Calcific Tendinitis of the Shoulder
Calcific tendinitis is caused by deposits of calcium crystals in the tendon within the rotator cuff, most commonly in the supraspinatus tendon. It may be acutely and severely painful, and can be very difficult to distinguish from a septic arthritis or infection within the shoulder in the early stages. It most commonly affects women between the ages of 30 and 60, and is associated with hypothyroidism and diabetes. It undergoes 3 stages, pre-calcific, calcific and post-calcific. The calcific stage is further subdivided into the formative, resting and then resorptive phases. It may take many months to resolve, and therapy is aimed at managing the pain and stiffness from the condition.
- Management
Non operative
About 6 in 10 patients resolve from a period of non-operative management involving rest, non-steroidal anti-inflammatories, physiotherapy and local steroid injections.
Operative
Surgery is usually reserved for cases who fail non-operative management, but calcium deposit size and position also influences the decision. In some select cases, needle injection and aspiration in the consulting rooms releases enough of the calcium to stimulate the healing process, and avoids surgery.
Surgery is through a shoulder arthroscopy and needle or other decompression of the calcium deposit. In certain cases a small open procedure may be required.
Postoperatively the arm is placed in a sling for comfort and range of motion exercises are initiated as early as possible once the pain has settled. Usually after 4-6 weeks patients are back to full range of movement.
In obstinate cases there are other treatment options that have shown some benefit that will be discussed.
Conditions Managed
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