Predictive factor for failure of conservative management in the treatment of calcific tendinitis of the shoulder

Abstract Introduction Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC). When conservative management fails, arthroscopic surgery for removal of the calcium may be considered. Surgical removal is often followed by rotator cuff repair to address the resulting tendon defect. This study was performed to assess predictive factors for failure of conservative management as well as to characterize the rate of rotator cuff repair in the setting of calcific tendinitis. We hypothesize that larger calcific lesion would have a higher likelihood to fail conservative treatment. Methods A retrospective review of patients who were diagnosed with calcific tendinitis at our institution between 2009 and 2019 was performed. Demographics, comorbidities, pain score (VAS), ASES, ROM and patient-reported quality of life measures were recorded and analyzed. All patients underwent a radiograph and MRI. Size of the calcific lesion was measured based on its largest diameter on MRI. Statistical analysis included chi-square, independent t test and ANOVA. Results 239 patients were identified in the study period; 127 (53.1%) were female. Mean age was 54 years and BMI 29.2 with mean follow-up of 6 months. 160 had an intact RTC (67.2%) and 78 had a partial RTC tear (32.8%). 93/239 (38.9%) patients failed conservative treatment after an average of 4.4 months necessitating surgical management. Among patients who underwent surgery the majority of patients, 77/93 (82.8%) required a concomitant rotator cuff repair. Sub-analysis demonstrates that calcific lesions > 1 cm was significantly associated with failure of conservative treatment (odds ratio=2.81, 95% CI 1.25-6.29, p Conclusion Patients with calcific lesions >1 cm had a 2.8x-increased likelihood to undergo operative treatment in the setting of calcific tendinitis of the shoulder. The majority of patients who undergo surgical management for removal of the calcific deposit required a concomitant rotator cuff repair and had significant improvements in shoulder pain and function. This information can be helpful to guide Orthopedic Surgeons on preoperative planning and discussion when treating calcific tendinitis of the shoulder.