A commentary on “BMI and body fat distribution play an important role in rotator cuff calcific tendonitis: evidence from retrospective study and Mendelian randomization”

Calcific tendinitis of the shoulder is a common, painful rotator cuff disorder with both nonoperative and operative treatment options. The optimal nonoperative modality remains unclear, and it is not well understood how previous nonoperative treatments influence eventual surgical outcomes. The purpose of this study was to compare success rates, defined as avoidance of surgery, among 3 nonoperative treatments for calcific tendinitis: physical therapy (PT), corticosteroid injection (CSI), and ultrasound-guided barbotage (USB). For patients who underwent surgery, outcomes were compared according to previous nonoperative management. It was hypothesized that success rates and postoperative outcomes would not differ significantly between modalities. Cohort study; Level of evidence, 3. A retrospective review of patients diagnosed with calcific tendinitis from 2009 to 2023 was performed. Exclusion criteria were lack of radiographic confirmation, <6 months follow-up, or incomplete electronic medical record data. Patients were categorized by attempted nonoperative treatment (none, PT, CSI, USB, multiple) and by final management (nonoperative vs operative). Patient-reported outcomes included the visual analog scale (VAS), Subjective Shoulder Value (SSV), and range of motion (ROM), collected at initial and final presentation. Radiographic findings were extracted from radiology reports. Statistical testing used parametric or nonparametric methods as well as a multivariable Cox proportional hazards model to predict nonoperative failure. Significance was set at P < .05. A total of 257 patients (mean age 55 ± 11 years) were analyzed with a mean follow-up of 18 ± 16 months with an overall nonoperative success rate of 63%. Success rates did not differ significantly among PT (59%), CSI (75%), and USB (72%), but patients with multiple tendon involvement or calcifications >3 cm were more likely to fail nonoperative management. Patients completing successful nonoperative management improved in VAS, SSV, and ROM, with no between-group differences. All patients who attempted multiple modalities (18/18; 100%) required surgery (P < .01). Among 121 patients undergoing surgery, final VAS, SSV, and ROM outcomes did not differ based on previous nonoperative management. PT, CSI, and USB demonstrate similar rates of avoiding surgery for calcific tendinitis. For patients ultimately requiring surgery, outcomes are not influenced by previous nonoperative management. Surgical intervention may be indicated after failure of a single nonoperative modality.

We investigated the relationship between hyperlipidemia, menopause, and the risk of calcific tendinitis (CT) of the shoulder in female participants aged 30-70 in the Taiwan Biobank (TWB). Our analysis included 14,274 women, with 6,883 categorized as menopausal and 4,586 diagnosed with hyperlipidemia. We identified 244 women with CT of the shoulder. We employed logistic regression analyses to investigate the associations between menopause and hyperlipidemia with the risk of developing CT. The models controlled for several variables, including age, body mass index, education level, physical activity, smoking status, alcohol consumption, coffee and tea intake, diet, hormone therapy (HT), diabetes, and hypertension. Among the 244 women diagnosed with CT, a significant majority(186 [76.23%]) were postmenopausal, and 139 (56.95%) had hyperlipidemia. Logistic regression analysis revealed significant associations: hyperlipidemia increased the odds of CT (odds ratio [OR]=1.72, 95% CI: 1.27-2.33), while menopause presented an even higher risk (OR=2.37, 95% CI: 1.69-3.33). Stratified analyses indicated that women with hyperlipidemia who were not menopausal had an OR of 1.58 (95% CI: 0.85-2.94). Meanwhile, menopausal women without hyperlipidemia showed an OR of 2.29 (95% CI: 1.52-3.45). The highest risk was observed in women with both conditions, yielding an OR of 4.03 (95% CI: 2.67-6.07). Our findings underscore a significant association between hyperlipidemia, menopause, and the risk of CT of the shoulder in women within the Taiwan Biobank cohort.

