Calcific Tendinitis of the Shoulder

Understanding Calcific Tendinitis of the Shoulder

Calcific tendinitis occurs when calcium deposits form within the rotator cuff tendons, most often the supraspinatus. It is different from age-related wear: the deposit forms in otherwise healthy tendon and usually goes through a formative phase and then a resorptive phase, in which the body breaks the calcium down on its own ^{[1, 2]}.

The resorptive phase is often the most painful. Patients may have sudden, severe pain that wakes them at night and makes it hard to lift the arm, sometimes with no injury at all. Calcific tendinitis is most common between ages 30 and 60 and somewhat more common in women ^[1].

Because many deposits eventually resorb on their own, treatment starts with pain control, physical therapy and, when needed, a corticosteroid injection ^[2]. For persistent pain, nonsurgical options can break up the deposit: in a randomized trial published in the New England Journal of Medicine, therapeutic ultrasound helped calcifications resolve and improved short-term pain compared with a sham treatment ^[3], and ultrasound-guided lavage (barbotage), which washes out the calcium through a needle, has a high success rate and low complication rate ^[4]. Arthroscopic removal of the deposit is reserved for pain that continues despite these treatments ^[2].

Causes & Risk Factors

• Calcium deposits within the rotator cuff tendon, most often the supraspinatus
• Most common between ages 30 and 60
• The cause of the deposits is not fully understood
• Pain is often worst as the body breaks down (resorbs) the deposit

Symptoms

Common signs and symptoms of Calcific Tendinitis include:

• Sudden, severe shoulder pain, often with no injury
• Pain at night that disturbs sleep
• Pain and difficulty raising the arm
• Tenderness at the front or top of the shoulder
• Stiffness when pain limits movement

Treatment Options

Treatment for Calcific Tendinitis depends on the severity of your condition and may include:

• Rest, ice and anti-inflammatory medication
• Physical therapy to maintain motion
• Corticosteroid injection for severe pain
• Therapeutic ultrasound or shockwave therapy to help break up the deposit
• Ultrasound-guided lavage (barbotage) to wash out the calcium
• Arthroscopic removal of the deposit for persistent pain

References

1. Uhthoff HK, Loehr JW. Calcific Tendinopathy of the Rotator Cuff: Pathogenesis, Diagnosis, and Management. J Am Acad Orthop Surg. 1997;5(4):183-191. doi.org/10.5435/00124635-199707000-00001
2. Merolla G, Singh S, Paladini P, et al. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment. J Orthop Traumatol. 2016;17(1):7-14. doi.org/10.1007/s10195-015-0367-6
3. Ebenbichler GR, Erdogmus CB, Resch KL, et al. Ultrasound therapy for calcific tendinitis of the shoulder. N Engl J Med. 1999;340(20):1533-8. doi.org/10.1056/NEJM199905203402002
4. Gatt DL, Charalambous CP. Ultrasound-guided barbotage for calcific tendonitis of the shoulder: a systematic review including 908 patients. Arthroscopy. 2014;30(9):1166-72. doi.org/10.1016/j.arthro.2014.03.013