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What is calcific tendonitis and what causes it?

Calcific tendonitis is a condition caused by calcium deposits building up in a person s muscles or tendons. If calcium builds up in an area, a person may feel pain and discomfort there.

Although this condition can occur in other parts of the body, the most common area for calcific tendonitis to develop is the rotator cuff. This is the group of muscles and tendons that provide strength and stability to the upper arm and shoulder.

Although medication or physical therapy, or a combination of the two, can usually treat the condition successfully, surgery may be required in some cases.

In this article, we look at how to identify calcific tendonitis and what causes it, along with information on treatment and recovery.

Symptoms

Calcific tendonitis can cause shoulder pain
If a person has calcific tendonitis, they are likely to experience pain in the shoulder and down the arm.

Most people will experience shoulder pain and discomfort when calcific tendonitis develops.

The pain from calcific tendonitis is usually concentrated in the front or back of a person s shoulder and down into the arm.

Some people may experience severe symptoms. They may be unable to move their arm, and the pain can interfere with sleep.

As the calcium deposits build up in stages, the pain a person feels may come on suddenly or increase slowly and gradually.

The three stages are known as:

  • Pre-calcification. The body undergoes cellular changes in the areas where the calcium will eventually build up.
  • The calcific stage. Calcium releases from the cells and begins to build up. During this stage, the body reabsorbs the calcium buildup, which is the most painful part of the process.
  • The postcalcific stage. The calcium deposit disappears, and a healthy tendon takes its place.

However, it is possible to have the condition without any noticeable symptoms.

Causes and risk factors

Doctors cannot say for sure why some people are more prone than others to calcific tendonitis.

Calcific tendonitis occurs more frequently in adults between 40 and 60 years old, with women more likely to experience the condition than men.

The buildup of calcium deposits may be linked to one of the following factors:

  • aging
  • damage to the tendons
  • a lack of oxygen to the tendons
  • genetics
  • abnormal thyroid gland activity
  • cells growing abnormally
  • chemicals produced by the body to fight inflammation
  • metabolic diseases, including diabetes

Diagnosis

If a person s shoulder pain or discomfort does not go away, a doctor should check it out. At the appointment, a doctor will ask about a person s symptoms and medical history.

The doctor will perform a physical examination of the affected area to see whether the range of motion has changed and how severe the pain is.

A doctor who suspects calcific tendonitis will usually request imaging tests, which will reveal any calcium deposits or other abnormalities in the joint.

An X-ray can help identify large buildups of calcium. An ultrasound scan can reveal any smaller deposits that the X-ray may have missed.

The size of the calcium deposits found by these tests will affect the treatment plan.

Treatment options

shock therapy for calcific tendonitis
Shockwave therapy delivers mechanical shocks to areas where the calcium deposits have built up.

Medication and physical therapy can usually be used to treat calcific tendonitis.

Common medication prescribed to treat the condition includes nonsteroidal anti-inflammatory drugs NSAIDs, which are also available over the counter.

A doctor may also prescribe corticosteroid injections, which can help to reduce pain and swelling.

Other treatments that can help relieve the symptoms of calcific tendonitis include:

Extracorporeal shockwave therapy ESWT

ESWT involves a small handheld device that delivers mechanical shocks to a person s shoulder, close to where the calcium deposits have built up. These shocks can break up the deposits.

The treatment usually takes place once a week for 3 weeks.

The higher the frequency of these shocks, the more effective they are. The shocks can be painful, and a doctor can adjust the level to ensure that a person can tolerate them.

Radial shockwave therapy RSWT

This procedure is very similar to ESWT and involves a handheld device that will deliver low- to medium-energy shocks to the shoulder where the calcium has built up.

Therapeutic ultrasound

During a therapeutic ultrasound, a doctor will use a handheld device that directs a high-frequency sound wave where the deposit has built up to break it down. This procedure is usually painless.

Percutaneous needling

During this procedure, a doctor will first give a local anesthetic to the affected area before using a needle to make holes in the skin.

The doctor will then remove the calcium deposits through these holes, usually by using an ultrasound to guide them to the correct places.

Surgery

Most people can expect their calcific tendonitis to be successfully treated without the need for surgery. However, around 10 percent of people do need it. There are two types of surgery for removing calcium deposits.

Open surgery involves a doctor making an incision in the skin with a scalpel. They can then manually remove the deposit through the incision.

Arthroscopic surgery involves a doctor making an incision where they will insert a tiny camera. The camera helps to guide the doctor to where the deposits have built up so that they can remove them more accurately.

Recovery

Physiotherapy treats calcific tendonitis
Physiotherapy is recommended to help people recover from calcific tendonitis.

Physical therapy is recommended for people with moderate or more severe forms of the condition. The focus will be on doing gentle exercises to relieve any discomfort and help to recover a full range of motion.

Some people find they have completely recovered within a week. Others may continue to experience some pain and discomfort that limits their movements and activities.

If surgery is necessary, the recovery time will depend on the number, location, and size of the calcium deposits, and the type of surgery. Open surgery has a longer recovery time than arthroscopic surgery.

A doctor may recommend that the individual wear a sling for a few days after surgery to help support the shoulder if it was affected.

Physical therapy may also take longer after open surgery, and a person can expect to be in physical therapy for around 6 to 8 weeks. After arthroscopic surgery, improvements to discomfort and movement can be felt after 2 to 3 weeks.

Outlook

Calcific tendonitis can cause pain and discomfort and limit a person s range of motion, although some people do not experience any symptoms.

The majority of cases are treated with pain medication and quick, simple procedures that can take place in a doctor s office. More severe cases may require surgery followed by physical therapy.

Calcific tendonitis can disappear on its own without any treatment. Ignoring the condition is not recommended, however, as it can lead to complications, such as rotator cuff tears and frozen shoulder.

Once calcific tendonitis disappears, there is no evidence to suggest it will return. But people should remain aware of the condition and report any new onset of pain to a doctor.