60. The supraspinatus tendon is most commonly involved, and the presence of endocrine disorders (diabetes, hypothyroidism) has been identified as a risk factor for the development of calcific tendonitis. Radiographs, which will demonstrate intratendinous calcification, are often diagnostic (Figure A).

This condition progresses along a predictable course. There are three stages of calcific tendonitis, and the second stage has three sub-phases. The first stage is the precalcific stage, characterized by pain-free fibrocartilaginous metaplasia of the affected tendon. The second stage, the calcific stage, has three sub-phases. The formative phase is characterized by cell-mediated calcific deposition in the tendon, which may or not not cause pain. The second phase is the resting phase, a phase that lacks inflammation or vascular infiltration. The third phase is the resorptive phase, which is the most painful, and characterized by phagocytic resorption and vascular infiltration. The final stage is the postcalcific stage.

Uhtoff and Loehr provide a historical review of the pathogenesis, diagnosis, and management of calcific tendonitis of the rotator cuff. The authors note that careful attention should be paid to the condition's clinical presentation and radiologic characteristics, as surgical intervention should be avoided during the resorptive phase.

Suzuki et al. provide an updated review of the management options for calcific tendonitis. The authors note that the mainstay of treatment is nonoperative and report that many novel noninvasive and invasive options have been introduced to manage this condition. The authors note that the resorptive phase is typically when patients note the highest pain levels.

Figure A is an AP radiograph of a right shoulder, demonstrating calcifications within the supraspinatus tendon, a diagnostic finding for calcific tendonitis.

Incorrect Answers:
Answer 1: While vascular infiltration does occur during the resorptive phase, this process is associated with high degrees of patient pain.
Answer 2: This describes the resting phase.
Answer 4: This describes the formative phase.
Answer 5: This describes the precalcific stage.