When calcium deposits start to form within the tendons of your shoulder, this is a condition known as calcific tendinitis of the shoulder. This condition most commonly occurs in people aged between 30 and 40 years, and the reasons for its occurrence are unknown. Calcific tendonitis can cause significant shoulder pain due to tissue inflammation, and in some cases you may also experience impingement (pinched tendons) due to a reduction in the amount of space between the acromion and rotator cuff.
More than 90% of people with calcific tendonitis will eventually recover, with calcium deposits slowly disappearing over a period of about 12-18 months. The severity of pain during this time varies for each individual, with some noticing mild pain when moving their arm and others experiencing severe pain. It is important to work in consultation with your physiotherapist, as they will be best placed to provide guidance on managing your condition and reducing pain.
The Phases of Calcific Tendonitis
There are 5 distinct phases of calcific tendonitis, which include:
- Normal Tendon – this is where you feel no pain and your tendon does not have a calcium deposit.
- Formation of Calcium – calcium will start to form over 0-3 months, but you will not experience any pain.
- Resting Period – This period lasts 3-9 months, accompanied by minor shoulder pain.
- Resorption Phase – this is when pain is most severe, and it lasts between 9-12 months.
- Post Calcific to Normal – over a period of 12-18 months your tendon should start to heal with new tissue forming, and there will be no pain throughout this period.
Some individuals may experience acute, severe and persistent pain – but this is very unlikely for most people. This is usually a sign that you are in the resorption phase, and your pain should start to ease over time.
It may be necessary to immobilise the shoulder via the use of a sling, along with analgesics, the use of ice packs and cortisone injections. It is rare that surgery is required, with most patients responding favourably to treatment as advised by their doctor or physiotherapist. Once the severe symptoms subside, you should be aware that mild symptoms may persist for around 3-6 weeks.
Impingement and Calcium Deposits
Some individuals may experience impingement, which causes the tendon to rub against the bone due to its enlarged size from the formation of calcium deposits. The constant irritation could lead to bursitis, which is inflammation of the bursae that cushion the joints. This condition can be very painful, especially during the evenings and for those who do a lot of overhead activity. Bursitis can be treated with anti-inflammatory tablets, cortisone injections and physiotherapy. Once the calcium deposits start to resorb, your symptoms should subside.
Is Surgery Necessary?
Surgery is normally only necessary if the calcific deposit and symptoms persist, causing loss of movement and negatively effecting your daily activities. Most people do not require surgery, as they find that the calcium disappears over time, with a full resolution of symptoms taking around 12-18 months. For the latter, physical therapy may suffice.
People with persistent and/or acute calcific tendinitis may consider surgery. Surgery is done using arthroscopy (keyhole surgery), which involves small incisions around the tendon to extract calcium deposits and increase the space around the tendon. X-rays are taken following the procedure to ensure that all calcium deposits have been removed.
Post-surgery, patients will need to wear a sling for two weeks. It is important to move and exercise the arm to avoid stiffness, and your physiotherapist will suggest appropriate exercises and routines.
Other treatment options
Radial shock wave therapy is one alternative treatment that may be recommended by your specialist. This non-invasive therapy uses high-frequency sound waves to promote healing of the tendon. It is usually a 3-4 week course, with each session lasting around 15 minutes. Some people report relief from pain after the first session, although results vary from person to person.
Therapeutic ultrasound is another non-invasive therapy that can be used to treat calcific tendonitis. This works by using sound waves to generate heat, which helps to break down the calcium deposits and promote healing.
Extracorporeal Shockwave Therapy (ESWT) is a newer technology that has shown some promise in the treatment of calcific tendonitis. Extracorporeal shock-wave therapy uses a specially made hand held device that can be used to deliver mechanical shocks to the affected area.
Chronic calcific shoulder tendinitis is a condition that can be difficult to treat, and unfortunately there is no sure-fire cure. However, with the right treatment and management plan, most people make a full recovery.
If you have any concerns about your condition, please do not hesitate to speak to your specialist.
