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Calcific Tendonitis - Diagnosis and Treatment Options




Calcific Tendonitis - Diagnosis and Treatment Options

There are many different conditions that can lead to shoulder joint stiffness and pain. Many of these conditions remain unknown to the afflicted individual because they do not present any noticeable symptoms and will ultimately resolve on their own. It is estimated that thirty percent of the population older than the age of thirty but younger than seventy and seventy percent of the population over seventy have some sort of shoulder impingement. Calcific tendonitis is one of the more common types of shoulder impingements and most of the time it too will resolve on its own.

What is a shoulder impingement?

A shoulder impingement is a generalized term for an inflammation that prevents the tendons and bursa in the shoulder joint from moving freely.

Tendons are the tough connecting tissues that anchor the muscles to the bones.   When the muscles contract, they tug on the tendon which in turn pulls on the bone. The tendons need to slide effortlessly between the bones of the joint to achieve optimal performance. The body facilitates this by placing a bursa under the tendons that must pass over joints that have bony extensions (e.g. the shoulder bones). Not all joints need to have a bursa under the tendons but bursas are distributed in muscle tissue around the body.

Inflammation of the tendons and the bursa causes them to swell.   Since there is limited space between the bones of the shoulder joint, the swelling prevents the tendons from sliding through the joint.   The result is pain, stiffness and restricted movement.

In the case of calcific tendonitis calcium deposits thicken the tendons (called the rotor cuff) and thus cause the impingement between the rotor cuff and the acromion (the bony protrusion of the scapula that forms part of the shoulder).

Calcific tendonitis

Calcific tendonitis (a.k.a. calcium deposits) may not cause any symptoms at all; especially if they are located deep within the tendons.   If the calcium deposit is large enough or located in more exposed position, pain and restricted movement may be the result.   As the calcium deposits increase in size more pressure is placed on the tendons and joint. Chemical irritation from the calcium may also contribute to the inflammation.   In this case, the pain can be very intense and lead to frozen shoulder syndrome (an extremely painful condition where the shoulder is largely or completely immobilized).

What causes calcific tendonitis?

Scientists are not certain as to what precipitates the calcium deposits, but they are certain that it is not an excess of calcium in the diet or blood.   Individuals who have calcific tendonitis will very often have normal blood calcium levels.   Thus there is no point in restricting dietary calcium since this may rob the body of the calcium it needs to function properly.   When this happens the body will attempt to compensate for this calcium deficiency by releasing calcium from the bones (leading to osteoporosis).

In rare incidences, there may be a metabolic condition that leads to the depositing of calcium in the tissues. In other cases, there may be an irregularity with the kidneys that leads to high calcium levels.  

Calcium deposits are also not believed to be caused by an injury to the shoulder joint.   While injury may indeed lead to tendon inflammation and shoulder impingement, it is not responsible for the buildup of calcium in the tendons.

Studies show that calcific tendonitis forms in people who are minimally thirty to forty years old and is most common in people with diabetes.   Thus the condition has age related and metabolic components.

What is the progression of symptoms?

Doctors have recognized that there is a fairly predictable pattern for calcific tendonitis.

·         Pre-calcification is the stage when the joint cells are experiencing changes permitting the tissues to develop excess calcium.   During this stage there is no pain.

·         The calcific stage is when the cells start to discharge the calcium which in turn starts to coalesce into deposits. This calcification stage is followed by a resting stage which may last for any length of time.   Since the calcium is soft (resembling toothpaste) it is not painful.   The individual may still be unaware of the situation.   The next step is when the body starts to reabsorb the calcium. This is the painful portion of the process.

·         The post-calcific stage is when the body has reabsorbed the calcium and the rotor cuff returns to having a more normal appearance. This usually happens in one to four weeks.

Patients typically seek treatment during the painful re-absorption stage.   Other people may have calcium deposits discovered in the course of an examination for another issue (e.g. shoulder impingement).

Diagnosis of calcific tendonitis

Loss of arm and shoulder mobility as well as pain will alert your physician to the possibility of calcific tendonitis.

The diagnosis of calcific tendonitis may be confirmed with x-rays since the calcium deposits will be visible.   Large calcium deposits may be up to a half inch in diameter but even small deposits will show up on the x-ray.

Calcific tendonitis treatment options

Since most acute cases will eventually go away on their own, initial treatments are usually given to alleviate symptoms.   These include:

·         Application of ice to reduce pain and inflammation

·         Painkillers

·         Anti-inflammatory medications such as a steroid injection (e.g. cortisone). The injection applies the steroid locally and thus prevents most of it from circulating around the body.   Since overusing steroids can weaken tissues, many doctors will not inject cortisone in the same location more than three times.

·         Range of motion exercises in physical therapy and practiced at home will help prevent frozen shoulder from occurring.

·         A warm moist cloth will increase circulation to the area to relieve pain

·         Ultrasound can be used to guide a procedure that injects salt water solution to the targeted area.   This loosens the calcium which is then sucked out with a syringe.   This procedure is minimally invasive. Patients are able to resume normal functioning within a couple of days.

·         The most radical procedure is surgical removal of the calcium deposits.   This becomes necessary if the pain is extreme and cannot be controlled.   It may also be required if a very large deposit which greatly impedes movement cannot be removed with the needling procedure.   Surgery may be of the arthroscopic type (e.g. an endoscope is inserted through a small incision) or less frequently during open surgery.

For most patients, the first choice is usually to control the symptoms in order to allow sufficient time for natural resolution of the problem.




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