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



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.


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.


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).


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.



calcific tendinopathy

CI95% :

95% confidence interval


magnetic resonance imaging




rotator cuff




  1. 1.

    Bianchi S, Becciolini M (2019) Ultrasound appearance of the migration of tendon calcifications. J Ultrasound Med 38(9):2493–2506

    Article  Google Scholar 

  2. 2.

    Kachewar SG, Kulkarni DS (2013) Calcific tendinitis of the rotator cuff: a review. J Clin Diagn Res 7(7):1482–1485

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    De Carli A, Pulcinelli F, Rose GD, Pitino D, Ferretti A (2014) Calcific tendinitis of the shoulder. Joints 2(3):130–136

    Article  Google Scholar 

  4. 4.

    Jacobson JA (2018) Shoulder ultrasound. In: Jacobson JA (ed) Fundamentals of musculoskeletal ultrasound, 3rd edn. Elsevier, Philadelphia, pp 55–126

    Google Scholar 

  5. 5.

    Serafini G, Sconfienza LM, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F (2009) Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle US-guided percutaneous treatment--nonrandomized controlled trial. Radiology 252(1):157–164

    Article  Google Scholar 

  6. 6.

    ElShewy MT (2016) Calcific tendinitis of the rotator cuff. World J Orthop 7(1):55–60

    Article  Google Scholar 

  7. 7.

    Harvie P, Pollard TCB, Carr AJ (2007) Calcific tendinitis: natural history and association with endocrine disorders. J Shoulder Elbow Surg 16(2):169–173

    Article  Google Scholar 

  8. 8.

    Chiou HJ, Chou YH, Wu JJ, Hsu CC, Huang DY, Chang CY (2002) Evaluation of calcific tendonitis of the rotator cuff: role of color Doppler ultrasonography. J Ultrasound Med 21(3):289–295

    Article  Google Scholar 

  9. 9.

    Merolla G, Bhat MG, Paladini P, Porcellini G (2015) Complications of calcific tendinitis of the shoulder: a concise review. J Orthop Traumatol 16(3):175–183

    Article  Google Scholar 

  10. 10.

    Uhthoff HK, Loehr JW (1997) Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis, and management. J Am Acad Orthop Surg 5(4):183–191

    CAS  Article  Google Scholar 

  11. 11.

    Speed CA, Hazleman BL (1999) Calcific tendinitis of the shoulder. N Engl J Med 340(20):1582–1584

    CAS  Article  Google Scholar 

  12. 12.

    Beckmann NM (2016) Calcium apatite deposition disease: diagnosis and treatment. Radiol Res Pract 2016:4801474

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    McLaughlin HL, Asherman EG (1951) Lesions of the musculotendinous cuff of the shoulder. IV. Some observations based upon the results of surgical repair. J Bone Joint Surg Am 33A(1):76–86

    Article  Google Scholar 

  14. 14.

    Friedman MS (1957) Calcified tendinitis of the shoulder. Am J Surg 94(1):56–61

    CAS  Article  Google Scholar 

  15. 15.

    Farin PU, Jaroma H (1995) Sonographic findings of rotator cuff calcifications. J Ultrasound Med 14(1):7–14

    CAS  Article  Google Scholar 

  16. 16.

    Beckmann NM, Tran MQ, Cai C (2019) Incidence of rotator cuff tears in the setting of calcific tendinopathy on MRI: a case controlled comparison. Skeletal Radiol 48(2):245–250

    Article  Google Scholar 

  17. 17.

    Sucuoğlu H, Asan A (2020) Relationship between calcific tendinopathy and rotator cuff tear on shoulder magnetic resonance imaging: case-controlled comparison. Pol J Radiol 85:e8–e13

  18. 18.

    Hsu HC, Wu JJ, Jim YF, Chang CY, Lo WH, Yang DJ (1994) Calcific tendinitis and rotator cuff tearing: a clinical and radiographic study. J Shoulder Elbow Surg 3(3):159–164

    CAS  Article  Google Scholar 

  19. 19.

    Oliva F, Via AG, Maffulli N (2012) Physiopathology of intratendinous calcific deposition. BMC Med 10:95

    Article  Google Scholar 

  20. 20.

    Wolfgang GL (1957) Surgical repair of tears of the rotator cuff of the shoulder: factors influencing the result. J Bone Joint Surg Am 56(1):14–26

    Article  Google Scholar 

  21. 21.

    Jim YF, Hsu HC, Chang CY, Wu JJ, Chang T (1993) Coexistence of calcific tendinitis and rotator cuff tear: an arthrographic study. Skeletal Radiol 22(3):183–185

    CAS  Article  Google Scholar 

  22. 22.

    Brinkman JC, Zaw TM, Fox MG, Wilcox JG, Hattrup SJ, Chhabra A, Neville MR, Hartigan DE (2020) Calcific tendonitis of the shoulder: protector or predictor of cuff pathology? A magnetic resonance imaging-based study. Arthroscopy 36(4):983–990

    Article  Google Scholar 

  23. 23.

