This 1997 review by Uhthoff establishes the pathogenic framework for calcifying tendinitis of the rotator cuff. It argues the disease is a reactive, cell-mediated process — not degenerative — progressing through defined precalcific, calcific, and postcalcific stages. The central question it answers: how do you distinguish the formative from the resorptive phase, and why does that distinction completely change management?
A patient presents with sudden, severe shoulder pain and a fluffy, ill-defined calcium deposit on X-ray. The intuition is that more calcium means more pain — but this paper shows the opposite is true. Acute pain marks the RESORPTIVE phase, when the deposit is being phagocytosed. The dense, well-circumscribed deposit of the formative phase is often painless.
This distinction is what determines treatment: when the deposit is fluffy and the patient is in agony, perform lavage with two large-bore needles. The creamy consistency makes aspiration possible and decompresses intratendinous pressure. When the deposit is dense and homogeneous and conservative measures have failed, that is the indication for surgical removal.
Do not operate during the resorptive phase. The body is already doing the work. Routine acromioplasty at the time of deposit removal is not supported by evidence and should be reserved for concurrent impingement findings.
This 1997 review by Uhthoff establishes the pathogenic framework for calcifying tendinitis of the rotator cuff. It argues the disease is a reactive, cell-mediated process — not degenerative — progressing through defined precalcific, calcific, and postcalcific stages. The central question it answers: how do you distinguish the formative from the resorptive phase, and why does that distinction completely change management?
A patient presents with sudden, severe shoulder pain and a fluffy, ill-defined calcium deposit on X-ray. The intuition is that more calcium means more pain — but this paper shows the opposite is true. Acute pain marks the RESORPTIVE phase, when the deposit is being phagocytosed. The dense, well-circumscribed deposit of the formative phase is often painless.
This distinction is what determines treatment: when the deposit is fluffy and the patient is in agony, perform lavage with two large-bore needles. The creamy consistency makes aspiration possible and decompresses intratendinous pressure. When the deposit is dense and homogeneous and conservative measures have failed, that is the indication for surgical removal.
Do not operate during the resorptive phase. The body is already doing the work. Routine acromioplasty at the time of deposit removal is not supported by evidence and should be reserved for concurrent impingement findings.