Calcific tendinitis (or calcific tendonitis) is a self-limiting condition due to the deposition of calcium hydroxyapatite within tendons, usually of the rotator cuff. The supraspinatus tendon is the most affected. When calcium forms inside the tendon, it can determine an increase of pressure in the tendon, as well causing a chemical irritation that can lead to pain. The calcific deposits also can reduce the space under the acromion and determine a subacromial impingement.
How common is it?
Calcific tendinitis is a fairly common condition affecting women more than men. The cause is unknown and is not related to diet, injury or osteoporosis. It tends to be more common in people between the ages of 30-60 years of age. It does eventually disappear spontaneously, but this can take between 5 to 10 years to resolve.
What are the stages of the disease?
Calcific tendinitis has a precalcific stage when the cells in the tendon change and create conditions for the calcium to form. The second stage is the calcific stage with 3 phases: formative, resting and resorptive. The resorptive phase hen calcium is resorbed is the most painful. A third stage is the postcalcific stage when stiffness can occur.
What are the symptoms of calcific tendinitis?
The main symptom is pain that can be only mild at the beginning when the calcium forms but can be one of the most painful conditions in the shoulder when the calcium is resorbed. The pain can radiate to your arm and can be worst with lifting the arm up. In time stiffness can develop and pain can be constant including night time.
How is it diagnosed?
A clinical examination will raise the suspicion. A simple x-ray can show the calcium deposits and their location. Ultrasound scans and MRI scans also can show calcific tendinitis.
What is the treatment?
First line of treatment consists in antiinflamatory drugs, physiotherapy and steroid injections in the subacromial space. Resolution of symptoms can occur in about 60% of the cases. If symptoms persist or recur a barbotage of the calcific deposits under x-ray or ultrasound control can be helpful especially in the resorptive phase. Extracorporeal shockwave therapy or platelet rich plasma injections have been used with success in certain cases mainly in the formative and resting phases.
Is surgery successful in the treatment of calcific tendinitis?
Arthroscopic removal of calcium is indicated when conservative treatment has failed and symptoms persist. Outcomes are very good. The advantage of surgery is that it can address other pathologies like subacromial impingement or rotator cuff tears in the same time. Rehabilitation can be long sometimes and your shoulder may become stiff after surgery requiring extended physiotherapy.