What is calcific tendonitis?
Calcific tendonitis is a condition distinguished by the formation of hydroxyapatite (crystalline calcium phosphate) within the rotator cuff tendons. These calcium deposits are usually 1 to 2 cm in size. This condition has a higher incidence rate in women between the ages of 30 to 40 and in diabetics.
As the calcium crystals are deposited and accumulated in the rotator cuff, the buildup increases the pressure applied against the tendon, resulting in severe shoulder pain. Additionally, the calcific deposits reduce the space between the muscles and the acromion, which can result in subacromial impingement.
No exact cause is strongly identified to calcific tendonitis. But it is proven that the calcific buildup is not caused by excessive calcium intake or by injury to the rotator cuff muscles.
Signs and Symptoms
The signs and symptoms related to calcific tendonitis depend on the stage of the condition. It undergoes in 3 stages: precalcification, calcific and postcalcification.
The precalcification stage is identified with cellular changes in the tendons, possibly causing the development of calcium deposits. This stage has usually has no evident or observable signs or symptoms.
The calcific stage occurs when cells excrete calcium, which coalesces into calcium deposits. This stage is further subdivided into resting and resorptive phases. Calcium deposits appear chalky in resting phase.
There is also no pain felt by the patient at this point. During the resorptive phase, the calcium deposits turn into toothpaste-like in appearance. This is stage is characterized by severe and intense pains.
The postcalcific stage is when the calcium deposits start to disappear and the the rotator cuff tendons regain their normal appearance. This is a painless stage.
The pain usually experienced in calcific tendonitis is considered as one of the worse shoulder pains. Elevation of the affected joint above the shoulder level and lying on the affected side could further aggravate the pain. Joint stiffness and weakness are also common.
Diagnosis can be done thru an X-ray imaging and ultrasonography. To obtain an accurate diagnosis, a direct inspection of the rotator cuff tendons and a thorough physical examination are usually done by the physician. A complete and detailed medical history is also obtained.
The initial treatment regimen of calcific tendonitis consists of conservative measures. The main objectives of the treatment course include pain and inflammation control and avoidance of a frozen shoulder.
For pain and inflammation relief, anti-inflammatory drugs and cortisone steroid injections are prescribed. Moist heat application with a warm washcloth is usually recommended to aid in decreasing the pain.
Physical therapy sessions that include exercises focusing on joint strengthening and flexibility are regularly done to prevent the occurrence of joint stiffness and frozen shoulder.
Surgery is prescribed only when the symptoms progress or are unresponsive to conservative treatments. When constant pain already interferes with the patient’s activities, surgery also becomes an option. Needling or the aspiration of the calcium, a milder procedure, might be indicated.
The patient can return to normal activities immediately after this procedure. In chronic conditions, excision of the deposits might be necessary.
The deposits are located and removed in shoulder arthroscopy, a more painful procedure that requires the patient to undergo sessions of physical therapy afterward to regain shoulder strength and normal joint movements.