Calcific tendinitis of the rotator cuff

Calcific tendinitis may require surgery if it does not resolveCalcific tendinitis of the rotator cuff is a painful condition associated with calcium deposits in the shoulder. These may sometimes also be found in asymptomatic people. Calcific tendinitis can cause pain which may limit normal shoulder use and interfere with sleep. The calcium deposits may disappear with time. In some instances surgery may be needed to remove the calcification…

What is calcific tendinitis?

Calcific tendinitis of the shoulder is a painful condition associated with calcium deposits in the rotator cuff. The rotator cuff is a group of tendons which control lifting and rotation of the arm. In some people calcium deposits may appear inside the tendon. These may be small enough to be seen on ultrasound scan only. Sometimes the deposits are quite large and are easily seen on x-ray.

Calcific tendinitis commonly occurs in patients in their 30’s and 40’s and is more common in women.

What causes calcific tendinitis?

Calcium deposit in rotator cuff

A deposit of calcium in the rotator cuff

There are several theories as to why calcific tendinitis develops but no one knows for sure, however. It is thought that there is a change in the nature of the affected tendon cells. This occurs in the area where the calcium develops, but why this happens is not clear. There may be an association with trauma. Diabetes, thyroid disorders, and autoimmune diseases may also be associated with this condition.

Why is it so painful?

Calcific tendinitis can cause severe pain. The pain is worse with overhead activities and rotational movement of the arm. It can interfere with sleep. It may be difficult to lie on the affected shoulder.

The cause of the pain is not always clear. Many people have calcium deposits discovered by chance on an X-ray – these people may never have had any shoulder pain.

Studies have found an increase in blood vessel growth and pain receptor formation in the area of the calcium deposits. This may explain the pain in symptomatic individuals.

Calcium deposit in rotator cuff

Inflammation surrounding the calcium deposit, causing pain

Just above the rotator cuff tendon in the shoulder is the bursa. The bursa is tissue which helps with gliding movements in the shoulder. It may become inflamed as a result of a large underlying calcium deposit (read: I have shoulder pain – could this be shoulder bursitis?). This can cause pain and secondary impingement. Impingement is a type of pinching caused by the bone which forms the roof of the shoulder, the acromion (read: What does shoulder impingement surgery involve?).

All these factors may combine to cause a painful shoulder. Some episodes of severe pain are thought to be due to calcium leaking into the surrounding tissues. This can cause further inflammation and discomfort.

Will it go away?

Calcific tendinitis may disappear on its own. It may take many months or years to resolve. In some instances the calcific deposits do not disappear on x-ray. Despite this, the individual may become asymptomatic.

What is the treatment for calcific tendinitis?

Needling of calcium deposit

Needling of the calcific deposit

Initial treatment consists of rest and anti-inflammatories; occasionally physiotherapy helps. If there is bursal inflammation (bursitis), an injection of cortisone into the inflamed tissue will help treat the pain.

If the calcific tendinitis does not respond to conservative measures, other treatments may be tried. Needling may be used to break down the calcium deposit. This also causes a local inflammatory/healing response and is done through the skin under ultrasound guidance.

Another treatment is extracorporeal shock-wave therapy (ESWT). This involves high-energy sound waves similar to those used to treat patients with kidney stones. Several sessions are used to break down the calcium and to simulate a local healing response.

Surgery for calcific tendinitis

Calcium extruding from rotator cuff

Calcium extruding from the rotator cuff

Surgery may be needed if the calcium deposit is large or has not responded to other treatments. The calcium is removed arthroscopically “keyhole surgery”. This can be done as a day-case procedure. This means you do not have to spend the night in hospital. During the arthroscopy the shoulder joint is evaluated. It may be easy to see a large calcium deposit in the rotator cuff, ultrasound and x-ray in theatre is also useful to confirm the location. The calcium is needled under direct vision and the calcium in the deposit is removed. The painful, inflamed bursa can be removed as well. Often, a small bony procedure is performed if impingement is found (acromioplasty).

How long does calcific tendinitis take to heal?

Calcific tendinitis surgery can provide rapid resolution of symptomsWith conservative treatment healing time is extremely variable may take from as little as a few weeks to many months. After surgery, healing is expected within 2 to 4 weeks. A sling is usually worn for about two weeks after the operation. If a very large deposit was removed it may be needed for longer. Post-operative physiotherapy may assist with quicker recovery and rehabilitation. Patients who have surgery often report a significant and rapid resolution of their symptoms.

Yours in good health,

Dr Warren Matthee

MB BCh (Wits), MRCS (England), MMed (Ortho Surg), FC Orth (SA)

Orthopaedic Surgeon

admin@drmatthee.com

(011) 304 6784

About the author…

I am an orthopaedic surgeon with a special interest in sports injuries and minimally invasive (arthroscopic) surgery of the knee and shoulder. I treat patients at Waterfall Hospital in Waterfall/Midrand and Morningside Mediclinic in Sandton. Besides these, I also treat patients from other areas as well, including Rosebank, Sunninghill and Fourways.

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