Calcific tendonitis of the shoulder means calcium build up in your tendons. Calcific tendonitis most often affects the tendons of the rotator cuff in the shoulder. Once the calcium deposition takes place in the tendons, they become inflamed and it is accompanied by severe pain in the shoulder. It is one of the most common causes of shoulder pain.
The rotator cuff is formed by the tendons of muscles around the shoulder. These muscles originate from the scapula and are inserted into the upper end of the humerus (upper arm bone). They mainly provide stability at the shoulder joint and also allow various movements to take place at the shoulder. Calcium salts deposition usually takes place in supraspinatus tendon.
People between the ages of 40 and 60 years are more at risk to develop calcific tendonitis. The disease affects women more as compared to men. You’re more likely to suffer from this condition if you perform a lot of overhead motions, such as heavy lifting, or play sports like basketball or tennis.
In this article, you will get to know the complete information regarding calcific tendonitis shoulder and the step you have to take to avoid this condition.
Stages of calcific tendonitis in the shoulder
There are three stages of calcific tendonitis:
- Pre-calcific: This is the initial stage of calcification in which changes take place at the cellular level. Due to this, the movement is associated with pain and there will be decreased range of motion.
- Calcific: It is characterized by calcium build up(1) inside the cells. After some time, the body starts to resorb the calcific deposits. It is the most painful stage.
- Post-calcific: It is the recovery stage in which the calcium deposits are replaced by healthy tissue of the tendons. The range of movements begins to improve during this stage.
Causes of calcific tendonitis shoulder
The exact cause of calcific tendonitis is unknown. Wear and tear of the shoulder is usually the most common cause. Other conditions usually associated with calcific tendonitis are;
Advancing age is the most common cause. As one gets older, degenerative changes take place in many tissues of the body including the degeneration of tendons. This facilitates calcium deposition in the tendons.
Abnormal activity of the thyroid gland is also a cause of this condition. The thyroid gland is usually involved in the regulation of calcium. When there is abnormal functioning of the thyroid gland, levels of calcium are elevated in the body which promotes calcification.
Vigorous movements at the shoulder joint may cause the rotator cuff tears. Athletes involved in repeated movements of arms up and down are more prone to damage their tendons. This promotes wear and tear of tendons at the shoulder joint.
There is also a genetic predisposition to the development of this condition. It is more likely to run in families. An individual is more likely to suffer from this condition if there is a family history of calcific tendonitis.
A metabolic condition such as diabetes mellitus(2) is also a cause of calcific tendonitis. Diabetes mellitus affects the functioning of many systems of the body. It disturbs various metabolic processes. Calcium levels in the body are also disturbed which is associated with an increased risk of calcium deposition in soft tissues
How does calcific tendonitis occur?
Calcific tendonitis is the inflammatory reaction to the deposition of calcium in the tendons. When the tendons are damaged due to some condition, calcium salts are deposited within them. This stimulates the inflammatory reaction in response to calcium deposition.
This condition may contribute to the development of shoulder bursitis (impingement syndrome). This involves the inflammation of the subacromial bursa, which is present between the acromion process and rotator cuff tendon. Additionally, it may also affect the biceps tendon.
Whenever the inflammatory reaction takes place in response to a certain condition, there is the release of certain chemical substances that contribute to the development of swelling and pain. Due to this, movements at the shoulder joint is reduced or the movements are associated with intense pain.
As the rotator cuff is a group of tendons around the shoulder, calcification most often occurs in the rotator cuff tendons(3). The inflammatory response to this calcification promotes swelling in the shoulder and affects the normal functioning of the shoulder joint.
Signs & symptoms
Calcific tendonitis shoulder does not have any particular symptoms. However, these are some symptoms that are frequently associated with this condition.
Sudden onset of pain in the shoulder. This is due to the inflammatory reaction which occurs in response to the calcification of tendons. There is the release of certain chemical substances that irritate nerve endings and cause pain. The pain may be sudden in onset or gradual. Due to this intense pain, the patient is unable to sleep properly.
Movements at the shoulder joint are associated with intense pain. Calcification of the tendon decreases its contraction ability. Due to this, the range of movements is decreased at the shoulder joint. Calcification causes the tendons to be hardened and this contributes to the stiffness of the shoulder.
Tenderness over the rotator cuff also indicates calcific tendonitis shoulder. The rotator cuff tendons are more susceptible to developing calcification. The tenderness is associated with decreased movements at the shoulder joint (giving rise to frozen shoulder-like like symptoms). As the muscles are unable to contract properly, they may undergo atrophy(decreased muscle mass).
