Patel Hina P, Patel Shaan, Zalin Michael, Agrawal Devendra K
Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, 91766, USA.
J Orthop Sports Med. 2025;7(3):379-391. doi: 10.26502/josm.511500218. Epub 2025 Aug 4.
Rotator cuff tendinopathy is a common cause of shoulder pain and dysfunction, presenting in two primary forms: calcific and non-calcific. These subtypes differ significantly in their pathophysiology, clinical manifestations, and natural history, necessitating tailored diagnostic and therapeutic approaches. This review delineates the clinical presentations of calcific rotator cuff tendinopathy (RCCT), characterized by distinct pre-calcific, calcific, and post-calcific stages, and contrasts them with the more insidious, degenerative course of non-calcific rotator cuff tendinopathy. Diagnostic imaging, particularly musculoskeletal ultrasound, plays a pivotal role in differentiating these conditions, offering advantages in cost, accessibility, and dynamic, real-time assessment over MRI. Treatment strategies range from conservative management with NSAIDs and physical therapy to interventional techniques including ultrasound-guided barbotage, extracorporeal shockwave therapy, corticosteroid injections, and emerging regenerative therapies such as platelet-rich plasma and prolotherapy. Despite advances, further high-quality studies are needed to optimize individualized care per rotator cuff tendinopathy classification and to clarify long-term outcomes. This review highlights current evidence and clinical decision-making considerations to improve the diagnosis and management of rotator cuff calcific and non-calcific tendinopathies.
肩袖肌腱病是肩部疼痛和功能障碍的常见原因，主要有两种形式：钙化性和非钙化性。这些亚型在病理生理学、临床表现和自然病程方面有显著差异，需要采取针对性的诊断和治疗方法。本综述阐述了钙化性肩袖肌腱病（RCCT）的临床表现，其特点是具有明显的钙化前期、钙化期和钙化后期阶段，并将其与非钙化性肩袖肌腱病更隐匿的退行性病程进行对比。诊断性影像学检查，尤其是肌肉骨骼超声，在区分这些疾病方面起着关键作用，与MRI相比，在成本、可及性以及动态实时评估方面具有优势。治疗策略包括使用非甾体抗炎药和物理治疗的保守管理，以及介入技术，如超声引导下冲洗、体外冲击波治疗、皮质类固醇注射，还有新兴的再生疗法，如富血小板血浆和注射疗法。尽管取得了进展，但仍需要进一步的高质量研究，以根据肩袖肌腱病的分类优化个体化治疗，并阐明长期疗效。本综述强调了当前的证据和临床决策考量因素，以改善钙化性和非钙化性肩袖肌腱病的诊断和管理。
