What Is Calcific Tendonitis?
Calcific tendonitis is a condition that causes the formation of a small calcium deposit and can occur within any tendon of the body, but most commonly in the tendons in the shoulder know as the rotator cuff. These calcium deposits are normally found in patients who are at least 30-40 years old and can cause pain and inflammation, however calcium deposits are not always painful, and often spontaneously resolve after weeks without any treatment.
What Are The Causes 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 following injury, or surgery. The rotator cuff is an important group muscles that help maintain the ball of the shoulder centred in the small socket and they help control subtle glides and slides (of the ball on the socket) in the shoulder that are necessary in achieving full shoulder movement.
Normally if a tendon is irritated, or injured it 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 and are subsequently replaced by osteoblasts (bone forming cells), these osteoblasts stimulate bone growth in the tendon. This changing from collagen forming cells to bone forming cells leads to the laying down of the calcium deposit rather than the normal scar tissue.
There are considered to be a few stages to a classic calcific tendonitis:
- Pre-Calcification Stage
In the pre-calcific stage, there are usually no symptoms. During this stage the calcification tends to develop, cellular changes occur predisposing the tissues to developing calcium deposits.
- Calcific Stage
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 in-turn is a painful stage in which the calcium deposits look something more like toothpaste. Patients are most likely to seek out treatment during the painful resorptive phase of this calcific stage, more so than in any other stage of calcification.
- Post-Calcific Stage
Post-calcific stage is again usually a painless stage of calcification, this is the stage where any calcium deposit starts to disappear and is replaced by a more “normal” appearance tissue.
Treatment For Calcific Tendonitis Of The Rotator Cuff
Conservative treatment protocol for calcific tendonitis is similar to the treatment for a standard rotator cuff impingement syndrome, includes physiotherapy and anti-inflammatory medications both of which can help lesson any symptoms. The condition almost always resolves and eventually resolves without any need for surgery. However in some situations, if symptoms persist, surgical intervention which will involve excision of the calcium deposit is considered. More invasive treatment as always is used as a last resort, prior to considering surgery for stubborn calcific tendonitis complaints. The use of needling and aspiration of the calcium deposit, a technique 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.
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.
Tip – Moist heat (simply delivered by a warm washcloth or similar) in some people can significantly help manage pain levels in calcific tendonitis.
Although calcific deposits will often remain in some patients, for most any calcium deposit will resolve given time without the need for any of the more invasive options mentioned above.
Shockwave Therapy And Calcium Deposits
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%. At Sydney Physio Clinic we have used shockwave therpay for years in the successful management of a number of soft tissue conditions including the treatment of calcium deposit related pain.
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.