The rotator cuff is a group of 4 muscles in the shoulder that is important in shoulder function. Each muscle has a tendon at its end that inserts into bone (the head of the humerus). When calcium is formed within one or more of these tendons, it is called calcific tendonitis.
Calcific tendonitis is a common cause of shoulder pain. We don’t know exactly why it develops, and most likely there are a few contributing causes. It certainly doesn’t have any relation to calcium in the diet. It mainly affects people aged 40 – 60 years, and more often occurs in people with sedentary occupations. Women are more commonly affected than men. It can be present in both shoulders in 10 – 25% of patients.
Calcific tendonitis goes through different stages. Initially calcium may be present in a rotator cuff tendon without causing pain and may be found incidentally. Patients may complain of a vague discomfort when the arm is in certain positions and may complain of pain at night. The pain is typically worse when lifting the arm above shoulder level. When the calcium deposit ruptures into the surrounding tissue (bursa) it causes a sudden onset of severe pain and all shoulder movements may be very painful and limited. This is due to an inflammatory response as the body tries to resorb the calcium. The good news is that the process is self-limiting and should settle after a while. Occasionally patients may develop a frozen shoulder which implies that the shoulder will be stiff for a prolonged period.
Diagnosis and work-up:
The calcium deposit is clearly visible on ultrasound and X-rays. Further imaging or tests are usually not required.
Conservative treatment is effective for 90% of patients and options include:
- Rest and ice packs during acutely painful episodes.
- Pain-killers and anti-inflammatory medication
- Physiotherapy to maintain shoulder movement
- Cortisone injections
- Shock wave therapy
This is performed in the rooms as an outpatient procedure. After an injection of local anaesthetic to numb the rotator cuff tendon, one or more needles are placed into the calcium deposit under ultrasound guidance. Water is injected into the calcium deposit and the calcium is aspirated with a syringe.
Surgery is considered when conservative management has failed or when the pain is too severe to consider conservative management. The calcium deposit is removed arthroscopically (key-hole surgery) under general anaesthesia (you are asleep). If there are visible signs that the overlying bone (acromion) has been rubbing on the tendon, part of it will be shaved away (acromioplasty). If there is a large hole in the rotator cuff tendon following removal of the calcium deposit, the tendon may need to be repaired.
Following surgery, the arm is placed in a sling. The sling is only worn for a week or two and can be removed once pain allows. If the rotator cuff tendon had to be repaired, the sling will have to stay on for 4 weeks to protect the tendon and allow it to heal.
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