Deciphering pain through imaging: what do MRI and ultrasound reveal in calcific tendinopathy?

Abstract

To assess the relationship between imaging findings and clinical symptoms in rotator cuff calcific tendinopathy using magnetic resonance imaging and ultrasound, focusing on calcification morphology, bursitis, and pain severity. This retrospective study included 60 patients with rotator cuff calcific tendinopathy. Ultrasound (US) and magnetic resonance imaging (MRI) were used to evaluate calcification size, shape, localization, acoustic shadowing, and associated bursitis. The Constant-Murley Score was used to assess pain severity. Interobserver reliability was measured for US findings. Statistical analyses included correlation tests and regression models. Calcification morphology and bursitis were significantly associated with pain severity. Fragmented and multifocal calcifications correlated with higher pain scores, while arc-shaped calcifications showed milder symptoms. Bursitis presence strongly correlated with increased pain. US demonstrated high interobserver agreement and was superior in detecting inflammation, while magnetic resonance imaging better characterized deep structural changes. Bursitis and calcification morphology are key determinants of pain severity in rotator cuff calcific tendinopathy. US provides real-time inflammation assessment, while magnetic resonance ımaging enhances structural evaluation. These findings support a combined imaging approach for accurate diagnosis and treatment planning.