Calcific Tendinopathy Of The Shoulder
Calcific tendinopathy (also known as calcific tendinitis) refers to the buildup of calcium deposits in the tendons of the rotator cuff. The majority of cases will affect the supraspinatus tendon (80%), followed by the lower third of the infraspinatus (15%) and subscapularis (5%) (Serafini et al, 2009). When the calcium builds up, this puts pressure on the tendon and then leads to intense pain.
These symptoms normally resolve spontaneously once the body resorbs the calcium. However some cases can be persistent.
Symptoms of Calcific Tendinopathy of the Shoulder
There is usually a rapid onset of symptoms. These symptoms include:
- A severe stabbing pain with constant deep dull ache located around the shoulder and may refer down towards the elbow.
- Pain tends to be worse at night and disrupts sleep.
- Intense pain when moving the shoulder which restricts range of movement
Causes of calcific tendinopathy
The exact cause of calcific tendinopathy is unknown. It is most commonly seen in women aged between 40-60 years old (De Carli et al, 2014). It also appears more often in sedentary workers than heavy manual workers (Elshewy, 2016). The condition has also been associated with diabetes and thyroid disorders (Oliva et al, 2011).
How to diagnose
Your physiotherapist will perform a clinical assessment of your shoulder and may perform an ultrasound scan to confirm the diagnosis. Calcific Tendinopathy is easily visualised with Ultrasound imaging and we can then proceed to an intervention if Calcific Tendinopathy is present and acutely painful.
Shoulder Joint Anatomy
The shoulder is a “ball and socket” joint made up of the humeral head (ball) and glenoid (socket).
The rotator cuff is a group of four muscles in the shoulder. These include the supraspinatus, infraspinatus, teres minor and subscapularis. The rotator cuff plays an important role in the shoulder – it helps raise and rotate the arm and stabilises the humeral head against the glenoid of the shoulder blade.
Up to 80% of calcific tendinopathy cases will resolve with conservative treatment (Min-Su et al, 2020). This includes a course of non-steroidal anti-inflammatory medication, a period of rest and physiotherapy treatment. Physiotherapy treatment can help reduce pain, improve mobility and regain strength in the shoulder.
Extracorporeal Shockwave Therapy
If the pain is still persistent following conservative treatment, there are other options available.
Extracorporeal shockwave therapy (ESWT) helps stimulate the healing process, breaks down the calcium on the tendon and encourages the body to reabsorb the smaller deposits.
Several studies have demonstrated the effectiveness of ESWT for the treatment of calcific tendinopathy (Mouzopoulos et al, 2007). A study by Cosentino et al (2003) found that ESWT resulted in reduced pain and improved shoulder function, as well as complete calcification resorption of 31% of cases.
Steroid injection for Calcific Tendinopathy
If the pain is not settling, causing disruption to your sleep and ability to perform every day activities, you may benefit from an ultrasound guided steroid injection. A small amount of corticosteroid is injected into the area surrounding the calcification and can reduce inflammation and pain in the early acute stages.
Consentino, R., De Stefano, R., Selvi,F., Manca, S., Frediani, B. and Marcolongo, R. (2003) Extracorporeal shockwave therapy for chronic calcific tendinitis of the shoulder: single blind study. Annals of rheumatic diseases. 62(3) pp. 248-250.
De Carli, A., Pulcinelli, F., Delle Rose, G., Pitino,D. And Ferretti, A. (2014) Calcific tendinitis of the shoulder. Joints. 2(3) pp.130-136.
Elshewy, M. (2016) Calcific tendinitis of the rotator cuff. World journal of orthopaedics. 7(1) pp.55-60.
Min-Su, Kim., In-Woo, K., Sanghyeon, L. and Sang-Jin,S. (2020) Diagnosis and treatment of calcific tendinitis of the shoulder. Clinics in shoulder and elbow. 23 (4) pp. 210-216.
Mouzopoulos, G., Stamatakos, M., Mouzopoulos, D. and Tzurbakis, M. (2007) Extracorporeal shockwave treatment for shoulder calcific tendonitis: a systematic review. Skeletal Radiology. 36(9) pp.803-811.
Oliva, F., Via, A. and Maffulli, N. (2011) Calcific tendinopathy of the rotator cuff tendons. Sports medicine and arthroscopy review. 19(3) pp. 237-243.
Serafini, G., Sconfienza, L., Lacelli, F., Silvestri, E., Aliprandi, A and Sardanelli, F. (2009) Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment – nonrandomized controlled trial. Radiology. 252(1). Pp. 157-164.