The clinical presentation of acute calcific bursitis/tendinitis is often very impressive. The onset of symptoms is usually spontaneous and is associated with the rapid development of excruciating shoulder pain and inability to sleep. The patient is exceedingly tender to palpation about the bursa and has extreme pain with any attempted motion of the shoulder.

There may be warmth and fullness anterolaterally. Elbow and hand motion are normal and distal neurocirculatory examination is intact. Neck motion also is generally normal and careful neurologic exam should exclude cervical radiculitis and Parsonage-Turner syndrome. Infection must be ruled out with blood studies and aspiration if necessary. Milwaukee shoulder syndrome is associated with massive calcification in elderly women and severe glenohumeral joint degeneration and dissolution of the rotator cuff.

The severe acute symptoms will usually subside in 3 to 7 days, often with the help of analgesic and anti-inflammatory medications and subacromial corticosteroid injections with local anesthetic. Motion gradually returns and the resolution of pain often correlates with the dissolution of the deposit and complete resolution of the syndrome or its containment in a cyst-like shell.

Retained calcium may be associated with subacute and chronic calcific tendinitis. Symptoms in these stages often depend on the size and location of the calcific lesion and the morphology of the coracoacromial arch. Large supraspinatus lesions can be associated with anterior impingement while subscapularis lesions lead to anterior subcoracoid impingement. Acute symptoms may recur periodically when the calcific mass leaks or ruptures. As the calcific mass matures and hardens, mechanical symptoms such as painful snapping or catching can occur.

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7/8/2006

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