Calcific Tendonitis

Calcific tendonitis, and its less painful cousin, calcific tendinosis, is a condition affecting the rotator cuff tendons of the shoulder. It is caused by a build-up of calcium within the tendons of the shoulder. The calcium can take on one of two forms; either a dry and chalky consistency or a consistency more like toothpaste. Depending on what happens to the calcium, it can cause several different problems.

It is important to note that many people can get calcium build-up in their tendons as a normal process of ageing. This is a very different condition called dystrophic calcification and is a sign of wear and tear of your tendons.

Who gets calcific tendonitis?

The short answer is anyone! Most patients are middle-aged and otherwise healthy. Many people have calcium build-ups in their tendons without any symptoms. It is often when the body starts to clear the calcium that the symptoms start.

Symptoms

01 No problem at all: Most commonly, people are blissfully unaware of the calcium build-up in their shoulder. Up to 10% of people have this found by chance.

02 Impingement symptoms: The chunk of calcium in the tendon makes the tendon swell a little. This can cause the tendon to rub on the shoulder bones are you bring your arm up. This can cause pain at the front and side of your shoulder when you lift your arm, very similar to subacromial impingement.

03 Calcific tendonitis: Sometimes, the calcium can burst out of the tendon and irritate the tissues around the tendon. This often comes on suddenly and some people recall a minor injury setting it off. It is one of the most sudden and painful problems you can develop in your shoulder, causing a constant pain that makes it very difficult to move your shoulder or sleep. Fortunately, treatment can settle this down very quickly.

04 Frozen shoulder: In the most severe cases, the calcific tendonitis can cause a very painful form of frozen shoulder, with significant loss of movement.

How is calcific tendonitis diagnosed?

This starts with a conversation with your doctor to describe the problems you are experiencing with your shoulder. You will then be examined, with some specialised tests, paying careful attention to your shoulder movements. The diagnosis is usually made on X-ray, which will show a deposit of calcium in the tendon. An ultrasound scan can also pick up the calcium.

Treatment options

Non surgical

Simple painkillers and waiting

For some people, just knowing what the problem is, and having the reassurance that there is no major damage to the shoulder is enough. The pain can be controlled with simple painkillers, such as paracetamol and anti-inflammatories (if you can take them). This may be coupled with simple changes to your lifestyle, such as sleeping on the opposite side or putting items on lower shelves at home.

As stated above, often the pain starts when the calcium starts to be absorbed, but this process can take several months. If you do wait though, it will usually get better by itself.

Non surgical

Physiotherapy

A course of physiotherapy can be helpful if you have impingement symptoms from the build-up of calcium. Your physiotherapist will assess your movements and teach you ways of moving your shoulder without experiencing the pain. It can take several months to get the full benefit of physiotherapy, so it is important to work hard early on, even if you do not feel an immediate benefit.

Non surgical

Steroid injection

If you have a severe case of calcific tendonitis, you may be offered a steroid injection into your shoulder. This is sometimes referred to as a cortisone injection. This is a highly-effective treatment for calcific tendonitis and often brings about relief within minutes. The purpose of this injection is to settle down any inflammation in your shoulder. It is important that you start physiotherapy straight away to maintain mobility and reduce the chance of developing a frozen shoulder. There are several rare risks of steroid injections:

Allergic reaction: This is very rare, but can be life-threatening.
Infection: This is rare, but can result in severe pain 1-2 weeks after the injection and may require surgery to wash out the injection.
Change in the colour or texture of your skin where it is injected. This is very uncommon and more pronounced in people with darker skin colours.
Steroid 'flare': This can result in a temporary worsening of pain from 1-3 days after the injection.

Non surgical

Ultrasound-guided barbotage

You may be offered a special type of injection into your shoulder called barbotage. This is usually performed by a radiologist (X-ray doctor). Using an ultrasound scanner, the doctor can see the calcium deposit. After giving some local anaesthetic to numb the area, a needle is passed through the calcium, to release it from the tendon and sometimes draw it up into a syringe.

Surgical

Surgery

If the above treatments are not successful, surgery may be helpful to treat calcific tendonitis. This is usually performed 'keyhole' and is often referred to as an arthroscopic excision of calcific deposits. It involves putting a camera into the shoulder, finding the calcium, then removing it from the tendon and washing it out of your shoulder.

Most people with calcific tendonitis also have a lot of inflamed tissue in their shoulder which is also removed. This operation is very similar to an arthroscopic subacromial decompression, which you can read about here.