What is calcific tendonitis?

Calcific tendonitis usually presents with sudden onset of severe pain without preceding trauma, although it can also present in different ways depending on the stage of the disease process, size and location of the calcific deposit. It generally presents with features of subacromial impingement due to the clacification and the space occupying deposit within the tendon. It persists as dull aching pain with episodes of acute pain due to chemical inflammation from leakage of the calcium crystals into the subacromial bursa. Presentation can be sometimes confused with frozen shoulder due to pain inhibition of movements.

How is it diagnosed?

Usually the diagnosis is straightforward on X rays (pic 1). Occasionally ultrasound scan (pic 2) may be helpful if the size of the deposit is too small to be seen on X-rays. MRI is rarely needed. There are signs of impingement on clinical examination and cuff strength may appear less due to pain inhibition.

What are the predisposing factors?

The condition is not fully understood and as such there are no known risk factors. It is more common in middle aged women (30-50 years).

Will it resolve itself?

It varies; the body might absorb the calcium but it may take years to happen if the deposit is consolidated.

What are the treatment options?

Initially this can be treated with Painkillers and anti-inflammatory medications. Physiotherapy can be useful to keep your shoulder strong and flexible but may be difficult in acute phase due to pain inhibition

Cortisone steroid injections are useful to reduce inflammation and control the pain, but effect is variable and usually temporary. The deposit can also be broken under ultrasound guidance and the calcium can be sucked out into a syringe. It has variable success rate and some patients will continue to experience pain due to residual calcium crystals in the bursa that generate inflammation.

Surgery is required if the pain is not controlled with conservative means. The aim is to reduce the bulk of calcium deposit to prevent subacromial impingement and pressure effect of the deposit itself (pic 3). It is performed through keyhole (arthroscopy) and can be done as a day case (link to video).

The recovery is as per ASD procedure (see separate link – to the physio protocol page for subacromial decompression). For more information, please visit my website www.drsarda.in

If you are suffering from this condition, please contact —– to arrange an appointment.