Calcific Tendinitis of Shoulder

Calcific Tendinitis of Shoulder

Dr.Senthilvelan
Consultant Orthopaedic Surgeon
For Appointments/Queries
Contact 9566222533/nexusortho@yahoo.com



What is calcific tendinitis of the shoulder?

Calcific tendonitis is a condition that causes the formation of a small, usually about 1-2 centimetre size, calcium deposit within the tendons of the rotator cuff. The supraspinatus tendon is most frequently affected. These calcium deposits are usually found in patients at least 30-40 years old, and are more common in diabetics. It accounts for approximately 10% of all consultations for painful shoulder.


What Causes Calcific Tendinitis?

The cause of calcium deposits within the rotator cuff tendon is not entirely understood. Different ideas have been suggested, including blood supply and aging of the tendon, but the evidence to support these conclusions is not clear.




X rays Showing Calcific Deposit



What do patients complain of ?

Some people may have the calcific deposit incidentally recognised on X-rays.
Some patients have chronic pain in the affected shoulder or radiating downward the upper arm. Especially night pain occurs often. A few people experience sudden an extreme pain in the shoulder, when a calcium deposit is resorbed.

What are the Stages of Calcific Tendinitis?

 Pre calcification Stage

Patients usually do not have any symptoms in this stage. At this point in time, the site where the calcifications tend to develop undergo cellular changes that predispose the tissues to developing calcium deposits.

Calcific Stage

During this stage, the calcium is excreted from cells and then coalesces into calcium deposits. When seen, the calcium looks chalky; it is not a solid piece of bone. Once the calcification has formed, a so-called resting phase begins; this is not a painful period and may last a varied length of time. 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 something 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.



Do all calcium deposits cause problems?
Many calcium deposits are present for years without causing pain. Only when they are large enough to be pinched between the bones when the shoulder is elevated do they cause pain. Smaller deposits may cause pain if they become inflamed, especially when the calcium salts leak from the deposit into the sensitive bursal tissues of the joint lining.


Will calcium deposit damage the shoulder?


Some calcium deposits can cause erosion by destroying a portion of the rotator cuff tendon. However most calcium deposits remain on the outside of the rotator cuff tendon the bursa (the structures that hold the joint fluid) and only cause problems because of the pain caused when they catch during shoulder movement.


Therapy of calcium deposits at the shoulder:

After failed nonoperative treatment calcium deposits can be removed, arthroscopically. If non-operative treatment, like pain medication, injections, acupuncture and so on failed and pain is still the main problem for the patient, the deposits can be removed by an arthroscopic procedure.

Calcium deposits are tracked with a needle during the operative, endoscopic, procedure. If they are found a small cloud of calcium appears and they are removed using surgical instruments like spoons and shavers.



What is involved in arthroscopic surgery to remove calcium deposits?


The procedure is done as outpatient surgery under general anaesthesia. The operation is painless, and only a mild aching sensation is felt for a few days after the operation while the skin puncture sites heal. If the calcium has eroded in a hole in the rotator cuff, then it is necessary to remove a portion of the overhanging bone which will cause a little more discomfort for a few days.

Needling of calcific deposit before arthroscopy

What happens after the removal of a calcium deposit?

The operated arm and shoulder can be used actively, as far as residual pain allows it. A sling or splint is not used. Depending on the kind of work, the patient can return to it after 1 to 6 weeks. (1 week for example for office work or 6 weeks for heavy work ).


What will happen in the future to the operated shoulder / calcium deposit?

Once the calcium clot is removed it won´t come again. There is a higher statistical chance that it might occur on the other shoulder (estimated on 10 to 20%), in the future.


References

1. Uhthoff HK. Anatomopathology of calcifying tendinitis of the cuff. In: Gazielly DF, Gleyze PTT, editors. The cuff. Paris: Elsevier; 1997. p. 144–6.

2. Rotini R, Bungaro P, Antonioli D, Katusic D, Marinelli A. Algorithm for the treatment of calcific tendinitis in the rotator cuff: indications for arthroscopy and results in our experience. Chir Organi Mov 2005;90(2):105–12.

3. Costouros JG, Bassi O, Gerber C. Arthroscopic management of calcific tendonitis of the shoulder. Presented at the American academy of orthopaedic surgeons annual meeting,2006. p. 695.