Sonographic evaluation of the association between calcific tendinopathy and rotator cuff tear: a case-controlled comparison

Abstract

Objectives

To compare the incidence of rotator cuff (RC) tears on shoulder ultrasounds of patients with RC calcific tendinopathy (CaT) to that of a control group without CaT.

Method

In this retrospective case-control study, 50 shoulder ultrasounds of patients with CaT were compared independently by 2 musculoskeletal radiologists to 50 patients from a control group without CaT to catalog the number and type of RC tears. RC tears in the CaT group were further characterized based on location, into tears in the specific tendon(s) containing calcium versus all tendon tears.

Results

RC tears were diagnosed in 38% (19/50) of the control group (16 full-thickness) as compared to 22% (11/50) with CaT (6 full-thickness). The fewer full-thickness tears in the CaT group (12%, 6 of 50) compared to that in the control group (32%, 16 of 50) was statistically significant (P = 0.016, odds ratio 0.29). Only 7 of the 11 tears in the CaT group were in a calcium-containing tendon (3 full-thickness). The fewer calcium-containing tendon tears compared to tears in the control group was also statistically significant (P = 0.006, odds ratio 0.27). Furthermore, the fewer full-thickness calcium-containing tendon tears (6%, 3/50) compared to full-thickness tears in the control group (32%, 16/50) were yet more statistically significant (P = 0.001, odds ratio 0.14).

Conclusions

In patients with shoulder pain and CaT, we observed a decreased number of RC tears and especially calcium-containing tendon tears, as compared to similar demographic patients with shoulder pain but without CaT.

Key Points
Patients with rotator cuff calcific tendinopathy have few rotator cuff tears, especially full-thickness tears, compared to a control group without calcific tendinopathy.
The tendons containing the calcium hydroxyapatite deposition were the least likely to have a rotator cuff tear.
Future studies could evaluate if calcium hydroxyapatite deposition provides a protective mechanism against rotator cuff tears.
Musculoskeletal ultrasound is more sensitive than MRI in the evaluation of rotator cuff calcific tendinopathy.

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Data availability

The authors commit to making the relevant anonymized data used and/or analyzed in the current study available on reasonable request.

Abbreviations

CaT:

calcific tendinopathy

CI95% :

95% confidence interval

MRI:

magnetic resonance imaging

MSK:

musculoskeletal

RC:

rotator cuff

US:

ultrasound

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Acknowledgements

We thank Gordon Jacobsen, MS, Henry Ford Hospital, for his help with the statistics used in this manuscript. We also thank Stephanie Stebens, MLIS, AHIP, Henry Ford Hospital, for her editorial assistance in preparation of this manuscript.

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NCL, KAR, AT, and JRL interpreted data, contributed to the discussion and design of the study, and reviewed/edited the manuscript. CLK researched and interpreted data, contributed to the discussion and design of the study, and reviewed/edited the manuscript. SBS researched and interpreted data, contributed to the discussion and design of the study, and wrote the manuscript.

Corresponding author

Correspondence to Steven B. Soliman.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Institutional review board approval was obtained (IRB # 12367, July 13, 2018) and informed consent was waived. Our study complied with the Health Insurance Portability and Accountability Act.

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Laucis, N.C., Rosen, K.A., Thodge, A. et al. Sonographic evaluation of the association between calcific tendinopathy and rotator cuff tear: a case-controlled comparison. Clin Rheumatol (2021). https://doi.org/10.1007/s10067-021-05597-8

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Keywords

  • Calcific tendinopathy
  • Calcium hydroxyapatite deposition
  • Musculoskeletal ultrasound
  • Rotator cuff tear
  • Shoulder