[In Process Citation]

Calcifying tendinitis of the rotator cuff is a common||| disorder of the shoulder which affects mainly individuals between 30 and 50||| years of age. The etiology is still a matter of speculation. The calcification||| is a reactive process actively mediated by cells in a viable environment. The||| deposit undergoes an evolution (precalcific stage--calcific stage with||| formative phase, resting period and resorption--postcalcific stage), which||| ultimately remodels normal tendon tissue. However, the evolutionary stages of||| the disease do not always follow the typical sequence. A symptomatic deposit||| may persist or postcalcific tendinitis develop. The treatment should be based||| on the knowledge of the natural history of the disease, which shows a strong||| tendency towards self-healing by spontaneous resorption of the deposit. The||| stage of evolution of the disease should be judged, combining pain history,||| morphology of the deposit on plain X-rays, and ultrasound findings. The||| therapeutic approach depends on the evolution of the disease. During the||| resorption phase we favor a conservative approach. For deposits which are not||| under resorption we propose a concept which consists of three steps: a||| conservative approach, extracorporal shock wave therapy (ESWT) or needling, and||| arthroscopic surgery. The efficacy of ESWT and needling has still to be proven.||| Patients with persisting pain after steps 1 and 2 are candidates for surgical||| removal of the deposit. We prefer the arthroscopic approach. In some cases an||| additional arthroscopic subacromial decompression (ASD) is||| indicated.