Calcific tendinitis is an uncommon shoulder condition in which small calcium deposits form within the rotator cuff tendon, typically within the supraspinatus tendon near its insertion. It is more common in females than males and typically occurs in patients in their fifth or sixth decade of life. The cause is not fully understood. Symptoms can vary depending on the phase of the condition and, when pain develops, often present like impingement syndrome.
What Is Calcific Tendinitis?
Calcific tendinitis occurs when calcium deposits form within the rotator cuff tendon. The calcification usually resides within the mid-substance of the supraspinatus tendon near its insertion.
There is controversy regarding why calcific tendinitis occurs. Some consider it a degenerative process, while others believe it involves changes in the tendon fibers that eventually detach from the tendon and begin to calcify.
Calcific tendinitis may present differently in different patients, and symptoms can depend on the phase of the condition.
Causes and Risk Factors
The exact cause of calcific tendinitis is unknown. Possible causes and risk factors include:
- Possibly age-related degenerative changes
- Increasing age
- Poor physical conditioning, including strength and flexibility
- A sedentary lifestyle
Symptoms
Common signs and symptoms of calcific tendinitis include:
- Acute onset of severe pain around the shoulder, often along the side of the upper arm
- Pain that is worse when reaching away from the body or overhead
- Occasional aching when not using the arm
- Pain that often awakens you at night
- Occasional loss of strength or difficulty raising the arm
- Occasional crepitation, or a crackling sound, when moving the arm
Treatment
Initial treatment consists of therapeutic exercises to restore rotator cuff and scapular muscle strength, endurance, and mechanics to allow proper, non-painful motion of the shoulder. Avoiding activities that aggravate symptoms can also help relieve inflammation and pain. Supervision by an experienced physical therapist is strongly recommended.
A steroid injection to the inflamed area around the tendon, within the bursa, is sometimes recommended for patients who are extremely limited by pain.
Cold may also be used to relieve pain and reduce inflammation. It can be applied for 15 to 20 minutes every two to three hours for inflammation and pain and immediately after activities that aggravate symptoms. A cloth should be placed between the ice and skin to prevent burning or freezing the skin.
If a proper course of conservative treatment does not relieve symptoms, arthroscopic surgery may be recommended to perform extensive debridement or excision of the calcium deposits and repair the rotator cuff.
Recovery and Outcomes
The prognosis for calcific tendinitis is usually good. Relief of symptoms can occur within six to eight weeks with a steroid injection, elimination of aggravating activities, and therapeutic exercises for the rotator cuff and scapular muscles.
Some cases respond only temporarily to conservative treatment and require arthroscopic removal of the calcium and repair of the defect in the rotator cuff to achieve full recovery.
Return to full activity is usually possible in four to six weeks following therapy alone but may take three to six months if surgery is necessary.
Potential complications include prolonged recovery, persistent tendon inflammation and pain, shoulder stiffness or loss of motion, and recurrence of symptoms, particularly if activity is resumed too soon or the condition is incompletely treated. A rotator cuff tendon tear may also be present.
When to See Dr. Chudik
Contact Dr. Chudik’s office if symptoms worsen or if you are experiencing shoulder symptoms that require evaluation. Call 630-324-0402, email contactus@chudikmd.com or request an appointment online.