Purpose: The destination of calcium after the spontaneous rupture of tendon calcifications is not exactly understood. The purpose of our work is to describe the appearance of calcifications during the resorptive phase, depicting the most common sites of migration of calcium.
Materials and Methods: In a period of 40 months, we treated 815 patients, affected by calcific tendinitis of the shoulder, that were experiencing a hyperalgic pain crisis. Among these, 194 had a broken calcification. We considered as broken those calcifications whose walls were not continuous after the injection of a small amount of saline solution. Then, ultrasound-bursography was performed in all patients to assess the involvement of subacromial-subdeltoid (SASD) bursa.
Results: The ultrasound assessment showed a fuzziness of the contour of calcification in 16% of intact calcifications and in 94% of broken calcifications (p<0,001), SASD bursitis (75% versus 81%), diffusion of calcium in the SASD bursa and in the sub-bursal space (4% versus 100%, p<0,001), inhomogeneous ultrasound appearance of calcification (36% versus 42%) and disappearance of fibrillar echotexture of the tendon involved caused by a diffusion of calcium (26% versus 88%, p<0,001).
Conclusion: The fuzziness of the contour of calcification, diffusion of calcium in the SASD bursa and in the sub-bursal space and disappearance of fibrillar echotexture of the tendon involved caused by a diffusion of calcium are specific signs of a broken calcification. SASD bursitis and inhomogeneous ultrasound appearance of calcification are non-specific signs.