-Cyprus Orthopaedics

Calcific Tendonitis

Calcific tendonitis is a painful condition of the shoulder, which tends to affect individuals between the ages of 30 and 50 years. The condition usually commences with insidious onset of pain in the shoulder. Pain may persist at tolerable levels for many years before becoming severe.
Shoulder Conditions-Cyprus Orthopaedics

Calcific Tendonitis

Calcific tendonitis of the shoulder occurs when calcium deposits accumulate on the tendons in your shoulder. This can lead to inflammation in the surrounding tissues, resulting in significant shoulder pain. While this condition is relatively common, its exact cause remains unknown, and it is not associated with injuries, dietary factors, or osteoporosis. In addition to the discomfort caused by the calcium buildup, these deposits can also decrease the space between the acromion and the rotator cuff, leading to tendon impingement. Calcific tendonitis typically affects individuals over the age of 40.

Signs and Symptoms of Calcific Tendonitis

The signs and symptoms of calcific tendonitis can vary depending on the location of the affected tendon. In general, the most common symptom is pain, which can range from mild to severe. The pain is often worse with movement or when pressure is applied to the affected area. Other symptoms may include swelling, stiffness, and limited range of motion. In some cases, the calcium deposits may break free from the tendon, causing sudden and intense pain.

Diagnosing Calcific Tendonitis

To diagnose calcified tendonitis, the orthopedist will perform a thorough physical examination and review your medical history. He or she may also order imaging tests, such as X-rays or ultrasound, to visualize calcium deposits in the affected tendons. These tests can help confirm the diagnosis and determine the extent of the condition. In some cases, further imaging studies such as MRI or CT scans may be required to evaluate the surrounding structures and rule out other possible causes of your symptoms.

Different Treatment Options for Calcific Tendonitis

The treatment approach for calcific tendonitis depends on the severity of your symptoms and the location of the affected tendon. In mild cases, conservative, non-surgical treatments are often recommended. These may include rest, ice therapy, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections to reduce inflammation and pain. However, if the symptoms persist or if the calcium deposits are causing significant pain and limitation, surgical intervention may be necessary.

Non-surgical treatments for calcific tendinitis

Non-surgical treatments are usually the initial approach to managing calcific tendinitis. Resting the affected area and avoiding activities that aggravate the pain are essential.  Physiotherapy exercises are beneficial for strengthening the surrounding muscles and improving range of motion. In addition, the orthopedist may prescribe NSAIDs to reduce pain and swelling. In some cases, corticosteroid injections may be given directly into the affected tendon for immediate relief.

Surgical procedures for calcified tendinitis

If non-surgical treatments fail to provide adequate relief or if calcium deposits are causing significant pain and functional impairment, surgery may be considered. Surgical procedures for calcific tendinitis aim to remove the calcium deposits from the affected tendon. This can be done by various techniques, such as arthroscopic cleaning, extracorporeal shock wave therapy or open surgery. The orthopedic surgeon will determine the most appropriate surgical approach based on the location and severity of your condition.

Rehabilitation and recovery for calcific tendinitis

After surgery, rehabilitation plays a key role in the recovery process. Your orthopedic surgeon will prescribe specific exercises and physical therapy to help restore strength, flexibility and function to the affected tendon. It is important to follow your rehabilitation plan diligently and avoid overloading the tendon during the rehabilitation period. Gradually increasing the intensity of exercises and activities as advised by your doctor will help prevent re-injury and promote successful rehabilitation.

Calcium hydroxyapatite crystals are deposited in the rotator cuff most commonly in the supraspinatus tendon. The exact cause of this is unknown. In the initial “formative” phase, tenocytes (tendon cells) get converted to chondrocytes (cartilage cells) and calcium is deposited inside the chondrocytes. Small deposits merge to form a larger deposit. At this stage, symptoms are mild and often mimic subacromial impingement. This stage may last for some years. Later, in the “resorptive” phase, blood vessels proliferate at the edges of the calcium deposit and the body mounts an inflammatory response to try and clear the deposit. This inflammation is associated with worsening of pain.

The condition is diagnosed from the history of a painful shoulder, which has developed gradually over time. In the early stages, pain is often aching in nature, usually intermittent and experienced when reaching overhead and often when lying on the shoulder at night. Some patients will experience a sudden onset of excruciating pain, which severely limits their ability to use the arm for even simple daily activities. Examination shows pain with certain movements of the shoulder and on special rotator cuff tests. An ultrasound scan may demonstrate the location and size of the calcium deposit in the rotator cuff. An X-ray is essential to look at the size, location and type of the calcium deposit. MRI scans are generally unnecessary but may sometimes be useful when pain is of acute onset.

In the early phase, pain may be controlled with activity modification and the use of pain relieving or anti-inflammatory medication.

Supervised physiotherapy: You may be advised to see a physiotherapist to start a regime of specific exercises to maintain movements and overcome stiffness. Vigorous exercises should be avoided as these may aggravate symptoms.

Steroid injection: A steroid injection placed accurately into the subacromial space will often provide good short to medium term pain relief. Injections may be repeated after intervals if symptoms are mild.

Shockwave therapy: This is a non-invasive treatment, which aims to stimulate the body’s natural healing process for this condition. At least three treatments are required at weekly intervals.

Needling: Small calcium deposits may be amenable to treatment with needling (or “Barbotage”) and aspiration under local anaesthesia using ultrasound guidance. Following aspiration, steroid is usually injected into the subacromial bursa.

Surgery: If symptoms are troublesome and persist despite nonoperative treatment, it may be appropriate to undertake arthroscopic or “key-hole” surgery to remove the calcium deposit. For further information on surgical treatment, please refer to the procedures section.

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