1. Imaging Findings

Based on the provided shoulder X-ray and ultrasound imaging data, the main observations are:

• In the shoulder joint region, especially at the insertion area of the rotator cuff tendons (most commonly the supraspinatus tendon), there are local high-density shadows or enhanced echoes. These often appear round or irregular in shape, matching common presentations of calcifying tendinitis of the rotator cuff.
• Some X-ray images show dense calcifications, potentially with slight changes in soft tissue contours. On ultrasound, there may be high-amplitude echoes with posterior acoustic shadowing or uneven echo distribution indicating “cheese-like” or “toothpaste-like” calcification.
• No obvious large-scale bone destruction or definite fracture signs are observed, and there is currently no marked joint space narrowing. However, attention should be given to the soft tissue surrounding the calcific deposits.
• The adjacent bursa may show anechoic or heterogeneous echo areas, suggesting possible bursitis or small effusions. Notably, when calcific material penetrates the bursa, it can cause severe pain.

2. Potential Diagnoses

1. Calcifying Tendinitis of the Rotator Cuff
   • Typically presents with local calcium deposits in the rotator cuff tendons, most commonly in the supraspinatus tendon, and patients may experience significant shoulder pain and limited range of motion.
   • On imaging, dense spot-like or lump-like calcifications may be seen on X-ray, and high-echo foci on ultrasound.
   • It may be caused by poor blood supply, repeated microtrauma, or inflammation, and can be associated with bursitis or partial rotator cuff tears.
2. Partial Tear of the Rotator Cuff or Associated Chronic Tendinopathy
   • If calcification is widespread or combined with structural abnormalities of the tendon, a rotator cuff tear should be considered.
   • Clinically, pain may worsen with activity and range of motion can decrease. On imaging, there may be discontinuity or thickening of the tendon echo, or contour deformities.
3. Subacromial Bursitis
   • When there is fluid accumulation or inflammation in the bursa, it can lead to shoulder pain and limited mobility, particularly noticeable during shoulder abduction.
   • However, if there are significant calcific deposits, it is more suggestive of concurrent calcifying tendinitis or rotator cuff tear.

3. Final Diagnosis

Considering the patient is 34 years old, has had shoulder pain for 1 month, and imaging indicates dense or “irregular” calcific deposits in the rotator cuff tendon area, along with high-echo foci on ultrasound, the most likely diagnosis is Calcifying Tendinitis of the Rotator Cuff. If the clinical symptoms are severe, a concurrent mild rotator cuff tear or subacromial bursitis should also be suspected. It is recommended to combine clinical examination or perform MRI if necessary for further clarification.

4. Treatment Plan and Rehabilitation Plan

4.1 Treatment Strategies

• Conservative Treatment: Includes oral NSAIDs (nonsteroidal anti-inflammatory drugs), local corticosteroid injections, and physical therapy (e.g., shockwave therapy or ultrasound therapy). These approaches can be effective for mild to moderate pain and smaller calcifications.
• Minimally Invasive Intervention: Under ultrasound guidance, aspiration and lavage of the calcified material can be performed to relieve pain. For denser calcifications, the material can be repeatedly “fragmented” with a needle and then flushed out.
• Surgical Treatment: In cases of persistent symptoms or larger cuff tears, arthroscopic removal of the calcific deposits and repair of the rotator cuff may be considered. Surgery can effectively remove calcifications and repair tears to improve shoulder function.

4.2 Rehabilitation / Exercise Prescription and FITT-VP Principle

During rehabilitation, once shoulder pain and inflammation have subsided, functional exercises should be gradually introduced:

• Frequency (F): Perform exercises 3-4 times per week, adjusting based on individual pain and fatigue levels.
• Intensity (I): Begin with low-resistance, low-load shoulder movements, including passive range of motion exercises and low-load strength training. After significant pain relief, progress to light resistance exercises using resistance bands or small dumbbells.
• Time (T): Each session can start at 10-20 minutes, gradually increasing to about 30 minutes as tolerance improves.
• Type (T):
  • Range of Motion Exercises: Such as flexion, abduction, internal rotation, and external rotation to prevent shoulder stiffness.
  • Muscle Strength Training: Use resistance bands or dumbbells to strengthen external rotators, deltoid, and other surrounding muscle groups.
  • Joint Stability Exercises: Side-lying or prone-support exercises to enhance scapular stability and reduce stress on the rotator cuff.
• Progression (P): As pain and function improve, gradually increase the resistance level or complexity of movements. Avoid overexertion in a single session. Adjust the plan dynamically based on muscle strength and pain.

Throughout the rehabilitation process, if the patient experiences severe shoulder pain or recurrent inflammation, reduce or stop training intensity immediately and consult a professional doctor or rehabilitation therapist to prevent secondary injury.

5. Disclaimer

This report provides an analysis based on the submitted case information and imaging data for medical reference purposes only. It cannot replace in-person consultation or professional medical advice. If there is any doubt or change in condition, please seek prompt medical care or consult a specialist.