Calcifying Tendinitis: US Semiotics of Deposits and the Gartner Classification Question
In the provided source fragments (Jacobson, 2026; Griffith, 2025), there is no description of the Gartner classification of calcifying deposits on ultrasound, including its categories and criteria. Therefore, its specific gradations cannot be provided — [clarification from primary source needed]. Below is the US semiotics of calcifying tendinitis available in the fragments.
US Characteristics of Calcifications
Calcification or crystalline deposition within tendon substance varies in echostructure: from small hyperechoic foci with "comet tail" artifact to large confluent zones of hyperechogenicity with dense acoustic shadowing. Deposits represent discrete areas ranging from several millimeters to several centimeters.
According to Griffith (2025), ultrasound is more sensitive than radiography or MRI in detecting calcification or crystalline deposition within tendons. Small crystalline aggregates may not be visible on radiographs.
Deposit Morphology and Clinical Significance
The fragments demonstrate a clinically relevant division based on deposit "maturity":
| Type | US Features | Clinical and Tactical Significance |
|---|---|---|
| Soft, amorphous calcification | Soft amorphous calcification (e.g., in the biceps tendon at the proximal extent of the groove) | Suitable for aspiration |
| Mature, solid deposit | Solid appearance, well-defined margins, pronounced posterior acoustic shadowing | Little or no associated pain; marked tendency toward ossification; aspiration not feasible |
Localization and Background
Calcifying tendinitis affects tendon regions most prone to tendinosis and is located near the insertion zone. Usually associated with background tendinosis. With severe non-confluent calcification in the supraspinatus tendon, the insertion zone may be masked and acoustic shadowing may extend to the humeral head.
Differentiation from Crystalline Deposition and Role of Doppler
Crystalline deposition (solid deposits with strong posterior acoustic shadowing and tendency toward ossification) should be distinguished from true calcifying tendinitis amenable to aspiration. According to the fragments, color Doppler blood flow is a sign of tendinosis. The role of color Doppler ultrasound in assessing calcifying tendinitis of the rotator cuff is reflected in specific studies (Chiou et al., 2002).
Therapeutic Aspects
For soft aspiratable deposits of the rotator cuff, ultrasound-guided technique is applied — single-needle lavage technique (Lee & Rosas, 2010).
Frequently asked questions
Are there Gartner classification criteria in the sources?
No. In the provided fragments, the Gartner classification and its categories are not described — data require clarification from the primary source [clarification needed].
How to differentiate on US between soft and mature deposits?
Soft calcification is amorphous and suitable for aspiration. Mature deposit is solid with clear margins and pronounced posterior acoustic shadowing, not amenable to aspiration, and prone to ossification.
What is more sensitive in detecting calcification — US or radiography/MRI?
According to Griffith (2025), ultrasound is more sensitive than radiography and MRI; small crystalline aggregates may not be visible on radiographs.
Is color Doppler informative in calcifying tendinitis?
According to the fragments, color Doppler blood flow is a sign of tendinosis. The role of Doppler ultrasound in calcifying tendinitis of the rotator cuff is discussed in Chiou et al., 2002.
Where are deposits typically located?
In tendon regions most prone to tendinosis, near the insertion zone; usually in the setting of concomitant tendinosis.