A 42-Year-Old Male with Worsening Chronic Shoulder Pain

Differential Diagnosis

• Shoulder dislocation
• Hill Sachs deformity
• AC separation
• Calcific tendinitis
• Loose bodies

Diagnosis
The 12 mm amorphous globular calcific density projecting over the superior aspect of the humeral head is from calcific tendinitis of the rotator cuff.

Learnings/What to Look For

• Calcific tendinitis of the rotator cuff is characterized by deposits of hydroxyapatite in the tendons of the rotator cuff.
• This can cause pain and inflammation.
• Conservative therapy with NSAIDs and physical therapy is often successful.
• Surgical resection can be effective in severe cases.
• These injuries can be treated in the urgent care and do not require transfer except in cases of diagnostic uncertainty, severe pain (which may indicate a more serious cause) or intractable pain. Beware of attributing new-onset or pain out of proportion to calcific tendinitis, as this may be an incidental finding.

Acknowledgment: Image courtesy of Teleradiology Specialists.