Introduction
Calcific tendonitis is a painful condition affecting the rotator cuff tendons of the shoulder.
The rotator cuff is a group of four tendons around the shoulder which are responsible for movement and stability of the shoulder joint.
Calcium deposits of 1-2cm form in areas of tendon wear and tear. It causes tissue irritation and inflammation. It most commonly forms in the supraspinatus tendon.
This condition most commonly affects women and people in 30-60 year age group. Diabetics are also more commonly affected.
Causes
The exact cause is not known in many cases. The condition is often NOT related to a specific traumatic event. The incidence is higher in diabetics.
Symptoms and Signs
Diagnosis is based on patient symptoms, examination findings and scan results.
Pain
This is typically quite severe when the calcium is being resorbed by the body. It is worse with shoulder movement and may be quite painful at night when sleeping. The pain may radiate down the arm.
Clicking / Catching
This may occur with shoulder movement. Irritated tendons may occasionally click or snap with arm use.
Reduced movement
Some reduced movement may occur.
Weakness
Some weakness may occur.
Tests
X-ray
This will reveal an area of calcification.
Ultrasound and MRI
This will reveal the exact location of the calcium deposit within the rotator cuff tendon and if there is an associated tendon tear.
Non-surgical treatment
Treatment depends on length and severity of symptoms. Non-surgical measures are tried as first line treatment.
Activity Modification
Avoid repetitive shoulder use and sleeping on the affected side.
Pain Killers / Anti-Inflammatory Medications
Anti-Inflammatory medications such as Nurofen help settle the inflammation and pain down.
Heat or Ice
Heat or ice may be used to settle the inflammation down.
Physiotherapy
This is aimed at maintaining and restoring shoulder movement and strength.
Steroid Injection
This is used to provide a local anti-inflammatory effect to provide pain relief.
Needle Aspiration and Lavage
This is performed by a radiologist. Occasionally, large painful calcium deposits may be broken down with a needle, sucked out and washed out to reduce the calcium load and provide relief.