Calcific tendonitis of the subscapularis tendon causing subcoracoid stenosis and coracoid impingement

Calcific tendonitis is a common disease of the shoulder which usually responds to conservative treatment. In cases unresponsive to conservative management, arthroscopic treatment is sometimes required. While there are several reports on calcifications within the supraspinatus tendon, documented cases involving the subscapularis tendon are rare. We present a case of a 47 year old farmer with recurrent anterior shoulder pain. An MRI revealed calcium deposits as well as a large subcoracoid cyst. Arthroscopic excision of the multiple calcific deposits left a large defect in the subscapularis tendon which was repaired back to the lesser tuberosity using arthroscopic techniques. A coracoplasty resulted in an increased coracohumeral space. The patient followed a conservative postop rehabilitation protocol and ultimately regained full strength and was pain free at the latest follow-up. We postulate two possible etiologies of subscapularis calcific tendonitis: either an idiopathic calcific tendonitis caused a secondary coracoid impingement or a primary subcoracoid stenosis resulted in an interstitial subscapularis tear which eventually resulted in calcium deposition. This report describes the clinical and technical details of arthroscopic excision of calcific deposits of the subscapularis tendon as well as arthroscopic repair of the resulting subscapularis defect.