Calcific tendinopathy of subscapularis

Case contributed by Mohamed Salah Ayyad
Diagnosis certain

Presentation

Chronic shoulder pain

Patient Data

Age: 55 years
Gender: Female
ultrasound

The distal subscapularis tendon shows a lost fibrillary pattern with few linear foci of calcifications casting posterior shadowing. The distal part of the supraspinatus tendon shows a heterogeneous area of partial fiber interruption not reaching either the articular or bursal surface suggesting a small intrasubstance tear. There is distension of both subacromial and subcoracoid bursae with few loose bodies in the subacromial bursa suggesting chronic bursitis. The acromioclavicular joint shows osteoarthritic changes.

The distal part of the subscapularis tendon is thickened with an intermediate signal in both proton density and STIR images. The distal portion of the supraspinatus tendon shows a small area of abnormal intermediate to high signal in both proton density and STIR images not reaching the bursal or the articular surface suggesting a small intrasubstance tear.

Annotated image

Annotated images describing the correlation between the findings seen in both ultrasound and MRI:

  • linear calcification within the distal subscapularis tendon (blue arrow)

  • heterogeneous area of fiber interruption within the distal supraspinatus tendon (yellow and red arrows)

  • the intermediate to high signal in the distal supraspinatus tendon seen in proton density and STIR images (red arrowheads)

Case Discussion

Calcific tendinopathy is one of the causes of chronic shoulder pain. Ultrasound has been proven to be of great value in visualizing the calcific deposits within the tendons. Calcific deposits in ultrasound appear as echogenic linear foci with or without posterior shadow. Intrasubstane tears of the rotator cuff appear as an abnormal signal not communicating with the bursal or particular surfaces. In this case, we present a patient who suffered from chronic injury of both subscapularis and supraspinatus tendons.

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