CALCIFIC TENDONITIS

Calcific tendonitis is a condition where there is a build up of calcium in the rotator cuff, causing a build up of pressure in the tendon and chemical irritation.  This leads to pain which can be very intense.  The calcium deposit also reduces the space between the rotator cuff and the acromion (end of the shoulder blade) affecting the function of the rotator cuff.  

What Causes Calcific Tendonitis?

The cause of calcium deposits within the rotator cuff tendon is not clear. Different ideas have been suggested, including impaired blood supply, ageing of the tendon, and delayed healing after injury.

Stages of Calcific Tendonitis

Calcific tendonitis usually progresses predictably, and usually resolves eventually without surgery. The typical course is: 

Pre-Calcification Stage  You usually do not have any symptoms in this stage. The tendon undergoes changes that predispose the tissues to developing calcium deposits.

Calcific Stage  During this stage, the calcium is formed in the tissues. When seen, the calcium looks chalky, it is not a solid piece of bone. Once the calcification has formed, a resting phase begins, this is not a painful period and may last several years. After the resting phase, a resorptive phase begins--this is the most painful phase of calcific tendonitis. During this resorptive phase, the calcium deposit looks like toothpaste.

Post-Calcific Stage  This is usually a painless stage as the calcium deposit disappears and is replaced by more normal appearing rotator cuff tendon.

Patients usually seek treatment during the painful resorptive phase of the calcific stage, but some patients have the deposits found incidentally as part of their evaluation impingement syndrome, usually on X-ray.

Diagnosis

The calcific deposit can be seen on plain x-rays, however ultrasound scan can be useful identifying small calcific deposits. 

Treatment

Nonoperative treatment is usually the first line of treatment for calcific tendonitis. The treatment protocol is similar to the treatment of rotator cuff impingement of the shoulder. Non-operative treatment of calcific tendonitis is usually successful in settling the pain and the need for surgery is not common.  This includes:

·       Painkillers and anti-inflammatory medications

·       Physiotherapy – improves movement and shoulder function

·       Cortisone injections – reduces the inflammation and controls the pain

·       Ultrasound guided aspiration of the calcium deposit 

Surgery

Surgery can be recommended in the following situations:

·       When symptoms continue to progress despite treatment

·       When constant pain interferes with routine activities (dressing, combing hair)

·       When symptoms do not respond to other treatments

The goal of surgery is to reduce the effects of the impingement by removing the calcium deposit and increasing the space between the rotator cuff tendons and the acromion.

Complications from surgery

 As with any operation, there are risks associated with undergoing surgery.  The risks of having any operation such as bleeding, nerve damage, clots in your legs or lungs, heart attacks or a reaction to the anaesthetic could occur but are usually very uncommon occurring in less than 1%. There is a risk that infection could occur either in the wound or deep in the joint.  With deep infection, you are likely to require further surgery to address the issue.  The rate of this is around 1%.