Objective: This study aims to investigate whether suspected risk factors for tendinopathy also confer risk for rotator cuff calcific tendonitis (RCCT) through a retrospective and a Mendelian randomization (MR) analysis. Methods: Univariate and multivariate logistic regression analyses were performed, incorporating demographic (age, sex) and key metabolic parameters (body mass index, diabetes, dyslipidemia, hypertension) implicated in tendinopathy. Subsequently, a two-sample MR analysis was carried out to investigate causal relationships. The primary exposure was BMI. To dissect its effect, we further evaluated the causal relationships of body fat percentages in specific regions and grip strength with RCCT. Additionally, MR was used to provide a definitive assessment of the relationship between diabetes and RCCT. Results: Retrospective analysis of 71 patients and 80 controls identified older age, female sex, and higher BMI as independent risk factors for RCCT (all P &lt; 0.05). The MR analysis provided genetic evidence to clarify and extend these findings. First, it ruled out a causal role for either type 1 or type 2 diabetes in RCCT ( P = 0.364 and P = 0.183, respectively). Conversely, it confirmed that higher genetically predicted BMI is a causal risk factor for RCCT ( P &lt; 0.001). This causal effect was further delineated by measures of adiposity. Whole-body fat percentage, trunk fat percentage, waist circumference, and limb fat percentage all showed causal associations with increased RCCT risk. Conclusions: By integrating retrospective clinical analysis with MR, we robustly exclude a causal role for diabetes but establish elevated BMI and specific patterns of body fat distribution (trunk and limb adiposity) as independent and causal risk factors. Furthermore, greater grip strength is identified as a protective factor. These findings highlight that weight management and the maintenance of muscular strength – achievable through sustained physical activity – are central to the primary prevention of RCCT.

Calcific tendinitis of the medial collateral ligament (MCL) is an exceedingly rare cause of knee pain. We report an exceptional case of massive, refractory MCL calcific tendinitis, with a unique presentation potentially linked to an underlying malignancy. A 61-year-old female patient presented with a 3-month history of persistent left medial knee pain, unresponsive to conservative therapy. Physical examination revealed medial joint line tenderness and limited range of motion. Imaging-including radiography, 3-dimensional computed tomography, and magnetic resonance imaging-demonstrated an unusually voluminous, strip-like calcific deposit within the proximal MCL. Notably, a concurrent lesion was identified in the left lung during the diagnostic workup and was subsequently confirmed as invasive lung adenocarcinoma. Given the failure of nonoperative measures and the large size of the calcification, open surgical excision was performed, leading to rapid and complete resolution of symptoms. This case highlights that massive, refractory calcific tendinitis may be a marker of systemic calcium dysregulation. The coexistence of invasive lung adenocarcinoma warrants consideration of an underlying systemic process, including potential metabolic dysregulation or paraneoplastic mechanisms that may contribute to periarticular calcification. We suggest that clinicians should evaluate for underlying metabolic and/or oncological disorders when atypical or massive periarticular calcifications are encountered. In such complex scenarios, open excision remains an effective definitive treatment if conservative measures fail.

Background and purposeIn 2013, the first clinical practice guideline for subacromial pain syndrome (SAPS) was developed in the Netherlands to support healthcare professionals. SAPS refers to non-traumatic, non-rheumatologic shoulder complaints that are particularly painful during arm elevation. It includes conditions such as supraspinatus tendinosis, calcific tendinitis, and degenerative supraspinatus tears. Over 50,000 patients annually consult orthopedic surgeons for these issues. In response to new evidence and clinical needs, an updated guideline was developed. Part 1 addresses prevention, diagnosis, imaging, and non-surgical treatment. Using a multidisciplinary, evidence-based approach, the guideline aims to answer key clinical questions around SAPS.MethodsInitiated by the Dutch Orthopedic Society, the guideline committee identified knowledge gaps through group sessions. Each module was based on a PICO-formatted key question and reviewed by professionals from different fields. The AGREE and GRADE methods were applied to ensure a systematic evaluation of evidence, leading to conclusions and recommendations.Results(i) Inform patients about the potential positive effects of a healthy lifestyle and encourage gradual exercise within sport and work. (ii) Perform a cluster of physical diagnostic tests to diagnose SAPS. (iii) Perform ultrasonography in patients with clinical suspicion of (partial thickness) rupture of the supraspinatus tendon. Consider MRI if ultrasound is not available or inconclusive. (iv) Consider barbotage for symptomatic calcific tendinosis, preferably with corticosteroid injection in the bursa, if a previous corticosteroid injection was ineffective. (v) Consider a subacromial corticosteroid injection (with a local anesthetic) to enable exercise therapy in patients with severe complaints that impair their ability to participate in exercise therapy. (vi) Consider suprascapular nerve block for patients with therapy-resistant SAPS when other non-surgical treatment is ineffective.ConclusionThe updated guideline provides multidisciplinary recommendations for physical examination, imaging, and conservative management of SAPS.

