What Is Calcific Tendonitis?
Calcific tendonitis is a condition that causes the formation of a small calcium deposit within any tendon of the body, but most commonly in the tendons of the rotator cuff. These calcium deposits are normally found in patients who are at least 30-40 years old. The calcium deposits cause pain and inflammation however they are not always painful, and often spontaneously resolve after weeks.
What Is The Cause Of Calcific Tendonitis?
The cause of calcium deposits forming within the rotator cuff tendons is not entirely understood however one view is that it is related to delayed healing. Your rotator cuff is an important group muscles that help maintain the shoulder ball centred in the small socket and help provide subtle glides and slides of the “ball” on the socket to allow full shoulder movement.
Normally a tendon will heal via the action of fibroblasts (collagen forming cells). In calcific tendonitis it is suggested that after a period of weeks or months these fibroblasts become less numerous in the region and are replaced by osteoblasts (bone forming cells) and subsequently these osteoblasts stimulate bone growth in the tendon.
There are considered to be a few stages to classic calcific tendonitis:
In the pre-calcific stage you usually do not have any symptoms and during this stage where the calcification tends to develop undergoes cellular changes predisposing the tissues to developing calcium deposits.
During this stage calcium deposits form (noting that the deposits aren’t a solid piece of bone but appear chalky) calcification at this point is not painful however once the resorptive phase begins this is a painful stage which the calcium deposit looks something more like toothpaste. Note patients are most likely to seek treatment during the painful resorptive phase of the calcific stage as in any other stage of calcification.
Post-calcific stage is usually a painless stage as the calcium deposit disappears and is replaced by more normal appearing rotator cuff tendon.
Treatment For Rotator Cuff Calcific Tendonitis
Calcific tendonitis almost always resolves eventually without the need for surgery however in some situations, if symptoms persist, surgical intervention involving excision of the calcium deposit is considered. Conservative treatment protocol for calcific tendonitis is similar to the treatment for rotator cuff impingement syndrome includes physiotherapy and anti-inflammatory medications which can help lesson the symptoms.
Tip – Moist heat (simply delivered by a warm washcloth) can help quite significantly with pain relief from calcific tendonitis.
With the treatment of calcific tendonitis controlling the symptoms with the use of heat, anti-inflammatory medications and physiotherapy will allow sufficient time for resolution of the problem in most patients. Although calcific deposits will often remain in some patients, eventually in most the calcium deposit will resolve given time.
More invasive treatment is used as a last resort prior to considering surgery for stubborn calcific tendonitis complaints includes the use of needling and aspiration of the calcium deposit where a needle is inserted into the calcium deposit and an attempt to “suck out” as much of the calcium deposit as possible is made, then this procedure is frequently followed with the injection of cortisone to the area.
Shockwave Therapy For Calcific Tendonitis
Several studies have shown successful treatment of chronic calcific tendonitis with the use of shockwave treatment. Rates of improvement with shockwave therapy for chronic calcific tendonitis has been reported to be in the vicinity of 50-70%.
Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding Calcific Tendonitis should consult his or her orthopaedic surgeon, general practitioner, sports medicine specialist or physiotherapist.