Treatment of shoulder calcific tendonitis
In most instances, the calcium salts usually resorb naturally, therefore the condition resolves on its own without causing shoulder problems. However, some patients suffer from severe pain and other symptoms and therefore require proper treatment by an orthopaedic doctor. Various treatment options are given below;
Physical therapy as a treatment options for calcific tendonitis shoulder
Physiotherapy also plays a significant role in the treatment of musculoskeletal conditions such as calcific tendonitis. Massage by a Physiotherapist promotes muscle relaxation and improves blood supply. This is usually part of the rehabilitation process to restore normal muscle movements at the joint.
It involves the use of painkillers to relieve pain. The painkillers include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. These painkillers are easily available over the counter and are very effective in reducing pain. The administration of cortisone or other steroid injections(4) is also effective in reducing pain and swelling.
A needle is placed directly into the shoulder and normal saline is injected through the needle. The deposits are then broken up and it helps flush out calcium deposits.
Extracorporeal shockwave therapy (ESWT)
ESWT(5) involves the use of a small device that delivers mechanical shocks to a person’s shoulder, close to the build-up of calcium deposits. These shocks break up the deposits. The higher the frequency of these shocks, the more effective they are.
Radial shockwave therapy (RSWT)
This procedure is very similar to ESWT and involves a device that delivers low- to medium-energy shocks to the shoulder to break calcium deposits.
It involves the use of high-energy sound waves to break down calcium deposits. It is usually a painless procedure(6).
It involves the dissection of calcium deposits using an ultrasound-guided needle. This procedure can take place under local anaesthesia.
Surgical treatment is required if the symptoms worsen over time. It involves excision of the affected area. proper medical history is required prior to surgery. Most surgeries to correct calcific tendonitis are arthroscopic surgeries (arthroscopy) instead of open surgery. The surgeon uses an arthroscope to determine the exact area where calcium deposition has occurred. X-rays are also used to identify the area of calcium deposition. Then the calcium crystals are removed from the tendons.
The shoulder joint is one of the most important joints in the body, as it is involved in various arm movements. Therefore, you must take care to avoid calcific tendonitis of the shoulder, especially if you are an athlete or a sports person.
Avoid hard lifting and overhead activities. You must do proper stretching prior to the exercise. This increases the range of motion and improves the activity of your muscles. Warm up and cool down before and after your workout.
Maintain proper functioning of the thyroid gland. If you have any abnormality in the thyroid gland, you should immediately consult your doctor. Normal thyroid gland functioning is necessary if you want to prevent this condition.
Exercise regularly. Exercise has positive effects on most muscles of the body as it promotes stretching and increases the flexibility of muscles. However, do not exercise vigorously as it makes the muscles and tendons.
Try to avoid the development of any metabolic condition such as diabetes mellitus. It interferes with various processes in the body and contributes to the development of other disorders. Therefore, you must monitor your blood glucose levels regularly.
The calcific tendinitis of the shoulder is a painful condition and you should avoid it, especially if you are an athlete or involved in various sports. Here in this article, we have explained to you the causes and symptoms indicating calcific tendinitis of the rotator cuff. You should also keep in mind the preventive measures to avoid this condition because if you are an athlete, it can adversely affect your career. Moreover, it also interferes with your daily routine activities. If you experience this condition, you should stop doing any kind of movement at the shoulder joint. If the symptoms worsen over time, then seek your orthopaedic doctor’s advice immediately for proper medical care.
- Gärtner, J., & Heyer, A. (1995). [Calcific tendinitis of the shoulder]. Der Orthopade, 24(3), 284–302. https://europepmc.org/article/med/7617385
- Lui, P. P. Y. (2017). Tendinopathy in diabetes mellitus patients-Epidemiology, pathogenesis, and management. Scandinavian Journal of Medicine & Science in Sports, 27(8), 776–787. https://doi.org/10.1111/sms.12824
- Darrieutort-Laffite, C., Blanchard, F., & Le Goff, B. (2018). Calcific tendonitis of the rotator cuff: From formation to resorption. Joint Bone Spine, 85(6), 687–692. https://doi.org/10.1016/j.jbspin.2017.10.004
- Gaujoux-Viala, C., Dougados, M., & Gossec, L. (2008). Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomized controlled trials. Annals of the Rheumatic Diseases, 68(12), 1843–1849. https://doi.org/10.1136/ard.2008.099572
- Krasny, C., Enenkel, M., Aigner, N., Wlk, M., & Landsiedl, F. (2005). Ultrasound-guided needling combined with shock-wave therapy for the treatment of calcifying tendonitis of the shoulder. The Journal of Bone and Joint Surgery. British Volume, 87-B(4), 501–507. https://doi.org/10.1302/0301-620x.87b4.15769
- Gatt, D. L., & Charalambous, C. P. (2014). Ultrasound-Guided Barbotage for Calcific Tendonitis of the Shoulder: A Systematic Review including 908 Patients. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 30(9), 1166–1172. https://doi.org/10.1016/j.arthro.2014.03.013