Calcific tendonitis of rotator cuff is observed on plain radiographs in 10% of adults, but remains asymptomatic in half these cases. We looked for differences on ultrasound (US) and power Doppler findings between symptomatic and asymptomatic cases of shoulder calcific tendonitis.

US was performed in 62 patients (81 shoulders) with symptomatic (n=57) or asymptomatic (n=24) calcific tendonitis. Calcific plaque morphology, power Doppler signaling, and widening of the subacromial-subdeltoid bursa (SSB) were recorded. US-guided steroid injection into the SSB (n=21) or needle puncture of calcific deposits (n=29) was performed at the end of US evaluation in 50 of the 57 patients, and a questionnaire was sent to each patient after 11±6months.

Larger (p=0.0015) and fragmented (p=0.01) calcifications were associated with pain. A power Doppler signal and a widening of the SSB was identified in 21 and 17 of the 57 symptomatic calcification respectively, but in none of the cases of asymptomatic calcification (p<0,005). At least one of these signs was present in 31 of the 57 (54%) symptomatic shoulders (p<0.001). Long-term outcome was favourable for 60% of our patients after steroid injection. The presence of a SSB widening before bursal steroid injection was associated with an improvement of the symptoms (p=0.06).

Positive power Doppler signal within the calcific deposit and SSB widening are US features strongly associated with pain. Moreover, larger calcifications are also more symptomatic. According to these results, US can help physicians to confirm that calcification is responsible for shoulder pain.