Background and purposeIn 2013, the first clinical practice guideline for subacromial pain syndrome (SAPS) was developed in the Netherlands to support healthcare professionals. SAPS refers to non-traumatic, non-rheumatologic shoulder complaints that are particularly painful during arm elevation. It includes conditions such as supraspinatus tendinosis, calcific tendinitis, and degenerative supraspinatus tears. Over 50,000 patients annually consult orthopedic surgeons for these issues. In response to new evidence and clinical needs, an updated guideline was developed. Part 2 focuses on supraspinatus tears, biceps tendon pathology, and calcific tendinosis. Using a multidisciplinary, evidence-based approach, the guideline aims to answer key clinical questions around SAPS.MethodsInitiated by the Dutch Orthopedic Society, the guideline committee identified knowledge gaps through group sessions. Each module was based on a PICO-formatted key question and reviewed by professionals from different fields. The AGREE and GRADE methods were applied to ensure a systematic evaluation of evidence, leading to conclusions and recommendations.Results(i) Start with exercise-based therapy (with corticosteroid injection) for isolated, symptomatic, non-traumatic supraspinatus tears. Consider cuff repair if no improvement after 3–6 months. (ii) Avoid biceps tenotomy/tenodesis on a healthy tendon unless at risk during cuff repair. (iii) Evaluate patient- and tear-specific factors; use MRI for detailed assessment. (iv) Consider barbotage for calcific tendinosis; repeat once if needed. Reserve surgery for persistent large calcifications. (v) Postoperative immobilization should not exceed 3 weeks.ConclusionThe updated guideline provides multidisciplinary recommendations for surgical management.

This systematic review aimed to evaluate prognostic factors associated with outcomes following needling and shockwave therapy (SWT) for RCCT rotator cuff calcific tendinitis (RCCT). MEDLINE, EMBASE, and CENTRAL databases were searched for studies on prognostic factors in RCCT treated with needling or SWT that included multivariable analyses. The risk of bias was assessed using the Quality in Prognosis Studies tool, and the quality of each prognostic factor was evaluated using a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. 13 studies involving 1693 shoulder patients were included, of which 11 evaluated needling and two evaluated SWT, all showing moderate-to-high risk of bias. Across needling studies, 32 variables were evaluated in multivariable models, with five showing potential predictive value for treatment success based on GRADE quality: larger calcification size, Type III Gartner-Heyer (fluid-like) classification, shorter distance between the subacromial bursa and deposit, normal bursal appearance, and fewer needling sessions. In SWT studies, four variables were analysed, with Type III calcifications and shorter symptom duration associated with better outcomes. Certain disease- and procedural-related factors may predict better outcomes with needling or SWT for RCCT, though the evidence is limited and requires prospective validation to refine patient selection. III.

Background:The association between calcific tendinitis (CaT) and rotator cuff tears (RCTs) remains controversial, and it is unclear whether CaT represents a predisposing risk factor for tendon tears. This study aimed to investigate the relationship between CaT and RCTs using magnetic resonance imaging (MRI), with a comprehensive evaluation of tear prevalence, tendon involvement, and anatomical overlap patterns between calcifications and tears.Methods:This retrospective case-control study included 328 patients who underwent shoulder MRI for shoulder pain between 2021 and 2024. The CaT group consisted of 164 patients with CaT detected on MRI and confirmed by radiography or computed tomography, while the control group included 164 consecutive patients without MRI evidence of CaT. Rotator cuff tears were evaluated using established MRI-based classification systems for partial- and full-thickness tears. Tear prevalence, tendon involvement, tear size, degree of retraction, and the anatomical relationship between calcifications and tendon tears were systematically analyzed.Results:The prevalence of RCTs was significantly lower in the CaT group compared with the control group (21.9% vs. 35.3%, P = .01). No significant differences were observed between groups regarding tear type distribution or tendon involvement patterns. Within the CaT group, only 7.3% of calcifications demonstrated direct anatomical overlap with tendon tears in the same segment.Conclusion:This study demonstrates that CaT does not increase the prevalence of RCTs and that calcifications are predominantly located in anatomical segments independent of tendon tears. The findings indicate that CaT is not a risk factor for RCTs and likely represents an independent biological mineralization process rather than mechanical degeneration.

Improvement of calcified tendonitis following human placenta extract injection: A retrospective, single-arm, multicenter observational study.

Periarticular Soft Tissue Disorders: Enthesopathies, Tendinopathies, and Bursitis-Pathophysiology and Radiotherapeutic Approaches.

Effectiveness of suprascapular nerve block associated with physiotherapy compared with physiotherapy isolated for treatment of adhesive capsulitis: a randomized controlled trial.

Exploring Mechanisms of Calcific Tendonitis Using a Novel Turkey Model.

