Calcific Tendinitis of the Shoulder: Causes & Treatment
Calcific tendinitis of the shoulder is a painful condition in which calcium deposits form in the tendons of the shoulder, causing significant pain and restricted movement.
Things worth knowing about "Calcific Tendinitis of the Shoulder"
Calcific tendinitis of the shoulder is a painful condition in which calcium deposits form in the tendons of the shoulder, causing significant pain and restricted movement.
What is Calcific Tendinitis of the Shoulder?
Calcific tendinitis of the shoulder (also known as tendinosis calcarea or calcifying tendinitis) is a condition in which calcium crystal deposits build up within the tendons of the rotator cuff. The rotator cuff is a group of four muscles and their tendons that surround and stabilize the shoulder joint. The supraspinatus tendon is most commonly affected. The condition primarily affects adults between the ages of 30 and 60 and can involve one or both shoulders.
Causes
The exact cause of calcific tendinitis is not yet fully understood. Several contributing factors have been identified:
- Reduced blood supply to the tendons: Insufficient blood flow can lead to tissue changes and subsequent calcium deposition.
- Tendon degeneration: Age-related wear and tear of tendon fibers promotes the formation of calcium deposits.
- Mechanical overload: Repetitive movements or chronic improper loading of the shoulder, for example in certain occupations or sports.
- Metabolic disorders: Conditions such as diabetes mellitus or thyroid dysfunction are considered risk factors.
- Genetic predisposition: A familial tendency has been observed in some cases.
Symptoms
Calcific tendinitis typically progresses in phases and can cause a wide range of symptoms:
- Severe pain: Especially during arm movements such as lifting or rotating. Pain may also occur at rest or at night.
- Restricted range of motion: Patients are often unable to fully raise or extend the arm to the side.
- Acute pain flare-up: When the calcium deposits begin to dissolve, a sudden and very intense episode of pain can occur.
- Tenderness to touch: The area around the shoulder is often sensitive to pressure.
- Muscle weakness: Protective postures due to pain can lead to weakening of the shoulder muscles over time.
Diagnosis
The diagnosis of calcific tendinitis is established through several steps:
- Medical history and physical examination: Assessment of symptoms, occupation, and sports activities, along with evaluation of range of motion and pain points.
- X-ray: The most reliable method for detecting calcium deposits within the tendons.
- Ultrasound (sonography): Allows precise localization and evaluation of the calcium deposits and surrounding soft tissues.
- MRI (Magnetic Resonance Imaging): Used to rule out associated rotator cuff tears or other shoulder pathologies.
Treatment
Conservative Treatment
In most cases, calcific tendinitis resolves without surgery. The following approaches are commonly used:
- Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen or diclofenac) help reduce pain and inflammation.
- Physiotherapy: Targeted exercises improve mobility and strengthen the shoulder muscles.
- Extracorporeal Shock Wave Therapy (ESWT): High-energy sound waves can break up calcium deposits and represent a well-established non-surgical approach.
- Corticosteroid injections: Can provide short-term relief during severe inflammatory episodes.
- Cold and heat therapy: Applied depending on the phase of the condition to help manage pain.
Surgical Treatment
If conservative measures fail to provide sufficient relief after approximately six to twelve months, surgical intervention may be considered:
- Arthroscopy (shoulder joint endoscopy): This minimally invasive procedure allows the calcium deposits to be removed under camera guidance. Outcomes are generally favorable.
- Needle aspiration (barbotage): Under ultrasound guidance, a needle is used to break up and aspirate the calcium deposit.
Prognosis and Outlook
In some cases, calcific tendinitis resolves spontaneously as the body partially reabsorbs the calcium deposits on its own. With consistent treatment, the overall prognosis is good. The majority of patients achieve complete or near-complete relief of symptoms through conservative methods. Only a small proportion of patients ultimately require surgical intervention.
References
- Deutsche Gesellschaft fuer Orthopaedie und Unfallchirurgie (DGOU): Clinical guideline on Tendinosis calcarea of the shoulder, 2022.
- Gerdesmeyer L. et al. - Extracorporeal Shock Wave Therapy for the Treatment of Chronic Calcifying Tendonitis of the Rotator Cuff. JAMA. 2003;290(19):2573-2580.
- Rockwood C.A., Matsen F.A. - The Shoulder. 5th ed. Elsevier Saunders, 2016.
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