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CALCIFIC TENDONITIS

What is Calcific tendonitis?

Calcific tendonitis is a condition in which calcium is deposited within the tendons of the rotator cuff of the shoulder.

Why does it occur?

The cause of calcium deposits within the rotator cuff tendon is not entirely understood. Different ideas have been suggested, including altered blood supply and aging of the tendon, but no one knows for sure

However it is known that these calcium deposits are more common in patients over 30-40 years old and in those with diabetes.

What are the symptoms?

The most common symptom is pain. The pain is typically felt over the shoulder and upper arm. The pain can be extremely severe and the patient can be in agony. Some women say that the pain is worse than that of childbirth!

On the other hand, sometimes calcium deposits are not painful and are found by accident when the shoulder is x-rayed for some other reason. When painful, the symptoms often resolve slowly over a period of a few weeks. The pain may be made worse by movements reaching away from the body or behind the back. It is common to feel pain at night making it difficult to sleep.

Why is it so painful?

It is thought that the pain does not occur when the calcium is first deposited in the tendon, but occurs when the calcium is resorbed by the body. During this process there is a build up of pressure in the rotator cuff tendon as well as chemical irritation. This leads to intense pain.

Later on the pain may change in character and become less severe and chronic due to impingement. This occurs when the calcium deposit reduces the space between the rotator cuff and the overlying shoulder blade (acromion), and adversely affects the normal function of the rotator cuff. This can lead to rubbing of the acromion on the rotator cuff when lifting the arm above shoulder height which causes aching pain in the shoulder.

Does the pain go away on its own?

The pain associated with this condition often resolves spontaneously over a period of 1-4 weeks. The calcium deposit itself, however, takes much longer to disappear. Calcific tendonitis usually progresses predictably, and almost always resolves eventually without surgery

Will I need any investigations?

An x-ray of your shoulder will be required as this may show the calcium deposit. If intervention is being considered, an ultrasound or MRI scan be needed.

What is the treatment?

The initial treatment is nearly always non-operative.

This includes:

  • Rest, ice, painkillers and anti-inflammatory medications
  • Corticosteroid injections – these reduce inflammation and help control the pain
  • Physiotherapy – once pain is under control, physiotherapy can help to keep your shoulder strong and flexible and reduce irritation
  • Ultrasound guided Injection & Aspiration (“Barbotage”): Under ultrasound guidance the calcific deposit is injected with a saline solution and the calcium is also sucked out into a syringe. The area is then repeatedly washed and a steroid may be given.

When is surgery required?

Surgery is required if the pain is not controlled with non-operative means or if the pain is extremely severe. It is a key hole operation and is performed under general anaesthetic as a day case.

The aims of the surgery are to decompress the rotator cuff tendon by removing the calcium deposits and to increase the amount of space between the tendon and the shoulder blade (acromion) by shaving away a few millimeters of excess bone.

How successful is surgery?

The operation is very well tolerated and the overall success rate for relieving pain and returning to good shoulder movement and function is about 85-90%.

What are the potential risks of surgery?

Though all surgical procedures carry risks, this is a low risk procedure. Every effort will be made to minimize the risks in order to ensure the best possible outcome from your surgery. The risks of the operation include infection, bleeding, nerve damage, stiffness and incomplete relief of symptoms.

What is the recovery after surgery?

You will initially wear a sling for comfort for about 2-3 days. You will then be allowed to use the shoulder within the limits of comfort. You will see a physiotherapist prior to discharge from the hospital who will advise you on an exercise programme. You will be seen in clinic two weeks after surgery to check the wounds and assess your progress. Absorbable sutures will be used so there will be no sutures to be removed. You will be able to most things with your shoulder within a few weeks, although it can take several months before you fully return to normal. You may return to driving when you feel you have full control of your vehicle, which is usually about 2 weeks after surgery.

Are other treatments available for calcific tendonitis?

Over the last decade or so, several reports have shown successful treatment of chronic calcific tendonitis with the use of shockwave therapy. Most reports on this method of treatment of calcific tendonitis show guarded success--perhaps 50-70% of patients improving after one or two high-energy shockwave treatments. This treatment of calcific tendonitis can be painful, and usually requires anesthesia in order for it to be tolerated by the patient. I personally have no experience of this method of treatment.

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