Calcific tendinitis of the shoulder is a condition characterized by calcium deposits and tendon degeneration at the attachment sites of the rotator cuff tendons. The most common symptom is severe pain in the front and side of the shoulder, along with restricted shoulder movements. Diagnosis is typically made through a simple shoulder X-ray, where calcium deposits are clearly visible.
The first step in treatment includes non-surgical methods such as pain relievers, ultrasound-guided needle lavage (barbotage), corticosteroid injections, and physical therapy. However, in patients who experience persistent symptoms despite these treatments, arthroscopic surgery to remove calcium deposits is recommended.
Accurate diagnosis and an appropriate treatment plan are crucial for maintaining shoulder health and improving quality of life.
What is Calcific Tendinitis of the Shoulder?
Calcific tendinitis of the shoulder occurs when calcium deposits form on, within, or beneath the rotator cuff tendons (supraspinatus, infraspinatus, teres minor, and subscapularis). It most commonly affects the supraspinatus tendon.
The tissues surrounding the calcium deposits become inflamed, causing significant shoulder pain. It is one of the common causes of shoulder pain. Although the exact cause is unknown, it is believed to result from abnormal calcium release by cells during the body's attempt to repair small tendon tears.
Which Part of the Shoulder is Affected?
Calcium deposits most commonly form in the supraspinatus tendon, which is part of the rotator cuff.
What Does Tendinitis Mean?
Tendinitis refers to inflammation of the tendons. Tendons are connective tissues that attach muscles to bones. This inflammation typically occurs due to repetitive movements, trauma, or aging.
What Causes Calcific Tendinitis in the Shoulder?
Calcific tendinitis does not occur because your body has excess calcium or because you consume calcium-rich foods. Although the exact cause remains unclear, it is thought to result from a deviation in the body's repair mechanism following tendon damage, leading to calcium deposition.
Stages of Calcific Tendinitis in the Shoulder
Calcific tendinitis progresses through specific stages:
Pre-calcification Stage: No pain is present.
Deposition Stage: Pain may occur.
Resorption Stage: Pain is often present.
Pain is most intense during the resorption stage, as the body attempts to break down and reabsorb the calcium deposits.
What Accumulates in the Tendon in Calcific Tendinitis?
In calcific tendinitis, calcium hydroxyapatite crystals accumulate within the tendon.
Symptoms of Calcific Tendinitis in the Shoulder
Pain: Calcific tendinitis of the shoulder primarily presents with pain, which is often the most prominent and distressing symptom. In some cases, patients describe the pain as the most intense they have ever felt. Women who have given birth often compare this pain to or even more severe than labor pain.
Characteristics and Severity of Pain:
Sudden Onset: Pain typically begins abruptly and has a sharp, stabbing nature.
Severe Pain: Especially during the resorption stage, when the body attempts to break down the calcium deposits, the pain can become extremely intense.
Pain at Rest: Pain may persist even when the shoulder is immobile.
Pain Aggravated by Movement: Overhead arm movements or reaching backward can exacerbate the pain.
Night Pain:
Intensified Night Pain: The pain often worsens at night, disrupting sleep patterns.
Sleep-Disrupting Pain: Patients may frequently wake up from their sleep due to pain.
Pain Aggravated by Position: Lying on the affected shoulder can make the pain significantly worse.
Restricted Movement: The pain and stiffness caused by calcific tendinitis can lead to a loss of shoulder mobility. Lifting the arm may become extremely painful. In severe cases, patients may struggle to sleep due to persistent pain. Restricted mobility is also a hallmark symptom of frozen shoulder. If you'd like more information about frozen shoulder, you can click this link.
How is Calcific Tendinitis in the Shoulder Diagnosed?
After obtaining a detailed medical history and performing a thorough physical examination, diagnosis is confirmed with a simple shoulder X-ray. Ultrasound and X-ray imaging also help pinpoint the exact location of the calcium deposits.
Non-Surgical Treatment of Calcific Tendinitis in the Shoulder
Pain relief medications and physical therapy
Ultrasound-guided lavage and corticosteroid injection (Barbotage)
Removal of Calcium Deposits with the Barbotage Method
If the patient experiences significant pain and does not find sufficient relief with painkillers, I perform an ultrasound-guided procedure in my practice. The area is first numbed, and a needle is advanced into the calcification site. The calcium deposit is then flushed, and finally, a corticosteroid injection is administered directly into the calcific tendinitis focus.
Following this procedure, a significant portion of the patient
Barbotage is performed by visualizing the calcified area using ultrasound and inserting a needle into the calcification site under local anesthesia. Calcium deposits are then extracted using the needle.
In some cases, two needles are used during the procedure. Fluid is injected through one needle while it is simultaneously aspirated through the other. During this flushing process, some of the calcium deposits are also removed.
You can watch the Barbotage procedure performed by Dr. Utku Erdem Özer, MD by clicking here.
Surgical Treatment of Calcific Tendinitis in the Shoulder
If pain and movement restriction continue to worsen despite the previously mentioned non-surgical treatments, especially the barbotage procedure, surgery becomes the necessary solution.
Arthroscopic Resection
Surgeries performed to treat calcific tendinitis are typically arthroscopic. An arthroscope is a specialized TV camera inserted into the shoulder joint through a small incision in the skin. Surgical instruments are inserted through additional small incisions to remove the calcified deposits from the body.
It is essential to remove calcium crystals, as they can be highly irritating to surrounding tissues.
Conclusion
Calcific tendinitis is a condition caused by calcium deposits accumulating in tendons. While it can occur in various parts of the body, it most commonly affects the supraspinatus tendon in the rotator cuff of the shoulder.
Calcific tendinitis manifests with severe pain and restricted movement. Among non-surgical treatment methods, the barbotage procedure is particularly effective. In resistant cases, shoulder arthroscopy is performed to remove calcium deposits.
Thank you for reading our article. If you wish, you can visit
the homepage of utkuerdemozer.com for a broader overview.
