Calcific Tendinitis of the Shoulder (Reactive Calcification)

Calcific tendonitis occurs when calcium builds up in the muscles or tendons. It can happen in any tendon in the body, but it is most common in the rotator cuff.

Calcific Tendonitis of the Shoulder Anatomy

The rotator cuff is the group of muscles and tendons that connects the upper arm to the shoulder. Calcium buildup in this area will restrict the shoulder’s range of motion and cause extreme pain and discomfort.  

Calcific Tendonitis of the Shoulder Causes

Doctors believe that the tendency to develop calcium buildup in the rotator cuff could be a result of:

  • A genetic predisposition
  • Abnormal cell growth
  • Abnormal thyroid gland activity
  • Bodily production of anti-inflammatory agents
  • Metabolic diseases, such as diabetes

The condition is more common in people who play sports or who repeatedly raise and lower their arms over the course of their day, placing more stress on the rotator cuff.

This condition is more common in adults between the ages of 40 and 60 and is also more likely to occur in women than men. However, this condition can affect anyone. 

Calcific Tendonitis of the Shoulder Symptoms

Shoulder pain is the most common symptom, though a few lucky people don’t experience any noticeable symptoms. 

However, the vast majority of people will feel varying degrees of pain, mostly in the front or back of the shoulder. Some people report the pain as being so severe it prevents them from sleeping.

If you do feel pain, it can begin suddenly or build up gradually. This is because the calcium build-up occurs in three stages, with the final stage being resorption. This is when your body begins to absorb the fully-formed calcium deposit. It is widely agreed to be the most painful stage.

Calcific Tendonitis of the Shoulder Diagnosis

After inquiring about your medical history and symptoms, your doctor will likely conduct a physical examination. They will probably ask you to lift and rotate your arm.

The most common method of diagnosing calcific tendonitis is through imaging tests like X-rays and ultrasounds. X-rays will generally only be able to catch larger deposits, and ultrasounds will be required to find smaller ones.

Calcific Tendonitis of the Shoulder Treatment

Most people are able to treat their calcific tendonitis without surgery. A mix of medication, physical therapy, and various nonsurgical procedures are typically used to treat it, though, in a few very rare cases, surgery may be necessary.

Medication

The first step of treatment in most cases will be nonsteroidal anti-inflammatory drugs. These are generally over-the-counter medications and can include:

  • Aspirin
  • Ibuprofen
  • Naproxen (Aleve) 

In most cases, these will be taken as directed on the medication’s packaging, unless your doctor advises otherwise.

Cortisone injections can also be used to help manage any pain or swelling.

Nonsurgical Procedures

If your case is slightly more severe, your doctor may recommend a few minimally invasive, outpatient procedures. These can include:

  • Extracorporeal shock-wave therapy: A small handheld device will be used to deliver mechanical shocks to the shoulder near the site of calcification. While higher frequency shocks are more effective, they can also be painful. Your doctor will be able to adjust the frequency to something you are comfortable with.
  • Radial shock-wave therapy: Similarly to ESWT, a small handheld device will be used to deliver mechanical shocks to the affected area of the shoulder. 
  • Therapeutic ultrasound: Again, a small handheld device will be used to direct a high-frequency sound wave at the deposit. This is typically painless and helps break down the deposit.
  • Percutaneous needling: This is the most invasive of all the nonsurgical procedures. Using local anesthesia to numb the area, small needles will be used to create holes in the skin which will allow your doctor to manually remove the calcium deposit. 

Calcific Tendonitis Surgery

Though it is not common, surgery is sometimes required to remove a calcium deposit from the shoulder area. Surgery can be performed openly or arthroscopically. 

In open surgery, an incision will be made directly above the deposit, and it will be removed manually.

With arthroscopic surgery, your doctor will make a very small incision and insert a camera to guide the surgical tool.

Calcific Tendonitis of the Shoulder Recovery

Recovery time depends entirely on the severity of your condition and the method in which it was treated. It is possible to return to normal activities within a couple of days, while others could experience post-surgical pain for several weeks. 

In some moderate or severe cases, physical therapy could be required to regain a normal range of motion and function in the arm. 

If no surgery was required, recovery time will depend on your level of pain. A physical therapist will teach you gentle exercises that will increase over time.

When surgery is required, recovery generally takes anywhere from six weeks to three months. People who undergo arthroscopic surgery typically recover more quickly than people who undergo open surgery. Your doctor will probably advise you to wear a sling for several days following surgery. 

Though this condition can disappear on its own, it can lead to problems like rotator cuff tears if it is left untreated. If you are experiencing persistent and unusual shoulder pain, see your doctor immediately. 

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