CASE OF THE DAY: Supraspinatus Calcific Tendinopathy and Impingement (Diagnostic Ultrasound)

Today we have a client who presented with a 3 month history of right shoulder pain.

History:
Difficulty bringing the arm out to the side and above the head (active abduction) that improved when externally rotating the shoulder so the palm was facing up (supination). It was painful to lay on the right side at night, but also sore when laying on their left side and having the right arm fall across the body (Adduction).

Physical Shoulder Examination:
Active abduction restricted and painful - improved when palm supinated.
Resisted rotator cuff muscle tests - supraspinatus markedly weak and very painful, infraspinatus mildly painful and mild weakness. Could not get client into position to perform the 'lift off' test.
Palpation of the rotator cuff muscles elicited pain locally.
Active and passive external rotation mildly restricted on the right side but not significantly.
Acromioclavicular joint non tender on palpation, showed no signs of deformity compared to contralateral side.

Diagnostic MSK Ultrasound Findings:
Using diagnostic ultrasound we were able to see calcific densities within the supraspinatus tendon and associated tendon thickening compared to the contralateral side.
Dynamic examination of active abduction showed their pain to occur as the calcification attempted to pass between the acromion and greater tubercle - causing the shoulder impingement symptoms.

Treatment:
Due to the diagnosis of calcific tendinopathy being made I felt the best course of action would be to seek injection therapy into the subacromial bursa to help calm the potential inflammation in the supraspinatus tendon ultrasound. If that helps to improve function and decrease pain then that may be good enough. If not then we could look at using barbotage to remove some of the calcification with the idea that it reduces the cause of the impingement.

Using exercise therapy at this stage, in my opinion, will only cause further irritation. Exercise therapy should follow the interventions mentioned above..... again, in my opinion.

Note: We call tendon problems tendinopathy rather than tendonitis as inflammation is not always present.

The chiropractor/sonographer and lead clinician for Elevate Health Chiropractic and Wellbeing is Tom Butterfield.

[joe-zpge]

had the barbotage and it was successful. now doing physical therapy to strengthen the rotater cuff and get inflamation around bursa to a minimal. your video was the best on the internet and instrumental in helping me. the pain in calcific tendinitis is a 9 on 1 to 10 scale so i hope people view it

[joe-zpge]

very informative video. i was recently diagnoed with calcific tendinitis and impingement. had a cortisone shot and in 2 weeks will be getting barbitage. very dificult to do any therapy with this condition. after barbitage will i be able nto do therapy?