In this article, you will find out everything you need to know about Calcific tendonitis in the shoulder and the most effective ways to treat it, including an advanced treatment called Prolotherapy.

Calcific Tendonitis Shoulder

Calcific tendonitis of the shoulder means calcium particles in your tendons. Calcific tendonitis most often affects the tendons of the rotator cuff in the shoulder resulting in rotator cuff calcifications. Once the calcium deposits form 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 deposits form in the supraspinatus tendon and cause pain.  

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.  This condition is also called calcific tendinopathy.

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.

What are the stages of calcific tendinopathy

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. Because of this, movement is associated with pain, and the range of motion will decrease.
• Calcific: It is characterized by calcium buildup (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 leads to the calcium deposits in the tendons leading to chronic calcific shoulder tendinitis.

Abnormal activity of the thyroid gland is also a cause of this calcific tendinitis of the shoulder. 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 shoulder calcification.

Vigorous movements at the shoulder 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 and causes pain. 

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 tendinitis of the shoulder.

One of the metabolic diseases is diabetes mellitus(2) is also a cause of acute calcific tendinitis. Diabetes mellitus affects the shoulder function and 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 small calcific deposits in soft tissues.

How does calcific tendonitis occur?

Calcific tendonitis is the inflammatory reaction to the calcium deposit 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 (subacromial 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 are 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, causes pain, and affects the normal functioning of the shoulder.

Signs & symptoms

Calcific tendonitis shoulder does not have any different 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 shoulder pain. The pain may be sudden in onset or gradual. Due to this intense night pain, the patient is unable to sleep properly. 

 Movements at the shoulder are associated with intense sudden 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). 

How is calcific tendonitis diagnosed?

Your physician will inquire about your medical history and current symptoms. A thorough physical examination will be conducted. You might receive a referral to a specialist. for example, to an orthopaedic surgeon specializing in bones.

Tests could consist of the following:

Evaluation of the shoulder’s range of motion and its stability

X-ray is a test that uses radiation waves to create an image of the body’s architecture; it is used to detect calcific deposits.

Magnetic resonance imaging and radiography will be conducted to check the condition of the soft tissues.

Treatment

In most instances, the calcific deposit usually resorbs 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 orthopedic doctor. Various treatment options are given below;

Physical therapy

Sports physical therapy also plays a significant role in the treatment of musculoskeletal conditions such as calcific tendinitis caused by a sports injury. Massage by a Physiotherapist promotes muscle relaxation, decreases pain, and improves blood supply. This is usually part of the rehabilitation process to restore normal muscle movements at the joint.

Medical treatment

It involves the use of painkillers to decrease pain. The painkillers include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. These potent anti-inflammatory medications are easily available over the counter and are very effective in reducing shoulder pain. The administration of cortisone injection or other steroid injections(4) is also effective in reducing pain and swelling.

Lavage Treatment

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 shock wave therapy (ESWT)

ESWT(5) involves the use of a small device that delivers mechanical shock waves to a person’s shoulder, close to the build-up of calcium deposits. This extracorporeal shock wave treatment breaks up the deposits. The higher the frequency of these shocks, the more effective treatment they will provide for treating calcific tendinopathy.

Radial shock wave therapy (RSWT)

This shockwave therapy is very similar to extracorporeal shockwave therapy and involves a device that delivers low- to medium-energy shocks to the shoulder to break calcium deposits.

Therapeutic ultrasound

It involves the use of high-frequency sound waves to break down calcium deposits. It is usually a painless procedure(6).

Shoulder barbotage

It involves the dissection of calcium deposits using ultrasound guidance. This procedure can take place under local anesthesia.

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat calcific tendonitis.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help calcific tendonitis.

As prolotherapy is helping to treat the root cause of calcific tendonitis, it is deemed to be a permanent fix, preventing the symptoms from returning.

Surgical treatment

In severe cases, surgery will be required. However, most physicians agree that surgery should not be considered until six months have passed. During surgery, calcium deposits are removed and the space between the bone and shoulder tendon is widened.

