Calcific Tendonitis

WHAT IS IT?

Calcific tendonitis (tendinopathy) happens when calcium deposits form in the tendons (cuff) 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. It possibly occurs when there is a small injury to the muscle, the body tries to repair but the cells make more of a bone-like tissue rather than muscle. Cells are constantly changing and renewing so eventually the problem is likely to go away. This type of problem tends to occur between the ages of 40 and 60 years of age.

WHAT ARE THE SYMPTOMS?

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.

HOW IS IT DIAGNOSED?

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. One should be careful however, as sometimes calcific depositis may be seen on x-ray or ultrasound but they may not necessarily be the cause of the pain.

WHAT IS THE TREATMENT?

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.

NON-SURGICAL TREATMENT:

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 (sometimes called ultrasound guided barbotage), combined with a local anaesthetic and steroid injection. If possible, the calcium is aspirated (sucked-out) with a syringe. This tends to give the most favourable outcome in terms of pain relief but if the deposits can't be aspirated they can be broken up with the needle and then they get absorbed more easily by the body.

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

SURGICAL TREATMENT:

Once non-surgical treatment has been tried, your surgeon may recommend an arthroscopy (key-hole surgery). 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.

Spire Elland Hospital

Elland Lane
Elland
HX5 9EB

For an appointment, telephone:
Clinic bookings on 01422 324 069
Self pay enquiries on 01422 229 597
Main Hospital on 01422 229 632

BMI The Huddersfield Hospital

Birkby Hall Road
Huddersfield
West Yorkshire
HD2 2BL

Reception: 01484 533 131

Department of Orthopaedics & Trauma

Calderdale and Huddersfield NHS Foundation Trust
Huddersfield Royal Infirmary
Acre Street
Lindley
Huddersfield
HD3 3EA

NHS Secretary:
Mrs Margaret Thomas
Tel 01484 342 343

NHS Clinics

Trauma:
Calderdale Royal Hospital (Halifax)
Huddersfield Royal Infirmary

Elective Shoulder and Elbow problems:
Friday morning at Calderdale Royal Hospital, Halifax