by dr kalman piper
What Is It?
Calcific tendonitis is a condition whereby the body deposits calcium crystals within the tissue of the rotator cuff. The cause is unknown, however the condition is very common, and many people may have it without knowing. On average, the calcium deposits remain in the tendon for between 12 and 18 months. Eventually the body starts to absorb the calcium, and the deposit will disappear by itself. The calcium deposits, which look like chalk and have the consistency of toothpaste, are visible on X-rays and CT scans of the shoulder An MRI scan is also useful to check the condition of the rotator cuff, around the calcium deposit. The absorption phase at the end of the disease can be extremely painful and movement of the shoulder can be difficult. Luckily, in most cases the acute pain only lasts a few days and can be treated with pain relieving medication and anti-inflammatory medication. Unfortunately, in some people, the pain may persist for several weeks. Furthermore, swelling in tendon around the calcium deposit may cause the tendon to catch during certain movements (impingement), which further exacerbates pain and difficulty with movement.
How Is It Treated?
There are several treatment options available to patients with calcific tendonitis, which include:
- Pain relieving and anti-inflammatory medication.
- Remember, the pain usually represents the final stages of the condition, and in most people the severe pain only lasts a few days.
- Injection of local anaesthetic and corticosteroid.
- Injections of local anaesthetic and corticosteroid (a powerful anti-inflammatory) into the space above the tendon (subacromial space) may help relieve pain and inflammation within the tendon, while the body continues to absorb the calcium deposit.
- Ultrasound guided needle aspiration and lavage.
- Using an ultrasound machine to pin-point the calcium deposit within the tendon, a radiologist uses a needle to remove (aspirate) the calcium deposit from the tendon and wash (lavage) the cavity where it came from. This technique is successful in treating approximately 70% of patients with calcific tendonitis.
- Surgical debridement of the calcium deposit and subacromial decompression.
- Surgery involves removing the calcium deposit from the tendon and washing out the cavity using arthroscopic or “keyhole” techniques. In addition, a small amount of bone is removed from above the tendon to give the swollen tendon more room to move (subacromial decompression). If there is any damage to the rotator cuff tendon, it can be repaired at the same time. The procedure involves a general anaesthetic and usually an overnight stay in hospital. Surgery has a 90% success rate in treating calcific tendonitis.
- Physiotherapy is not useful for the shoulder while it is very painful, but should be commenced as soon as the pain starts to settle, to prevent stiffness.
Key Features of Calcific Tendonitis
- The cause is unknown.
- It eventually disappears by itself over a 12 to 18 month timeframe.
- Severe pain usually represents the end of the process (absorption phase).
- The severe pain usually only lasts a few days.
- Treatment options include:
- Ultrasound guided aspiration and lavage
- Surgical debridement and subacromial decompression
- Surgery has a high success rate, but is only performed in patients where the pain is very severe or persists for longer than expected.