Calcific Tendonitis

Calcific tendonitis happens when calcium deposits form in the tendons of your shoulder. The tendon tissue around the deposit can become inflamed, causing a lot of shoulder pain. It is not clear why this process occurs or why it happens to certain individuals. This type of problem tends to occur in the younger patient and can to go away by itself in many cases.

During the early stages, you may feel only mild to moderate pain or even no pain at all. For an unknown reason the deposits may only become painful when they are being resorbed. The pain and stiffness of calcific tendonitis can cause you to lose movement in your shoulder so that lifting your arm may be painful and may interfere with your sleep.
A proportion of patients may experience just one episode of pain, some get two or three and some people get regular flare-ups of symptoms over many years. In between the painful episodes, some patients experience no symptoms at all while others may have a constant background pain.

You need a thorough shoulder examination since the pain of calcific tendonitis can be confused with other conditions that cause shoulder pain. An X-ray is usually necessary to confirm the presence of calcium deposits and serial X-rays over time can show developing and then receding deposits. Ultrasound scans are also effective at determining the extent of calcific deposits.

Treatment is aimed at controlling the shoulder pain and maintaining the range of movement. No treatment yet has been found to be effective at altering the course of the deposits either developing or receding.

Initial treatment is rest and anti-inflammatory medication, such as ibuprofen. Your surgeon may suggest a steroid injection and this can be very effective at reducing pain and inflammation. At the time when the calcium deposits are being resorbed, the condition can be extremely painful. An effective treatment during this phase is to have the calcific deposits burst with a needle under ultrasound scan guidance, combined with a local anaesthetic and steroid injection.

Physiotherapy is also focused on easing your pain and maintaining movement. The physios may suggest heat or ice also.

Shock wave therapy is a newer form of treatment where shock wave pulses are delivered to the deposit. They are thought to help break up the deposit so the body can more easily absorb it. Recent studies indicate that this form of treatment can help ease pain and reduce the size of the deposit.

Once non-surgical treatment has been tried, your surgeon may recommend an arthroscopy. The arthroscope is used to locate the calcium deposit in the rotator cuff tendon. The deposit is often buried beneath the surface so it is not very obvious. If found, the surgeon can use instruments to remove the calcium deposits and clean the tendon. This is usually combined with a subacromial decompression, which increases the space available for the affected tendon to glide beneath the acromion.
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