Q: What causes calcifying tendinitis?
A: We still do not know. There is evidence that the oxygen concentration and blood supply to the tendon may be decreased. It is certainly not related to diet, osteoporosis, exercise nor injury.
Q: How common is this condition?
A: It is a very common disorder of the rotator cuff and accounts for approximately 10% of all consultations presenting with a painful shoulder. It affects women more often than men with its peak incidence in the fifth decade
Q: What symptoms do I get with this condition?
A: The pain can be constant and nagging and is felt in the shoulder and sometimes down the arm/hand. It is made worse by elevating the arm. Some patients also have excruciating attacks of pain, which then abate to a lower level after a few days. The calcium can spontaneously absorb and this process is associated with severe pain.
Q: What does a cortisone injection do?
A: It helps with the pain for a short term basis but it does not take away the underlying problem which is the calcium deposit.
Q: How many injections can I have?
A: Most doctors would say a maximum of three. There is in fact no absolute maximum. However, if you are having a lot of injections, then this is a sign that something definite ought to be done about it.
Q: What treatment options are available for calcifying tendinitis?
A:
- Non steroidal anti-inflammatory drugs
- Subacromial injection of steroid
- Physiotherapy
- Needle aspiration and irrigation
- Extracorporeal shockwave therapy
- Surgery
Q: Can physiotherapy help?
A: The physiotherapist can help you to maintain the range of movements in your shoulder. Some patients also find therapeutic ultrasound to be of benefit. However, the evidence that it works is conflicting. The Cochrane Musculoskeletal Database Review of 26 trials found that both ultrasound and pulsed electromagnetic field therapy resulted in significant improvement in pain compared to placebo. However, a further meta-analysis of 35 randomised controlled trials found that only 2 studies supported the use of therapeutic ultrasound over placebo. The remaining 8 showed that therapeutic ultrasound is no more effective than placebo.
Q: What is extracorporeal shockwave therapy?
A: Extracorporeal shock wave therapy utilises acoustic waves to induce fragmentation of the mechanically hard crystals.
Q: Would you recommend extracorporeal shockwave therapy?
A: Although this is used in some places, we do not recommend it. The recurrence rate following extracorporeal shockwave therapy is relatively high and some patients also find the procedure to be quite painful and can develop troublesome haematomas (blood clots) afterwards.
Q: What is needling?
A: Needling refers to needle aspiration and irrigation. The aim of this procedure is to drain a substantial portion of the calcium deposit; thereby stimulating the body’s cell mediated resorption.
Q: What are the advantages of needling?
A: Needle aspiration has the advantages over arthroscopic treatment in that this can be readily done under local anaesthesia in the outpatient setting, thus avoiding the need for an operation and general anaesthesia etc
Q: How is needling performed?
A: A local anaesthetic injection is given. Using a large bore needle, the calcium deposit is punctured under direct ultrasound guidance (Figure 1). Sometimes the creamy calcium material can be aspirated from the needle. A second needle is introduced and saline is injected, thus creating an inflow-outflow irrigation system between the two needles.
Q: What is the success rate of needling and what happens if it does not work?
A: About 80% are successful. The 'failed' ones are usually due to excess pain observed within the first week due to resorption of the calcium.
In these patients, one would then proceed to arthroscopic surgery.
Q: Is needling suitable for everyone?
A: No. Generally speaking, the best results are obtained in patients with an acutely painful shoulder, typically during the resorption stage in which the calcium is of toothpaste like consistency. Patients with an active frozen shoulder and those with small (<1.5cm) ill defined deposits are probably not suitable.
Q: What does the operation entail?
A: The entire operation is carried out arthroscopically (key hole surgery). Under a general anaesthetic, two to three little stab incisions (about 0.5 to 1cm each in size) are made around the shoulder. Through these arthroscopic portals, the camera as well as a variety of surgical instruments is inserted into the shoulder and the calcium is removed from the tendon under magnified vision. Sometimes, when the calcium deposit is large, the tendon may also need to be repaired at the same time.
Q: How long does it take to recover from surgery?
A: Total pain relief may take up to 3 months. There is usually no formal restriction on when you can return to work. Physiotherapy will be needed after surgery and the physiotherapist will guide you as to when you can return to sports.
Q: Are there any serious complications with surgery?
A: The most common complication is stiffness (approx 30%), sometimes referred to as Frozen shoulder. This is more common in patients with diabetes. If it does occur, it does not mean that further surgery is necessary. It just means the recovery may take a little longer.
- Biceps tendon
- Calcifying tendinitis
- Frozen Shoulder
- Impingement
- Labral tears
- Rotator cuff tears
- Arthritis
- Acromioclavicular joint injuries
This information does not replace medical advice. If you have a medical problem please see your doctor or consultant.
