Calcific tendonitis is a painful musculoskeletal condition that often causes alarm when patients hear the term “calcification.” This term can prompt searches about serious diseases, including cancer, due to the association of abnormal growths with calcification. However, this common condition is benign and involves a distinct biological process separate from malignancy. Understanding its nature helps alleviate concern and focuses management efforts.
Clarification: Calcific Tendonitis is Not Malignant
Calcific tendonitis is a self-limiting, non-malignant disorder and is not a form of cancer or a tumor. The fundamental difference lies in cellular behavior. Cancer involves the uncontrolled growth and division of cells that can invade other tissues, a process called metastasis.
In contrast, calcific tendonitis is a localized process involving the deposition of mineral crystals within the tendon tissue. This condition is characterized by a physical change in tissue composition, not the abnormal proliferation of cells. Although imaging may sometimes show features that mimic malignancy, the characteristic location and nature of the deposit distinguish it as benign.
Understanding Calcific Tendonitis
Calcific tendonitis is defined as the deposition of calcium hydroxyapatite crystals within the tendons, causing inflammation and pain. Hydroxyapatite is the mineral compound that gives bone rigidity. These deposits are most common in the rotator cuff of the shoulder, particularly the supraspinatus tendon, but can also affect the Achilles tendon, hip, elbow, or wrist.
The condition predominantly affects adults between 30 and 50 years old and is observed slightly more often in women. Symptoms range from mild discomfort to severe, acute pain and restricted movement, especially when lifting the arm overhead. Although the exact cause is often unclear, factors like diabetes, hypothyroidism, and metabolic disorders are associated with increased risk.
The Process of Calcium Deposition
The biological process leading to calcific tendonitis occurs in distinct, non-malignant phases. This sequence is described in three stages: the pre-calcific, the calcific, and the post-calcific phases. During the pre-calcific stage, the tendon tissue undergoes cellular changes, making it susceptible to calcium formation, but no deposits are yet visible.
The calcific stage involves the physical deposition of calcium phosphate crystals within the tendon matrix, often forming chalk-like material. This phase includes a formative stage and a resting stage, where the deposit is present but may not cause significant pain. The most painful part of the calcific phase is the resorptive phase, where the body actively attempts to break down and absorb the calcium deposit.
The intense pain during the resorptive phase is due to a vigorous inflammatory response as the body’s cells, such as macrophages, try to remove the crystals. This inflammatory process involves the release of pro-inflammatory cytokines and signals that the body is working toward resolving the issue. The final post-calcific phase sees the deposit replaced by healthy, remodeled tendon tissue, leading to the resolution of symptoms.
Managing Calcific Tendonitis
The management of calcific tendonitis focuses on relieving pain and encouraging the body to resorb the calcium deposits. Since the condition is frequently self-limiting, meaning it resolves on its own, initial treatment involves conservative measures. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage inflammation and pain, particularly during the acute resorptive phase.
Physical therapy is incorporated to maintain the shoulder’s range of motion and strength, preventing secondary complications like frozen shoulder. If conservative approaches are insufficient, a doctor may recommend a corticosteroid injection to decrease local inflammation and provide substantial pain relief.
More advanced, non-surgical options are available to actively break down or remove the deposits. Extracorporeal shockwave therapy (ESWT) delivers mechanical shock waves to the affected area, which fragments the calcium, allowing the body to absorb the smaller pieces. Another effective procedure is ultrasound-guided percutaneous needling, or barbotage, where a needle is used under imaging guidance to puncture the deposit and aspirate the calcium material. These interventions accelerate the natural resolution process.