Calcific Tendonitis (Shoulder)
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 aged between 30 and 60 years. Often patients experience of long-lasting, slow-onset and/or intermittent shoulder pain 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.
Causes & Symptoms
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.
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.
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. This involves 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 shoulder arthroscopy (such as rotator cuff tears), this will be addressed by your surgeon and may change post-operative aftercare (i.e. recovery time, period of immobilization, etc).
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 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 (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.