Anatomic extension-based description for rotator cuff calcifications: retrospective analysis of 100 consecutive cases

Area of Science:

• Orthopedics
• Radiology
• Musculoskeletal Imaging

Background:

• Rotator cuff calcific tendinopathy (RCCT) is typically viewed as an enthesopathy.
• Atypical patterns of calcium deposit extension into soft tissues or bone are not well-classified.
• Failure to recognize these atypical patterns can lead to misdiagnosis and unnecessary invasive procedures.

Purpose of the Study:

• To describe atypical patterns of calcium deposit extension in RCCT.
• To assess the incidence of these atypical patterns.
• To propose an anatomic extension-based classification for RCCT.

Main Methods:

• Retrospective review of 100 shoulder cases with radiographically confirmed RCCT.
• Categorization of calcific deposits by tendon involvement, size, morphology, and anatomic location.
• Classification into Type I (enthesis-confined), Type II (soft tissue extension), and Type III (bone involvement).

Main Results:

• 19% of RCCT cases showed bone involvement (Type III), and 14% showed soft tissue extension (Type II).
• Type III deposits were significantly associated with female patients and larger calcifications (>15 mm).
• Atypical patterns involving extension beyond the enthesis were frequent findings.

Conclusions:

• Calcium deposit extension beyond the rotator cuff enthesis is common in RCCT.
• An anatomic extension-based classification enhances diagnostic precision for RCCT.
• This classification may help avoid invasive differential diagnostic procedures.