BackgroundWith the advancement of hip arthroscopy, studies on the acetabular labrum and pathology have taken greater interest. To date, there are a handful of review articles on calcifications of the acetabular labrum and scattered case reports on calcific tendinitis of the rectus femoris. We aim to present a unifying classification for acetabular and periacetabular calcifications of the hip, along with corresponding medical imaging findings and arthroscopic pictures.ResultsPlain radiographs are very important as these small areas of calcification or ossification can easily be missed on MRI scans. Anatomical distinction between the acetabulum (bone), acetabular rim (rim) and periacetabular (at a distance from the rim) locations of the calcifications are crucial for establishing the diagnosis.This proposed classification can be broadly divided into 4 large groups based on their morphological appearance and sites - Type A: Calcifications of the acetabular rim; Type B: Calcifications of the direct portion of the rectus femoris; Type C: Heterotopic ossification of the hip capsule; and Type D: Mixed with combination of Types A and B.Type A calcifications have been previously described by Marc Safran and can be further subdivided into Type A1 – punctate/ partial calcifications within the labrum; Type A2 – large rounded calcifications/ Os Acetabulil; Type A3 – large fragments with a vertical line consistent with consolidated or non-consolidated stress fractures and Type A4 – complete circumferential ossification of the labrum adjacent to the lateral border of the acetabular rim. Type B calcifications can be furthered subdivided into Type B1 – short filiform type; Type B2 – long filiform type and Type B3 – rounded or diffuse calcifications of the direct portion of the rectus femoris. Type C ossification refers to that of heterotrophic ossification and can further be subdivided by the Brooker Classification. Type D calcifications refer to a mixed-type entity where there are combinations of the earlier described Types A and B calcifications that occur simultaneously at different anatomical sites.ConclusionAcetabular and periacetabular calcifications are complex with diverse etiologies and classification of the varied types will aid in accurate diagnosis and appropriate treatment.

Longus colli acute calcific tendinitis (LCCT) is a painful disease characterized by a triad of neck pain, neck stiffness and odynophagia. It is a relatively rare cause of neck pain, often unknown or underdiagnosed, but it is important to be aware of its existence as it can mimic other potentially more dangerous illnesses. We present a short series of five cases in which we gathered demographic and clinical data including imaging studies and compared our findings to previous reports by other authors. The diagnosis of LCCT was made by the combination of a compatible clinical presentation and blood workup plus the identification of a calcific deposit in the proximal oblique fibers of the longus colli muscle and retropharyngeal edema via computed tomography. Five patients were analyzed. Mean age was 44 years, three female and two male. All patients initially presented neck pain and painful mobilization, while only 60% presented with odynophagia. There were no patients with radiculopathy nor fever. The mean values for ESR, CRP and White Blood Cell (WBC) were 23.2mm/h, 2.97mg/dl and 10.21 * 10^9/L respectively. On CT and/or MRI exploration all the patients presented a visible calcific deposit on the anteroinferior border of the anterior C1 arch and visible signs of retropharyngeal oedema. LCCT is a self-limited pathology that is caused by a foreign-body type reaction in the retropharyngeal space secondary to the degradation and resorption of calcium hydroxyapatite deposits usually found at the anteroinferior border of the anterior C1 arch. It is necessary to create awareness of this pathology amongst physicians because it can mimic more serious illness like retropharyngeal abscess, meningitis and spondylodiscitis and this may lead to unnecessary expenditures and antibiotic usage.

Introduction: Gout affecting the shoulder joint is exceptionally rare. It can present with clinical and radiological features similar to calcific tendinitis, leading to misdiagnosis and inappropriate management. Case Report: A 37-year-old male presented with severe right shoulder pain for three months, unrelieved by repeated steroid injections. Radiographs and Magnetic Resonance Imaging (MRI) demonstrated a radiopaque intratendinous lesion within the supraspinatus tendon, suggestive of calcific tendinitis. The preoperative blood test showed a uric acid level of 6.8, which was within the normal range. Arthroscopic exploration revealed multiple white chalky deposits on the glenoid and humeral head, as well as dense intratendinous infiltration of tophaceous material. Histopathologic analysis confirmed monosodium urate crystal deposition. Because of deep tendon involvement, only partial arthroscopic debridement was performed, followed by side-to-side rotator cuff repair. The patient received urate-lowering medication postoperatively. He experienced rapid pain relief and regained full shoulder motion within three months, with no recurrence at one-year follow-up. Conclusion: Gouty tophus of the shoulder may mimic calcific tendinitis both clinically and radiographically. Diagnostic arthroscopy remains essential in unclear cases. Even when complete excision is not feasible, partial debridement combined with systemic urate-lowering therapy can lead to excellent recovery and prevent recurrence.

