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What is Calcific Tendonitis?

Calcific Tendonitis, as the name suggests, is the deposition of calcium in the rotator cuff of shoulders. Rotator Cuff is a group of muscles and tendons that surround the shoulder joint. When there is build up of calcium, it puts pressure on the rotator cuff which causes inflammation and pain. In fact, it is one of the worst pains in the shoulder. This calcium deposit also reduces the space between rotator cuff and the acromion (acromion is a bony process on the shoulder blade, scapula). This affects the normal functioning of rotator cuff thus creating a subacromial impingement between the acromion and the calcium deposit in the rotator cuff, while lifting the arm overhead. This condition is quite common and generally affects people over the age of 40.

Types of Calcific Tendonitis

There are two types of Calcific Tendonitis of the Shoulder – Degenerative Calcification and Reactive Calcification.

Calcific Shoulder Tendonitis

Causes

The exact cause of Calcific Tendonitis is not known. The wear and tear of shoulder due to aging is considered to be the primary cause of Degenerative Calcification. Some experts consider damage exerted by pressure on tendons to be the cause of calcium deposits. Others feel that calcium deposit forms because there is not enough oxygen to the tendons of rotator cuff. The cause of Reactive Calcification is unclear. It is not related to aging. It is the type which causes great deal of pain in the shoulder.

Symptoms

Symptoms include pain and stiffness in the shoulder. Lifting your arm can become quite painful. At advanced stages, it can cause loss of motion in your shoulder.

Diagnosis

X-rays are the best way to detect calcium deposits. In some cases, ultrasound scan may be needed as small calcium deposits might get missed on x-rays.

Treatment of Calcific Tendonitis

Treatment is normally started with non-surgical methods as follows:

  1. Rest and anti-inflammatory medicines
  2. Steroids in case of severe pain
  3. Insertion of needles and rinsing with sterile saline(called Lavage)
  4. Physiotherapy
  5. Shock Wave Therapy

In most cases, your body will reabsorb the calcium buildup once they are fully formed, though there is the risk of a relapse.  Medically there are surgical and non-surgical treatment modalities.  The first-line of treatment is as always conservative with anti-inflammatory medications like ibuprofen and naproxen.  If that does not yield the required benefit, as a little more effective way of dealing with the pain, the doctor may go for a cortisone injection.  A cortisone shot is likely to reduce the inflammation in the short term.

If the calcium tendonitis is a little serious in nature, the doctor may go in for a procedure called lavage where two needles are inserted into your tendon and then the area is rinsed with saltwater solution.  This technique can break the calcium particles and ameliorate the pain.  Some doctor may go in for another form of treatment called “barbotage” or “fine-needling”, where calcium deposits are sucked out of the tendon through fine needles.  If the pain is recalcitrant to all of the above treatment modalities, your condition may warrant an operative intervention, though the chance of resorting to an operative intervention is still rare.

When the non-surgical methods do not help in controlling the inflammation and severe pain, doctor may advise a surgery. Most of the surgeries performed for treating Calcific Tendonitis are arthroscopic surgeries. In rare cases, open surgery is required. In both cases, calcium deposits are removed from the tendons and the area is rinsed to get rid of calcium crystals.

Arthroscopic removal of calcium deposits (surgical intervention):

Arthroscopic surgery is the most preferred surgical intervention if it is decided to remove the calcium deposits via surgically.  A small cut is made into your area of calcific tendonitis and a small instrument that looks like a tube is inserted into your joint.  This way calcium deposits are removed and the area is rinsed.

However, in rare cases, open surgery is also adopted.  Here, a large cut is made to get to the calcium deposits out.

Importance of physiotherapy:

Whichever treatment route is pursued, post treatment you are likely to have physiotherapy rehabilitation to help regain your range of motion.  Physiotherapy includes a set of stretching and strengthening exercises to strengthen the affected area.  Your doctor will explain to you in detail what this means for you and how good it is for a speedy recovery.

If you have had conservative treatment for your calcific tendonitis, your physiotherapist will teach you a series of range-of-motion workouts to help regain flexibility in the affected body part.  Physiotherapy will start with gentle exercises and work up to isometric and light-weight bearing exercises over time.

However, if you had surgery, type of physiotherapy exercises can be very subjective.  In some cases, full recovery can take three or more months.  If the surgery was done arthroscopically, recovery time is shorter compared to open method.  Be it arthroscopic surgery or open surgery, post surgical procedure, your doctor may advise you wear a sling to protect the shoulder area.  A complete physiotherapy protocol may range from six to eight months.

Rehabilitation for Calcific Tendonitis

Your case may need a surgery or not, you will have to undergo a rehabilitation program. Your doctor may recommend you work with a physical/occupational therapist. Your therapist will suggest some exercises which will help ease the pressure on the calcium deposits. He might also suggest changes in your posture which can help avoid further problems.

In case you have undergone a surgery, your surgeon might advise you to wear a sling for couple of weeks (depending on the severity of the condition).  Patient has to undergo physiotherapy post surgery as well.

Relationship between calcium deposits and tendons?

As you may be aware, tendons connect muscles to the bones.  Sometimes there can be calcium deposits in them.  Calcium deposits are like toothpaste.  They can be found in one particular spot or they can spread around the tendons.  Medical fraternity still does not know what exactly causes calcific tendonitis.  Its onset is generally around middle age.  Medical studies show that there is a relationship between calcium deposits in tendons, diabetes and thyroid disorders.

In the beginning calcium deposits are not troubling, but when they come bigger and inflamed, it can trigger intense pain.  It may take years for one to feel pain arising out of calcific tendonitis as the process of calcium being deposited in tendons is gradual and slow.  The reason behind feeling pain only at the advanced stage is that calcium deposit goes through three stages.  The final stage known as resorption is considered to cause intense pain.  Our shoulder joint is vulnerable to calcific tendonitis.   Apart from shoulder joint, it can also be found in Achilles tendon, wrist, hip, thigh, knees, ankle and foot.  The patient affected with calcium tendonitis may feel it more troublesome in the morning, especially with movement.  Lifting the affected body part gets very difficult and it affects the patient’s sleep quality as well.  In order to zero in on the diagnosis, your doctor may go for a series of images to see clearly the calcific changes in your joint.

Am I at risk of developing calcific tendonitis?

As already mentioned, the exact reason for the development of calcium deposits in some people is not discovered, it is believed that calcium build up stems from:

  • genetic predisposition
  • abnormal cell growth
  • abnormal thyroid gland activity
  • bodily production of anti-inflammatory agents
  • metabolic diseases, such as diabetes

 

People who are sporty and raising the arm consistently up and down as part of their work are more at risk. The condition is prevalent among females than in males, especially between the age bracket of 40 and 60.

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