Calcific Tendonitis

What is Calcific Tendonitis?

Calcific tendonitis is a condition in which there is calcium build up within one or more of the tendons around the head of the humerus (rotator cuff). It can be extremely painful. These calcium deposits are usually found in patients aged 30-40 years old, and are more common in diabetics. They are not always painful, and even when painful, can spontaneously resolve over a period of weeks.

Why does calcific tendonitis occur?

It is unclear why these deposits form in the rotator cuff tendons. There are different theories proposed, including an alteration in local blood supply and ageing of the tendon. The evidence to support these theories is unclear.

How does the condition progress?

Calcific tendonitis usually progresses in a predictable manner.

There are typically three phases:

Precalcification Phase

Patients are usually symptom free. There are cellular changes at certain sites within the tendons that predispose the tissues to developing calcium deposits.

Calcific Phase

Calcium is excreted from cells and then coalesces into deposits. The calcium initially looks chalky, not solid. Once the deposits have formed, a so-called resting phase begins. This period is generally not painful and may last a varied length of time. After this resting phase, a resorptive phase begins where the calcium begins to dissolve. This is usually the most painful period. During this phase, the calcium deposit has the texture of toothpaste.

Postcalcific Phase

This is usually a painless stage, as the calcium deposit disappears and is replaced by more normal looking tendon.

What effect does the calcium deposit have?

Pain as a result of calcific tendonitis is thought to be caused by pressure within the tendon and chemical irritation. A large deposit can cause a block to the elevation of the arm, as it becomes trapped between the head of the humerus and the acromion, causing ‘impingement’.

How is 'Calcific Tendonitis' diagnosed?

Your surgeon will usually be able to diagnose this condition on the basis of your symptoms and an examination in conjunction with an x-ray, ultrasound or MRI scan.

What happens if nothing is done?

The condition is generally self limiting, but can cause significant restriction of shoulder function in the short to medium term.

What treatment options are there?

Physiotherapy: To prevent any further stiffness and help to maintain a good range of motion.

Medication: Painkillers and anti-inflammatories to treat the symptoms.

Injections: To reduce inflammation and provide pain relief.

Surgery: Surgery may be recommended in the following situations:

• Where symptoms continue to progress despite treatment
• When constant pain interferes with routine activities (dressing, combing hair)
• Where symptoms do not respond to conservative care

Treatments include needling and aspiration or removal of the calcium deposit using key-hole surgery.

Needling (also medically known as ‘barbotage’) can be done either under ultrasound control or as an arthroscopic (keyhole) procedure . A large needle is directed into the calcium deposit and an attempt made to suck out as much of the calcium as possible. An injection of saline or cortisone can be performed into the calcium deposit.

Removal of the deposit is a larger procedure, but can be necessary, especially in chronic cases. This would normally be performed either through a small incision or by key-hole surgery.

Shock Wave Therapy: There are several recent studies reporting the successful treatment of longstanding calcific tendonitis using shockwave therapy. The technique is thought to work by producing localised ‘microtrauma’ which stimulates blood flow to the affected area. Side effects and complications are minimal, although some localised bruising can occur.