Calcific tendonitis is a build-up of calcium deposits in a tendon. It can occur anywhere in the body but the condition commonly develops in the rotator cuff, which is the group of tendons that connect important shoulder muscles from your shoulder blade to your upper arm.
When there is a build-up of calcium in this area, it can cause severe pain which also restricts the range of movement in your arm. Calcific tendonitis is one of the most common causes of shoulder pain, occurring most frequently in people between 40 and 60 years and more often in women than men.
What are the symptoms of calcific tendonitis of the rotator cuff?
The symptoms of calcific tendonitis of the rotator cuff vary widely. Around a third of people are asymptomatic, which means there are no discernible symptoms, however for some people the pain is severe. There are three stages to the condition:
- Stage 1 is the pre-calcification stage. This is when the rotator cuff tendon cells start to undergo changes that predispose the cells to developing calcium deposits. There are not normally any symptoms at this stage.
- Stage 2 is the calcific stage when calcium deposits start to form. These appear as a chalky substance rather than a solid area of bone. The formation of deposits is followed by a resting phase, which tends to be painless. The most painful phase of calcific tendonitis is the resorptive phase which is when the body starts to reabsorb the build-up of calcium. During this phase the calcium resembles toothpaste. Unfortunately, some people can get stuck in this phase for a long time, resulting in chronic pain.
- Stage 3, the postcalcific stage, is when the calcium deposits start to disappear and the rotator cuff tendon begins to return to normal.
Who is most at risk?
The precise causes of calcific tendonitis of the rotator cuff aren’t fully understood. Certain factors increase your risk of developing the condition including:
- Having metabolic diseases, like diabetes.
- Thyroid problems.
How is it diagnosed?
If you are experiencing ongoing unexplained shoulder pain, you should talk to your doctor or a shoulder specialist who will speak to you about your symptoms and carry out an examination. An X-ray will identify large calcium deposits.
It is important not to leave the condition undiagnosed as it can cause complications of chronic pain and stiffness.
What treatments are available?
The treatment you are offered will depend on how much calcification there is and how severe the symptoms are. Most cases of the condition can be treated without surgery. Anti-inflammatories are normally recommended in the first instance as they help to reduce pain and relieve swelling. In some cases, your doctor may also suggest injections of corticosteroids to reduce inflammation in the affected area. In many cases this can be combined with needling of the calcific deposit under ultrasound guidance, to speed up release of the deposit from the tendon. Other non-surgical treatments that have been shown to be effective in treating the condition include:
- Therapeutic ultrasound – a handheld ultrasound machine is used to direct high frequency sound waves at the calcium deposits, helping to break down calcium crystals.
- Shockwave therapy – this involves using a handheld device to direct mechanical shocks to the site of the calcification which works in a similar way to therapeutic ultrasound.
In around 10% of cases, surgery will be needed to remove the calcification, but probably less than that if it is caught early. This may be performed arthroscopically (keyhole surgery), using a small camera inserted via a small incision above your shoulder. Physiotherapy will be an important part of the rehabilitation process, helping you to regain full range of motion in your shoulder.
Can I prevent it?
Because we are not completely sure what causes some people to develop calcific tendonitis it is not possible to recommend effective preventative measures. There is some anecdotal evidence to suggest taking magnesium supplements may help but this is not backed by scientific research so we would urge caution.
If you believe you may have calcific tendonitis or would like more information about diagnosis and treatment, contact us.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist). We can also offer consultations either online or face-to-face.
Telephone: 020 376 15987