Calcific Tendonitis

Calcific tendonitis of the shoulder happens when there are calcium deposits on the tendons of the shoulder. The tissues around the deposit can become inflamed, causing a great deal of shoulder pain. This condition is fairly common. It most often affects people over the age of 40.

Etiology

No one really knows what causes calcific tendonitis. Severe wear and tear, aging, or a combination of the two contribute to degenerative calcification. Some researchers think that calcium deposits form because there is not enough oxygen to the tendon tissues. Others feel that pressures on the tendons can damage them, causing the calcium deposits to form.

Symptoms

While the calcium is being deposited, one may feel only mild to moderate pain or even no pain at all. For some unknown reason, calcific tendonitis becomes very painful when the calcium deposits are being reabsorbed. The pain and stiffness of calcific tendonitis can cause a loss of motion in the shoulder. Lifting the arm may become painful. In severe cases, the pain may interfere with sleep.

Diagnosis

A physician will take a detailed medical history and do a thorough physical exam of the shoulder. The pain of calcific tendonitis can be confused with other conditions that cause shoulder pain. An X-ray is usually necessary to confirm the presence of calcium deposits. The X-ray will also help pinpoint the exact location of the deposits.

Medical Treatment

• Medication

A physician's immediate goal will be to help control the pain and inflammation. Initial treatment is likely to include rest and anti-inflammatory medication. A physician may suggest a cortisone injection if the pain remains severe even after trying other non-surgical treatments. Cortisone can be very effective at temporarily easing inflammation and swelling.

• Heat or Ice packs

A physician may use a rehabilitation program that  first focuses on easing the pain and inflammation. Treatments may include heat packs or ice packs.

• Ultrasound

Therapists may apply ultrasound treatments, which have been shown to help reduce the size of the deposit, lessen the pain, and gain better arm function. To get the full benefit, sound ultrasound treatments are usually repeated often in a six-week period.

• X-rays

The patient may be required to get a number of X-rays to help a physician keep track of the changes in the amount of calcification. By following the changes in the deposits, a physician can determine whether the condition will heal by itself or perhaps require surgery.

• "Lavage"

During the time that the calcium deposits are being reabsorbed, the pain can be especially intense. A physician may suggest trying to remove the calcium deposit by inserting two large needles into the area and rinsing with sterile saline. This procedure, called "lavage," sometimes breaks the calcium particles loose so they can be removed with the needles. Getting rid of the calcium deposits can help speed up the healing. Even when lavage fails to remove deposits, it may reduce pressure to the tendon, resulting in less pain.

• Shock Wave Therapy

Shock wave therapy is a newer form of non-surgical treatment that uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. The impulses are thought to break up the deposits so the body can more easily absorb them.

• Surgery

If the pain and loss of movement continue to worsen or interfere with daily life, surgery may be required. Surgery for calcific tendonitis does not usually require patients to stay in the hospital overnight. It does require anesthesia.