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EMJ Online First, published on January 15, 2014 as 10.1136/emermed-2013-203387
Images in emergency medicine

Plain radiographic evidence of

stages of calcifying tendinitis of
supraspinatus tendon of shoulder
CASE
A 47-year-old man initially presented to the orthopaedic clinic
describing symptoms of moderate shoulder pain of 3 years

Figure 3 Arrow pointing towards the calcific deposit decompressed

into bursal space.

duration. He had pain on abduction of 60–130° with positive

impingement signs.
Radiographs showed calcification in the region of supraspina-
tus tendon (figure 1). An ultrasound scan of shoulder demon-
strated intratendinous calcification in the distal part of
supraspinatus tendon (figure 2). He was initially treated with
steroid injection into subacromial space and physiotherapy. One
year after his initial consultation, with his symptoms settling, he
developed sudden onset of severe shoulder pain in the same
region. The pain was so intense that he attended his local emer-
gency department. Radiographs taken confirmed the calcifying
deposit had decompressed out of the supraspinatus tendon into
the subacromial bursal space (figure 3).

Figure 1 Arrow pointing towards the calcific deposit.
DISCUSSION
Pathophysiology of calcifying tendinitis includes the precalcific
stage, and then is followed by the calcific stage, during which
the deposit is formed and then resorbed. In the postcalcific
stage, tendon reconstitution occurs.1

Figure 2 Ultrasound scan confirming

the extent of calcific deposit in
supraspinatus tendon.

Copyright
Reddy Article
G, et al. Emerg author
Med J Month 2014 (or
Vol 0 their
No 0 employer) 2014. Produced by BMJ Publishing Group Ltd under licence. 1
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Images in emergency medicine
Figure 4 Evolution of calcifying tendonitis.
The natural history of calcifying tendonitis has been demon-
strated in this case report (figure 4). So during formative stage
the symptoms can be chronic and during the phase of resorp-
tion the symptoms are often acute and severe, needing attend-
ance to emergency department.
2 Reddy G, et al. Emerg Med J Month 2014 Vol 0 No 0
Gautam Reddy, Nicola Hodgson, Chris Peach, Nick J Phillips
Shoulder & Elbow Unit, University Hospital of South Manchester, Wythenshawe,
Manchester, UK
Correspondence to Gautam Reddy, Shoulder & Elbow Unit, University Hospital
of South Manchester, Wythenshawe, Manchester M23 9LT, UK;
gautamreddy20@yahoo.co.uk
Acknowledgements The author is grateful to Mrs Swathi Reddy for the artistic
diagram of figure 4 of this article.
Contributors GR and NH: wrote the manuscript; CP and NJP: edited the
manuscript.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
▸ Additional material is published online only. To view please visit the journal
online (http://dx.doi.org/10.1136/emermed-2013-203387).
To cite Reddy G, Hodgson N, Peach C, et al. Emerg Med J Published Online First:
[ please include Day Month Year] doi:10.1136/emermed-2013-203387
Accepted 21 November 2013
Emerg Med J 2014;0:1–2. doi:10.1136/emermed-2013-203387
REFERENCE
1 Uhthoff HK. Anatomopathology of calcifying tendinitis of the cuff. In: Gazielly DF,
Gleyze PTT. eds The cuff. Paris: Elsevier, 1997:144–6.
 Downloaded from http://emj.bmj.com/ on December 1, 2015 - Published by group.bmj.com

Plain radiographic evidence of stages of

calcifying tendinitis of supraspinatus tendon
of shoulder
Gautam Reddy, Nicola Hodgson, Chris Peach and Nick J Phillips

Emerg Med J published online January 15, 2014

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