Clinical diagnostic features of calcific tendonitis
This retrospective study lends support to a unique diagnostic trend in clinical assessment of passive shoulder mobility, which can aid in the differential diagnoses of common shoulder pathologies.
The authors concluded that clinical findings of passive glenohumeral movement, in particular restricted abduction accompanied by normal external rotation, was a hallmark sign of calcific tendonitis that may prove useful in the differentiation from suspected adhesive capsulitis.
Clinical tests in musculoskeletal assessment continue to be used to help guide clinical reasoning in identification of shoulder pathologies. However, due to limitations in reliability and validity, certainty in diagnoses is reserved against better judgement due to inherent weaknesses. Aside from compounding these tests to strengthen diagnostic accuracy, use of pattern recognition is a tool often used by experienced clinicians to further lend support in differential diagnoses.
Adhesive capsulitis and calcific tendonitis have both been described in the literature as having painful, globally restricted passive shoulder mobility in 40-60 year olds. Due to similarities in presentation, differentiating between these 2 common pathologies is of importance in both management and prognostication.
To aid in identification of pathology, the authors used radiographs and MR when available. Those with signs of osteoarthritis or bony abnormalities, confirmed by x-ray, and those with suspected rotator cuff involvement identified through clinical assessment, were excluded.
In total 57 patients were identified for calcific tendonitis and 77 for adhesive capsulitis. Trends in loss of abduction for the calcific tendonitis group averaged 10 degrees from contralateral side compared to the adhesive capsulitis group with a difference of 40 degrees. In relation to external rotation, the calcific tendonitis group had an average difference of 0 degrees compared to the adhesive capsulitis group of 40 degrees.
While this study has its limitations and does not aid in the pathologic reasoning for clinical restriction, in a population where osteoarthritis is not suspected, this study lends support to the inclusion of pattern recognition in the differential reasoning between adhesive capsulitis and calcific tendonitis.
> From: Jungwirth-Weinberger, Orthop J Sports Med 6 (2018-03-11 10:25:53) 2325967117752907. All rights reserved to The Author(s). Click here for the online summary.