Calcific Tendonitis

 SUMMARY

  • Calcific tendonitis is a condition where calcium deposits develop in the rotator cuff tendons.
  • It is usually a self-limiting condition but can take time to resolve.
  • If movement is lost a frozen shoulder can develop.
  • Treatment options include shock wave therapy, surgical decompression, and 'needling'.

What is calcific tendonitis?

Calcific tendonitis is a condition in which there is calcium build up within one or more of the tendons around the head of the humerus (rotator cuff). It can be extremely painful. These calcium deposits are usually found in patients 30-40 years old, and are more common in diabetics. They are not always painful, and even when painful can spontaneously resolve over a period of  weeks.

Why does calcific tendonitis occur?

It is unclear why these deposits form in the rotator cuff tendons. There are different theories proposed  including an alteration in local blood supply and aging of the tendon. The evidence to support these theories is unclear.

How does the condition progress?

Calcific tendonitis usually progresses in a predictable manner.

There are typically three phases:

Precalcification Phase
Patients are usually  symptom free. There are cellular changes at certain sites within the tendons that predispose the tissues to developing calcium deposits.

Calcific Phase
Calcium is excreted from cells and then coalesces into  deposits. The calcium initially looks chalky, not solid. Once the deposits have formed, a so-called resting phase begins. This period is generally not  painful and may last a varied length of time. After this resting phase, a resorptive phase begins whrere the calcium begins to dissolve. This is usually the most painful period. During this phase, the calcium deposit has the texture of toothpaste.

Postcalcific Phase
This is usually a painless stage as the calcium deposit disappears and is replaced by more normal looking  tendon.

What effect does the calcium deposit have?

Pain as a result of calcific tendonitis is thought to be caused by pressure within the tendon and chemical irritation. A large deposit can cause a block to elevation of the arm as it becomes trapped between the head of the humerus and the acromion causing 'impingement'.

How is 'Calcific Tendonitis' diagnosed?

Your surgeon will usually be able to diagnose this condition on the basis of your symptoms and an examination in conjunction with an x-ray, ultrasound or MRI scan.

 What happens if nothing is done?

The condition is generally self limiting but can cause significant restriction of shoulder function in the short to medium term.

What treatment options are there?

Physiotherapy: To prevent any further stiffness and help to maintain a good range of motion.

Medication: Painkillers and anti-inflammatories to treat the symptoms.

Injections: To reduce inflammation and provide pain relief.

Surgery: Surgery may be recommended in the following situations:

  • Where symptoms continue to progress despite treatment
  • When constant pain interferes with routine activities (dressing, combing hair)
  • Where symptoms do not respond to conservative care

Treatments  include needling and aspiration or removal of the calcium deposit using key-hole surgery.

Needling can be done either under ultrasound control or as an arthroscopic (keyhole)  procedure . A large needle is directed into the calcium deposit and an attempt made to  suck out, as much of the calcium as possible. An Injection of saline or  cortisone can be performed into the calcium deposit.

Removal of the deposit is a larger procedure, but can be necessary, especially in chronic cases. This would normally be performed either through a small incision or by key-hole surgery.

Shock Wave Therapy:  There are several recent studies reporting the successful treatment of longstanding calcific tendonitis using shockwave therapy. The technique is thought to work by producing localised 'microtrauma' which stimulates blood flow to the affected area. Side effects and complications are minimal although some localised bruising can occur.

Article written by
Mr Angus Robertson
Consultant Knee Surgeon and Shoulder Surgeon
Cardiff Sports Orthopaedics
Last updated 22/6/10

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