Calcific Tendinitis — SCE Rheumatology MCQ

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ModerateCrystal ArthropathyCalcific TendinitisSCE Rheumatology

A 55-year-old woman develops sudden severe atraumatic shoulder pain with marked restriction of active abduction. A radiograph shows a discrete calcific deposit adjacent to the greater tuberosity, without glenohumeral joint-space loss or subchondral destruction. Ultrasound localises the deposit within the supraspinatus tendon, which remains intact, with associated subacromial-subdeltoid bursitis. What is the most likely diagnosis?

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Correct answer: C — Calcific tendinitis

The diagnosis is calcific tendinitis of the supraspinatus, a basic calcium phosphate—predominantly hydroxyapatite—deposition disorder of rotator-cuff tendons. Acute severe pain commonly accompanies inflammation and migration of the deposit into the subacromial-subdeltoid bursa. The focal intratendinous calcification and intact cuff are decisive. Milwaukee shoulder also involves hydroxyapatite but is typically a rapidly destructive arthropathy in older patients, with large non-inflammatory effusions, rotator-cuff failure and marked glenohumeral destruction. CPPD more commonly produces cartilage chondrocalcinosis and contains calcium pyrophosphate crystals; gout contains monosodium urate crystals. A rotator-cuff tear is excluded by the intact tendon on ultrasound and would not itself explain the intratendinous calcific deposit.

Reference: Catapano M, Robinson DM, Schowalter S, McInnis KC. Clinical evaluation and management of calcific tendinopathy: an evidence-based review. Journal of Osteopathic Medicine. 2022. https://pubmed.ncbi.nlm.nih.gov/35119231/