Calcific tendonitis is a condition where calcium deposits accumulate within tendons, most frequently in the shoulder. This can lead to significant pain and limit an individual’s ability to perform daily activities.
What is Calcific Tendonitis?
Calcific tendonitis involves the formation of calcium phosphate, specifically hydroxyapatite crystals, within a tendon. These crystalline deposits can cause localized irritation and inflammation within the affected tissue. The most common location for these calcium formations is the rotator cuff in the shoulder, particularly the supraspinatus tendon, which accounts for up to 80% of cases. Less frequently, deposits may appear in other rotator cuff tendons like the infraspinatus or subscapularis, or in other areas such as the Achilles tendon or elbow.
The exact cause is not fully understood, but it involves a process where tendon cells transform, creating sites for calcium deposition. Contributing factors may include tissue degeneration, localized pressure, repetitive strain, and metabolic influences. The condition is not linked to dietary calcium intake and often affects individuals between 30 and 60 years old.
Calcific tendonitis progresses through stages. In the pre-calcific stage, the tendon undergoes cellular changes making it susceptible to deposits. This is followed by a calcific stage, including formative and resorptive phases. Calcium is first deposited, then the body reabsorbs it. The resorptive phase is associated with the most intense pain.
Recognizing the Symptoms
Individuals experiencing calcific tendonitis report pain in the affected area, which can range from a chronic, dull ache to sudden, severe episodes. This pain often begins without an obvious injury and can intensify rapidly over hours or days. The pain worsens with specific movements, such as lifting the arm, reaching overhead, or performing activities that involve the affected joint.
Pain is often more pronounced at night, disrupting sleep, especially when lying on the affected side. Other symptoms include joint stiffness and tenderness over the calcium deposit. A reduced range of motion is also common, as discomfort limits joint movement.
How Calcific Tendonitis is Diagnosed
Diagnosing calcific tendonitis begins with a thorough medical history and physical examination. A healthcare professional will inquire about the nature and onset of symptoms, as well as assess the range of motion and tenderness in the affected joint. This initial evaluation helps to identify characteristic patterns of pain and limitation.
The primary diagnostic tool to confirm calcific tendonitis is X-ray imaging. X-rays are effective at visualizing calcium deposits within tendons, appearing as dense formations. The appearance of deposits on X-ray can provide clues about the condition’s stage; for instance, dense, uniform deposits may indicate the formative phase, while cloudy, ill-defined deposits can suggest the more painful resorptive phase.
While X-rays are sufficient for diagnosis, other imaging techniques like ultrasound or magnetic resonance imaging (MRI) may be used. Ultrasound can locate smaller deposits and assess surrounding soft tissues, sometimes guiding treatment procedures. MRI offers detailed views of the tendon and surrounding structures, helping to rule out other conditions, such as rotator cuff tears, but it may not show calcium deposits as clearly as an X-ray.
Treatment Approaches
Managing calcific tendonitis begins with conservative, non-surgical methods to reduce pain and restore function. Initial steps include resting the affected area and modifying activities to avoid aggravating movements. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are recommended to alleviate pain and inflammation.
Physical therapy plays a role in treatment, focusing on exercises to maintain or improve joint range of motion and strengthen surrounding muscles. Corticosteroid injections, administered directly into the affected area, provide temporary relief by reducing inflammation and pain. These injections are considered when oral medications and rest alone do not provide sufficient relief.
For cases that do not respond to initial conservative measures, more advanced non-surgical procedures are available. Needle aspiration, also known as barbotage, involves using a needle, often guided by ultrasound, to break up and remove calcium deposits. Extracorporeal shockwave therapy (ESWT) is another option, delivering sound waves to the affected tendon to break down deposits and stimulate healing.
In severe or persistent cases where conservative and advanced non-surgical treatments have not been successful, surgical removal of the calcium deposits may be considered. This is performed arthroscopically, a minimally invasive procedure where small incisions are made. The goal of any treatment is to reduce pain and restore full function to the affected joint.