BackgroundThis study aimed to investigate the initial site of calcification development in rotator cuff tendons using serial ultrasonographic evaluations.MethodsA total of 21 patients with de novo calcifications were included. Ultrasonography was used to assess calcifications in the rotator cuff tendons. The distance from the tendon insertion on the humerus to the calcification site was measured, along with the long and short diameters and the long-to-short diameter ratio.ResultsIn 19 patients (90%), calcifications were in direct contact with the tendon insertion on the humerus. In the remaining two patients (10%), the calcifications were located 1 mm proximal to the tendon insertion site. The mean long and short diameters of the calcifications were 9.4 ± 4.6 and 2.7 ± 1.2 mm (range: 3.0-17.0 and 1.0-4.5 mm), respectively. The mean long-to-short diameter ratio was 2.4 ± 2.2 mm (range: 1.8-10.0 mm). Regarding shoulder disorders, 1, 7, and 13 patients had a rotator cuff tendon tear, calcific tendinitis, and adhesive capsulitis, respectively.ConclusionsCalcifications in the rotator cuff tendons appear to originate at the tenoperiosteal junction or in close periosteal proximity and extend along the tendon axis.

Introduction: Achilles tendinopathy is a common musculoskeletal condition that significantly impairs gait and overall mobility, ultimately reducing the quality of life. It is characterized by activity-induced pain, swelling, and functional limitations, and is often caused by repetitive microtrauma, increased mechanical load, or reduced vascular supply. Without appropriate treatment, abnormal gait patterns such as medial collapse may occur, leading to long-term biomechanical imbalances. Despite available conservative and surgical options, no clear consensus exists regarding optimal management, and many patients fail to respond adequately. These limitations highlight the need for novel pathophysiology-based therapeutic approaches.Case Presentation: A 49-year-old restaurant worker experienced chronic left heel pain for five years and was diagnosed with chronic Achilles tendinopathy accompanied by calcific tendinitis. Previous treatments, including nine triamcinolone-lidocaine injections and ten platelet-rich plasma sessions, resulted in minimal improvement, and surgical intervention was recommended. She received a total of 12 treatment sessions over a 47-day period. The patient underwent a four-stage ultrasound-guided acupuncture protocol. The protocol included the following: (1) management of paratenonitis, (2) fascial release between the gastrocnemius and soleus muscles using pharmacopuncture, (3) removal of neovascularization via high-volume injection, and (4) periosteal pecking technique (also called dry needling, and referred to as Golmak-Jaktak-beop in traditional Korean medicine) and high-frequency electroacupuncture targeting the Achilles tendon insertion. Post-treatment color Doppler ultrasonography showed reduced intratendinous neovascularization. The patient’s Foot and Ankle Outcome Score (FAOS) subscales demonstrated consistent improvement throughout treatment and at the two-month follow-up.Conclusion: This case suggests that a four-stage ultrasound-guided acupuncture approach may be a potential nonsurgical treatment option for chronic Achilles tendinopathy, especially in patients unresponsive to conventional therapies.

Background/Objectives: Rotator cuff calcific tendinitis (RCCT) is a common cause of shoulder pain. The role of acromial morphology in RCCT pathogenesis remains unclear. This study aimed to evaluate association between acromial morphological parameters and calcific deposit characteristics in patients with RCCT. Methods: We retrospectively analyzed 1185 patients who underwent shoulder radiography between January 2015 and January 2025 at Merkur University Hospital, Zagreb, Croatia. After excluding 281 radiographs of insufficient quality, 904 patients (503 females, 401 males; mean age 57.5 ± 13.6 years) were included. Calcific deposits were classified according to Bosworth and Gartner–Heyer systems. Acromial morphology was assessed using the acromion index (AI), critical shoulder angle (CSA), lateral acromial angle (LAA), and acromiohumeral interval (AHI). Non-parametric statistical tests were used with statistical significance set at p < 0.05. Results: The mean deposit diameter was 13.29 mm. According to Gartner–Heyer classification, 295 patients had type 1, 339 type 2, and 270 type 3 deposits. Significant correlations were found between deposit size and CSA (ρ = −0.08, p < 0.05), and AHI (ρ = 0.12, p < 0.001), while AI correlated with Gartner–Heyer type (ρ = 0.09, p < 0.01). No significant correlations were found for LAA. Kruskal–Wallis testing showed significant differences across deposit groups for AI, AHI, and LAA. Conclusions: Acromial morphology is significantly associated with calcific deposit characteristics in RCCT, supporting a potential biomechanical role in disease manifestation. These findings may refine diagnostic assessment and warrant further prospective validation.

Longus Colli Calcific Tendinitis: A Systematic Review on Current Trends in Management and Treatment