    Bianchi S, Martinoli C (2007) Shoulder. In: Bianchi S, Martinoli C (eds) Ultrasound of the musculoskeletal system. Springer, Berlin, pp 189–331

    Google Scholar 

  24. 24.

    Lee KS (2012) Musculoskeletal sonography of the tendon. J Ultrasound Med 31(12):1879–1884

    Article  Google Scholar 

  25. 25.

    Lee KS, Rosas HG (2010) Musculoskeletal ultrasound: how to treat calcific tendinitis of the rotator cuff by ultrasound-guided single-needle lavage technique. AJR Am J Roentgenol 195(3):638

    PubMed  Google Scholar 

  26. 26.

    Martin-Hervas C, Romero J, Navas-Acien A, Reboiras JJ, Munuera L (2001) Ultrasonographic and magnetic resonance images of rotator cuff lesions compared with arthroscopy or open surgery findings. J Shoulder Elbow Surg 10(5):410–415

    CAS  Article  Google Scholar 

  27. 27.

    Yablon CM, Jacobson JA (2015) Rotator cuff and subacromial pathology. Semin Musculoskelet Radiol 19(3):231–242

    Article  Google Scholar 

  28. 28.

    Siegal DS, Wu JS, Newman JS, Del Cura JL, Hochman MG (2009) Calcific tendinitis: a pictorial review. Can Assoc Radiol J 60(5):263–272

    Article  Google Scholar 

  29. 29.

    Zubler C, Mengiardi B, Schmid MR, Hodler J, Jost B, Pfirrmann CWA (2007) MR arthrography in calcific tendinitis of the shoulder: diagnostic performance and pitfalls. Eur Radiol 17(6):1603–1610

    Article  Google Scholar 

  30. 30.

    Lee MH, Sheehan SE, Orwin JF, Lee KS (2016) Comprehensive shoulder US examination: a standardized approach with multimodality correlation for common shoulder disease. RadioGraphics 36(6):1606–1627

    Article  Google Scholar 

  31. 31.

    Alves TI, Girish G, Kalume Brigido M, Jacobson JA (2016) US of the knee: scanning techniques, pitfalls, and pathologic conditions. Radiographics 36(6):1759–1775

    Article  Google Scholar 

  32. 32.

    van Holsbeeck MT, Introcaso JH (eds) (2016) Musculoskeletal ultrasound, 3rd ed. Jaypee Brothers Medical Publishers, Philadelphia

    Google Scholar 

  33. 33.

    Filippucci E, Delle Sedie A, Riente L, di Geso L, Carli L, Ceccarelli F, Sakellariou G, Iagnocco A, Grassi W (2013) Ultrasound imaging for the rheumatologist. XLVII. Ultrasound of the shoulder in patients with gout and calcium pyrophosphate deposition disease. Clin Exp Rheumatol 31(5):659–664

    PubMed  Google Scholar 

  34. 34.

    Izadpanah K, Jaeger M, Maier D, Sudkamp NP, Ogon P (2014) Preoperative planning of calcium deposit removal in calcifying tendinitis of the rotator cuff - possible contribution of computed tomography, ultrasound and conventional x-ray. BMC Musculoskelet Disord 15:385

    Article  Google Scholar 

  35. 35.

    van Holsbeeck MT, Kolowich PA, Eyler WR, Craig JG, Shirazi KK, Habra GK, Vanderschueren GM, Bouffard JA (1995) US depiction of partial-thickness tear of the rotator cuff. Radiology 197(2):443–446

    Article  Google Scholar 

  36. 36.

    Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K (2004) Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am 86(4):708–716

    Article  Google Scholar 

  37. 37.

    Teefey SA, Hasan SA, Middleton WD, Patel M, Wright RW, Yamaguchi K (2000) Ultrasonography of the rotator cuff. A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am 82(4):498–504

    CAS  Article  Google Scholar 

  38. 38.

    Wu Z, Mittal S, Kish K, Yu Y, Hu J, Haacke EM (2009) Identification of calcification with MRI using susceptibility-weighted imaging: a case study. J Magn Reson Imaging 29(1):177–182

    Article  Google Scholar 

  39. 39.

    Nörenberg D, Ebersberger HU, Walter T, Ockert B, Knobloch G, Diederichs G, Hamm B, Makowski MR (2016) Diagnosis of calcific tendonitis of the rotator cuff by using susceptibility-weighted MR imaging. Radiology 278(2):475–484

    Article  Google Scholar 

  40. 40.

    Roberts CC, Braunstein EM (2009) Crystal diseases. In: Weissman BN (ed) Imaging of arthritis and metabolic bone disease. Saunders, Philadelphia, pp 506–519

    Google Scholar 

  41. 41.

    Farin PU (1996) Consistency of rotator-cuff calcifications. Observations on plain radiography, sonography, computed tomography, and at needle treatment. Invest Radiol 31(5):300–304

    CAS  Article  Google Scholar 

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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.

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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).

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