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Calcific Tendonitis of the Shoulder Print E-mail

Introduction

Calcific tendonitis of the shoulder occurs when calcium deposits form on the tendons of your shoulder. The tissues around the deposit can become inflamed, causing a great deal of shoulder pain. This condition is fairly common and most often affects people over the age of forty.

 

Graphic showing calcific tendonitis of the shoulder.

Anatomy

Calcific tendonitis occurs in the tendons of the rotator cuff. The rotator cuff is actually made up of several tendons connecting the muscles around your shoulder to the larger bone of the upper arm (the humerus). Calcium deposits usually form on the tendon in the rotator cuff called the supraspinatus tendon.

 

Graphic of the shoulder anatomy including the muscles and the tendons.

There are two different types of calcific tendonitis of the shoulder: degenerative calcification and reactive calcification. Wear and tear of aging is the primary cause of degenerative calcification. As we age, blood flow to the tendons of the rotator cuff decreases and makes the tendon weaker. The fibers of the tendons begin to fray and tear, like a worn-out rope. Calcium deposits form in the damaged tendons as a part of the healing process.

Reactive calcification doesn't seem to be related to degeneration. Why this type of calcification occurs is somewhat unclear, but it is more likely to cause pain in the shoulder than degenerative calcification. Doctors think of reactive calcification in three stages. In the pre-calcific stage, the tendon changes in ways that make calcium deposits more likely to form. In the calcific stage, calcium crystals are deposited in the tendons and begin to disappear; the body simply reabsorbs the calcium deposits. It is during this stage that pain is most likely to occur. In the post-calcific stage, the body heals the tendon, and the tendon is "remodeled" with new tissue.

 

 Graphic showing reactive calcification in the shoulder joint.


Causes

No one really knows what causes calcific tendonitis. Severe wear and tear, aging, or a combination of the two are involved in degenerative calcification. Some researchers think calcium deposits form because there is not enough oxygen to the tendon tissues. Others feel pressure on the tendons can damage them, causing the calcium deposits to form. Reactive calcification occurs in younger patients and seems to go away by itself in many cases.

Symptoms

While the calcium is deposited in the early calcific stage, you may feel only mild to moderate pain, or even no pain at all. Calcific tendonitis becomes very painful when the deposits are being reabsorbed. The pain and stiffness of calcific tendonitis can cause loss of motion in your shoulder. Lifting your arm may become painful. At its most severe point, the pain may interfere with your sleep.

Diagnosis

Your doctor will take a detailed medical history and do a thorough physical exam of your shoulder. 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 will also help pinpoint the exact location of the deposits.

You will probably need to get several X-rays over time. This will help your doctor keep track of the changes in the amount of calcification. By following the changes in the calcium deposits, your doctor can determine whether the condition will heal by itself or perhaps require surgery.

Treatment

Non-Surgical Treatment

Your doctor's first goal will be to control your pain and inflammation. Initial treatment is likely to be rest and anti-inflammatory medication, such as ibuprofen. Your doctor may suggest a cortisone injection if your pain worsens. Cortisone can be very effective at temporarily easing inflammation and swelling.

When the calcium deposits are being reabsorbed, the pain can be especially bad. Your doctor may suggest trying to remove the calcium deposit by inserting two large needles into the area and rinsing with sterile saline, a saltwater solution. This procedure is called lavage. Sometimes lavage breaks the calcium particles loose. They can then be removed with the needles. Getting rid of the calcium deposits can help speed up the healing. Even when lavage fails to remove calcium deposits, it reduces pressure in the tendon, leading to less pain.

Your doctor will probably have a physical or occupational therapist direct your rehabilitation program. At first, therapy focuses on easing your pain and inflammation. Treatments may include heat or ice. Hands-on treatments and various types of exercises are used to improve the range of motion in your shoulder. Strengthening exercises will help you improve the strength and control of the rotator cuff and shoulder blade muscles. Your therapist will help you retrain these muscles to keep the ball of the humerus in the socket. This helps your shoulder move smoothly during all your activities. You may need therapy treatments for up to six or eight weeks. Most patients are able to get back to their activities with full use of their arm within this time.

Surgical Treatment

If the pain and loss of movement continue to get worse or interfere with your daily life, you may need surgery. Surgery for calcific tendonitis does not require patients to stay in the hospital overnight, but anesthesia is required.

Most surgeries to correct calcific tendonitis of the shoulder are arthroscopic surgeries. The arthroscope is a special TV camera that can be inserted into the shoulder joint through a small incision in the skin. Other small incisions allow the surgeon to insert small surgical instruments into the joint as well. The surgeon uses the arthroscope to locate the calcium deposit in the rotator cuff tendon. Once the deposit is found, the surgeon uses the small instruments to remove the calcium deposits and rinse the area. Loose calcium crystals must be removed or they can irritate the surrounding tissues.

 

Graphic showing arthroscopic surgery for calcific tendonitis of the shoulder.

 

In rare instances, open surgery is necessary. In open surgery, the doctor gets to the calcium deposit by cutting through muscles and other surrounding tissues. The tendon itself is cut so the calcium deposits can be removed. The doctor then rinses the area to get rid of calcium crystals and stitches the muscle and skin together.

 

Graphic showing an open surgery for calcific tendonitis of the shoulder.


Rehabilitation

You may need to follow a program of rehabilitation exercises, whether or not you need surgery. Your doctor may recommend you work with a physical or occupational therapist. Your therapist can create an individualized program of strengthening and stretching for your shoulder.

It is very important to strengthen the muscles of the rotator cuff, as these muscles help control the stability of the shoulder joint. Strengthening these muscles can actually decrease the pressure on the calcium deposits in the tendon. Simple changes in the way you sit or stand can ease pain and help you avoid further problems.

Rehabilitation after shoulder surgery can be a slow process. You will probably need to attend therapy sessions for several weeks, and you should expect full recovery to take several months. Getting the shoulder moving as soon as possible is important. However, this must be balanced with the need to protect the healing tissues.

You may be required to wear a sling to support and protect the shoulder for a few days after surgery. Ice and electrical stimulation treatments may be used during the first few therapy sessions to help control pain and swelling from the surgery. Your therapist may also use massage and other types of hands-on treatments to ease muscle spasms and pain.

Therapy can progress quickly after a simple arthroscopic resection. Treatments start out with range-of-motion exercises and gradually work into active stretching and strengthening. You should avoid doing too much, too quickly.

Your exercises are designed to get your shoulder working in ways that are similar to your tasks and activities. A therapist will help you find ways to do tasks that don't put too much stress on your shoulder. You will also learn new ways to avoid future problems.

 

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