Is calcific tendinitis a risk factor for rotator cuff tears? A retrospective magnetic resonance imaging-based case-control study

Abstract

Background: The association between calcific tendinitis (CaT) and rotator cuff tears (RCTs) remains controversial, and it is unclear whether CaT represents a predisposing risk factor for tendon tears. This study aimed to investigate the relationship between CaT and RCTs using magnetic resonance imaging (MRI), with a comprehensive evaluation of tear prevalence, tendon involvement, and anatomical overlap patterns between calcifications and tears. Methods: This retrospective case-control study included 328 patients who underwent shoulder MRI for shoulder pain between 2021 and 2024. The CaT group consisted of 164 patients with CaT detected on MRI and confirmed by radiography or computed tomography, while the control group included 164 consecutive patients without MRI evidence of CaT. Rotator cuff tears were evaluated using established MRI-based classification systems for partial- and full-thickness tears. Tear prevalence, tendon involvement, tear size, degree of retraction, and the anatomical relationship between calcifications and tendon tears were systematically analyzed. Results: The prevalence of RCTs was significantly lower in the CaT group compared with the control group (21.9% vs. 35.3%, P=.01). No significant differences were observed between groups regarding tear type distribution or tendon involvement patterns. Within the CaT group, only 7.3% of calcifications demonstrated direct anatomical overlap with tendon tears in the same segment. Conclusion: This study demonstrates that CaT does not increase the prevalence of RCTs and that calcifications are predominantly located in anatomical segments independent of tendon tears. The findings indicate that CaT is not a risk factor for RCTs and likely represents an independent biological mineralization process rather than mechanical degeneration.