Calcific Tendinitis

What is calcific tendonitis?

 

Calcific tendonitis is caused by the formation of calcium deposits within the tendons, and can occur in isolation or in several regions of the body.

When these deposits increase or become inflamed, they are responsible for intense and debilitating pain.

The shoulder is the most frequently affected region, namely the rotator cuff tendons.

What causes calcific tendonitis?

The true cause of calcific tendonitis has not yet been established, although it is known that it is more common in women between 40 and 50 years of age, and there may be a hormonal factor involved as it appears to be more common in people with thyroid problems or diabetes.

The formation of calcium deposits can occur silently and never manifest itself. However, the inflammation of these calcium deposits causes intense pain around the shoulder and can even reduce its mobility, either due to pain or associated stiffness.

 

Calcific tendonitis is a disease that develops in 3 phases, and may disappear at the end or recur cyclically:

    • Pre-calcification phase: changes occur at the cellular level, which can manifest insidiously with pain during certain movements and slight limitation of mobility in certain positions.
    • Calcification phase: the release of calcium from cells leads to the formation of calcium deposits. After some time, the body itself reabsorbs these deposits, which may be accompanied by an exuberant inflammatory reaction, which is reflected in the intense pain and limited mobility characteristic of the acute phase.
    • Post-calcification phase: replacement of calcium deposits by healthy tissue, with progressive resolution of pain and recovery of mobility. Residual pain may persist, with a tendency to resolve over time

    What are the symptoms of calcific tendonitis?

    The most common symptom is the appearance of intense pain that sets in quickly and without previous trauma or overload, located throughout the region around the shoulder and even extending to the neck and spinal region.

    Limited shoulder mobility with restricted arm elevation and opening, or difficulty reaching behind the back, are common associated complaints.

    The intensity of the pain can be extremely high and can even interrupt sleep, which requires medical advice during a consultation or emergency.

     

    How is the diagnosis made?


    The clinical history and physical examination performed by the physician must be complemented with imaging tests to establish the diagnosis of calcific tendonitis.

    Plain X-rays of the shoulder can detect calcifications in the rotator cuff tendons, especially when they are larger.  However, ultrasound of the shoulder is the examination of choice for diagnosis, and it is important that it be performed by a clinician with expertise in musculoskeletal ultrasound to visualize calcifications and possible associated injuries to the rotator cuff, such as fissures or tears.

    Other imaging tests, such as computed tomography (CT) or magnetic resonance imaging, may be useful for detailing bone structures or adjacent tissues, respectively.

     

    What is “Frozen Shoulder”?

    “Frozen Shoulder” is a condition of hyperinflammation of the joint capsule and adjacent tissues of the shoulder, causing pain and stiffness of the shoulder with limitation of passive mobility.  This condition is not exclusive to calcific tendonitis, but may occur in association, which results in significant disability with a strong impact on quality of life.

     

    What can I do about calcific tendonitis?


    Controlling local pain and inflammation, along with preserving shoulder mobility, are the cornerstones of treating calcific tendonitis. When pain begins and is noted to progress and worsen over the following hours or days, oral analgesics such as paracetamol or nonsteroidal anti-inflammatory drugs can interrupt the cycle of inflammation and reduce symptoms, combined with passive and active shoulder mobility exercises that reduce the progression to a “frozen” shoulder.

    Consultation with a specialist doctor allows for a timely assessment and prescription of immediate therapeutic measures, with a view to breaking the inflammatory cycle and reducing the pain and disability characteristic of calcific tendonitis. There are other conservative options that can be considered, such as infiltrations, ultrasound-guided calcification aspiration, or electromagnetic shock waves.

    Although conservative treatment is successful in most cases, arthroscopic surgery may play an important role.