Virginia Research Day 2025

Medical Resident Research Case Reports

05 Idiopathic Bilateral Calcific Tendonitis in Female Marathon Runner

Julia Stelter, DO, PGY-2; Justin Salak, DO, PGY-1; Priscilla Tu, DO; Christopher John, MD Corresponding author: jmstelter@carilionclinic.org

Carilion Clinic Institute of Orthopedics and Neurosciences Carilion Clinic - Virginia Tech Carilion Family Medicine Residency Program

Calcific tendonitis occurs in approximately 2-10% of the adult population, and it can be a relatively common cause of unilateral shoulder pain. However, this report demonstrates a rare case of bilateral calcific tendonitis, which occurs in 0.02-1.0% of the adult population. A 39-year-old female athlete presented to her primary care physician’s office with worsening bilateral shoulder pain that had been ongoing for 5 years. She denied any history of shoulder injuries or trauma. The patient received bilateral subacromial steroid injections and x-rays were ordered for further workup. X-rays showed diffuse calcifications along the supraspinatus and subscapularis tendons bilaterally. The steroid injections did not provide relief of the shoulder pain, and the patient was waking up from sleep due to pain. The patient was then referred to a primary care sports medicine provider a couple of months later, where the physical exam showed that she had decreased range of motion in abduction, flexion, and external rotation. She also had a positive Hawkin’s test bilaterally. All other special tests of the

shoulder were negative. Given the x-ray findings, the patient underwent ultrasound-guided barbotage (also known as calcific tendinopathy aspiration/lavage) and repeat subacromial steroid injection of the left shoulder. Ultrasound and aspiration revealed a large calcium burden. Due to the amount of calcium noted, the patient completed a 24-hour urine calcium level. Her urine calcium was 462 mg/24h, which is almost double the normal amount. A referral was placed to endocrinology for further workup of hypercalciuria and to help determine the cause of significant calcium burden which likely contributed to calcific tendonitis. The patient did experience some relief in pain after the barbotage procedure, and she had the same procedure completed on the right shoulder a few weeks later. However, the pain in the right shoulder persisted despite the barbotage and subacromial steroid injection. Repeat x-ray of the right shoulder showed slightly worsened calcific tendonitis, and, on exam, the patient had developed adhesive capsulitis. At this point, she was no longer able to run or lift weights due to pain. An MRI was ordered to better evaluate the structures in the shoulder, and the

images redemonstrated multifocal calcium deposits throughout the rotator cuff with adjacent soft tissue edema around the distal subscapularis tendon. She was then referred to orthopedic surgery for surgical management. She had a right shoulder arthroscopy with extensive debridement of supraspinatus and subscapularis tendons. Two months later, the same procedure was performed on the left shoulder. After completing physical therapy for both shoulders, the patient was pain-free. Regarding the endocrinology evaluation, the patient’s labs returned within the normal range, including parathyroid, parathyroid related protein, BMP, ionized calcium, and vitamin D levels. She also had a renal ultrasound and CT of the parathyroid glands completed, which were both normal. This patient’s cause of bilateral calcific tendonitis remains unknown; however, she is now back to running marathons and lifting weights.

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