There are two types of surgeries. Open surgery and closed surgery. Occasionally, open surgery is required. During open surgery,  a doctor reaches the area of calcium deposit by cutting through muscles and other surrounding tissues. The tendon is sliced in order to remove the calcium deposits. Following the removal of calcium crystals, the physician sutures the skin and muscles together.

Most surgeries to correct calcific tendonitis are arthroscopic surgeries (arthroscopy). It involves excision of the affected area. Proper medical history is required before surgery. In this type of surgery, a 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. Overall, the risk of shoulder surgery for calcific tendonitis includes infection, recurrence of calcium deposits, and chronic pain.

Rehabilitation after surgery

After shoulder surgery, rehabilitation can be a lengthy process. You will likely have to attend treatment sessions for several weeks, and you should anticipate a few months for a full recovery. It is essential to get the shoulder moving as soon as possible. However, this must be balanced against the necessity to protect the healing tissues.

After surgery, you may need to wear a sling to support and protect the shoulder for a few days. During the initial few therapy sessions, electrical stimulation and icing may be used to assist in managing pain and oedema caused by surgery. Your therapist may also apply massage and other manual therapies to alleviate pain and muscle spasms.

Following a simple arthroscopic resection, therapy can advance rapidly. Treatments begin with range-of-motion exercises and progress to strengthening and stretching over time. You should avoid performing too many tasks at once.

Your workouts are designed to train your shoulder in a manner analogous to your daily responsibilities and activities. A therapist will assist you in finding tasks that do not place undue strain on your shoulder. You will also learn how to avoid difficulties in the future.

Preventive measures

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 tendinitis of the shoulder, especially if you are an athlete or a sports person.

Avoid hard lifting and overhead activities. You must do proper stretching before 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.

Frequently Asked Questions –

How effective is surgery compared to other options for shoulder calcific tendonitis?

There are often no reliable studies comparing surgical and non-surgical treatments. However, the best research currently available indicates no difference in outcomes. As evidence suggests that you should only think about surgery after trying out other therapies like  1-2 injections and shockwave.

Should you undergo shockwave therapy for calcific tendonitis?

Evidence suggests that shockwave therapy for calcific tendonitis is as beneficial as injections. However, treatment typically takes longer (1 session per week for five weeks). In general, experts advocate a highly concentrated shockwave. A randomized clinical study indicates that high-energy shockwaves are superior to low-energy ones for treating calcific shoulder tendonitis. Patients reported major clinical improvement in their symptoms.

Is your food a cause of calcific tendonitis of the shoulder?

In general, no. Diet has no direct effect on whether or not someone develops calcific tendonitis of the shoulder. However, patients with obesity or diabetes are more prone to experience significant pain from calcific tendonitis.

Will calcific tendonitis resolve on its own?

In the majority of the situations, calcific tendonitis resolves on its own. It does not require treatment. However, if you believe you have calcific tendonitis, you should contact your healthcare professional to rule out other conditions such as frozen shoulder, tendon tear, or impingement.

Can calcific tendinitis come back?

Symptoms of calcific tendinitis might appear or disappear with time. Some individuals live for months or years without encountering problems. If you have had an illness in the past such as arthritis, or tendon tear, it is advisable to schedule periodic checkups with your doctor.

Conclusion

The calcifying tendinitis of the shoulder is a painful shoulder 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 calcifying 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 orthopedic doctor’s advice immediately for proper medical treatment.

References 

• • Gärtner, J., & Heyer, A. (1995). [Calcific tendo
  • nitis of the shoulder]. Der Orthopade, 24(3), 284–302. https://europepmc.org/article/med/7617385
  • Lui, P. P. Y. (2017). calcific Tendonitis 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
  • Loew M, Sabo D, Wehrle M, et al. Relationship between calcifying tendinitis and subacromial impingements: prospective radiography and magnetic resonance imaging study. J Shoulder Elbow Surg. 1996; 5:314–319. [ PubMed ] [ Google Scholar ]
  • Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br. 1970; 52:540–553. [ PubMed ] [ Google Scholar ]