Calcific tendonitis (shoulder)

When your shoulder hurts

Blow-drying your hair, hanging up your clothes or pulling your jumper over your head – anyone who has ever had persistent shoulder pain knows that the joint is indispensable for many movements. Everyday life can become torture for patients with painful calcific tendonitis.

Our shoulder experts at Schoen Clinic specialise in treating calcific tendonitis. We work with you to find the precise diagnosis, advising on the best course of action to resolve your condition and assist in relieving your pain.

What is calcific tendonitis?

Calcific shoulder tendonitis happens when a naturally occurring mineral present in the human body (hydroxyapatite) deposits within the tendons of the group of muscles around the shoulder (the rotator cuff). This condition is more frequent in women than men and is more common in those aged between 30 and 60 years. Patients with this condition often experience long-lasting, slow-onset or intermittent shoulder pain. This is caused by the inflammatory response of the body to resorption of the calcification. This happens as part of the natural cycle of the calcific deposit, which consists of three phases: formative, resting and resorptive, with the latter being the most painful. Sometimes a minor trauma or repetitive movement might irritate the tendon and the shoulder becomes very painful without any real resorption of calcific crystals.

Symptoms of calcific tendonitis

Patients with shoulder calcification complain about different symptoms which can vary depending on the stage of the disease and the location and size of the calcific deposit. Those affected who are in the early phase of shoulder calcification often show no signs or symptoms. As the condition progresses, minor pain can become worse, or in extreme cases severe. If you experience sudden pain in a resting position or the pain increases with movement, this may indicate calcific tendonitis. Signs & symptoms you may have calcific tendonitis:
  • Shoulder pain or discomfort
  • Pain is concentrated either on the front or back of your shoulder and down the arm
  • Sudden or gradual increase of pain (as calcium deposits build-up)
  • In severe cases, pain may immobilise the arm and interfere with sleep

Causes: How does calcific tendonitis develop?

The exact cause of this condition remains mostly unknown, although thyroid gland dysfunction, metabolic diseases (e.g. diabetes) and genetic predisposition have been proposed to play a role in increasing the risk of being affected.

The clinical picture may vary from patient to patient, depending upon which phase the deposit is in, but pain is certainly the hallmark of this condition. Such pain can be at times quite severe, to the point it will interfere with sleep and daily activities. A feeling of “catching” in the shoulder may also be present, therefore mimicking a condition of “shoulder impingement”, which can overlap calcific tendonitis in several ways. For this reason, it is essential to gain an accurate diagnosis of the condition so it can be treated appropriately.

How we diagnose calcific tendonitis

Calcium deposits within the tendon substance can be easily identified with a shoulder X-ray or alternatively an ultrasound scan. More advanced imaging techniques (such as CT scans and/or MRIs), are usually not needed and may be recommended only in cases of high suspicion, or in order to exclude other sources of pain in your shoulder.

Restoring shoulder mobility

Once the diagnosis is made, several treatment strategies are available, such as a trial of anti-inflammatory drugs, physiotherapy, shoulder injections, shockwave therapy and lastly, arthroscopic (keyhole) surgery to remove the calcium deposit. A trial of conservative (non-surgical) treatment is usually first carried out to relieve pain and improve function. Nevertheless, if the pain caused by the calcium deposit has been resistant to this approach, keyhole surgery can be carried out with excellent results.

Pain management and physiotherapy

In combination with pain medication or anti-inflammatory injections, physical therapy can be a very effective way of treating your calcific tendonitis. As soon as the pain subsides, you are able to begin exercises to reduce the pressure on the affected tendon. Daily self-directed exercise programmes are very helpful.

Treatment of your calcific tendonitis with shockwave therapies

Extracorporeal shockwave therapy (ESWT) is one method of shockwave therapy which involves delivering mechanical shocks to the area of the calcific build-up. During this therapy, the calcific deposits are broken open by the shockwaves. The shocks can be painful, but the higher the frequency, the more effective the shocks are at breaking up the deposits. Your specialist will be able to adjust the level of frequency to ensure the pain level is tolerable. Many of our patients describe this treatment method as very effective.

Therapeutic ultrasound is another method which uses soundwaves to break up the deposits. Radial shockwave therapy is very similar to ESWT but delivers low to medium level shocks to the affected area. Your specialist will go through the most appropriate options with you to formulate a plan for the best outcome.

Calcific tendonitis surgery

Surgery for calcific tendonitis can be carried out arthroscopically, during a minimally invasive procedure, or during an open surgery. Both procedures involve removing the deposit plus or minus shaving away part of the acromion bone (subacromial decompression) to give the tendon(s) more space to function. If other accompanying pathology is seen during the shoulder procedure (such as rotator cuff tears), this will be addressed by your surgeon and may change post-operative aftercare (i.e. recovery time, period of immobilisation, etc.).

Calcific Tendonitis: Aftercare

If the decision is made to perform surgery, you will be admitted as a day-case, meaning you can expect to go home on the same day of the operation. You will have your affected arm immobilised in a sling and dressings covering the wounds where the camera and surgical instruments were inserted. The shoulder and upper limb area might feel numb all the way down to your hand and fingers due to the effect of anaesthesia. This numbness will subside in a few hours and you might experience some degree of post-operative pain, which is usually well managed with pain killers taken by mouth. Ice packs applied locally (for 15 to 30 minutes, 3 to 5 times daily) may also help reduce pain. Unless a rotator cuff tear is seen and repaired during arthroscopy, you are expected to wear a sling for comfort only and discard its use as soon as your pain level allows. A sedentary job (i.e. typing) may be resumed after 5-7 days, whereas those who have a heavier physical workload (i.e. lifting weights, moving objects above shoulder level) may require a longer period of absence. Sustained or repetitive overhead activities should be avoided for a minimum of three months in any case. You will be seen by your surgeon at three weeks post-operatively to inspect your wounds, monitor your progress and discuss the next steps in your rehabilitation plans.

Calcific tendonitis: Our specialists

Our specialists at Schoen Clinic are experts in treating calcific tendonitis conditions. Working as part of a multidisciplinary team they advise on the best course of action so you can make an informed decision.

Calcific tendonitis: our specialised hospital

Schoen Clinic Orthopaedic and Spinal Hospital is located in the idyllic Harley Street area of London and is home to some of the finest experts in all aspects of shoulder conditions. From the beginning of your treatment to the end you are considered as a partner in your care and because we have a data driven approach to clinical outcomes, your return to a positive quality of life is always our primary goal.