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Commonly asked questions about Calcifying Tendinitis

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 – 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:

Treatments include:

  • 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. Full references are given at the end

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 many patients also find the procedure to be quite painful and can develop troublesome haematomas (blood clots) afterwards

Q:

What does the operation entail?

A:

This is a very successful and satisfying operation carried out using arthroscopic (key hole surgery) techniques. Two to three mini skin 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.

When the calcifying tendinitis condition is acute, the calcium is easily expressed from the tendon using a fine needle and appears like a toothpaste material.


When the calcifying tendinitis condition is chronic, the calcium is more ‘stuck’ to the underlying tendon

Q:

How long does it take to recover from surgery?

A:

There is dramatic instant relief of pain after surgery. Total recovery in terms of regaining full muscle power may take 3 to 4 months. There is no restriction on what you can and cannot do after surgery and most people return to work within a few days and return to sports as they feel comfortable

Q:

Are there any serious complications with surgery?

A:

The most common complication is stiffness (approx 10%), 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.


Further reading:

Modern management of calcifying tendinitis of the rotator cuff
F Lam, D Bhatia, K van Rooyen, JF de Beer
Current Orthopaedics December 2006; 20(6): 446-452
pdf file

Will rotator cuff defects heal after arthroscopic excision of calcium and subacromial decompression?
F Lam, R Chidambaram, D Mok
British Elbow and Shoulder Society 17th Annual Scientific Meeting in Edinburgh 2006
Click her for futher reading


Radiograph showing the calcium deposit before surgery
calcium deposit

Radiograph of same shoulder taken at 2 weeks after surgery showing complete disappearance of the calcium deposit
calcium deposit

Some examples of radiographic appearances of calcifying tendinitis
calcifying tendinitis
calcifying tendinitis

Arthroscopic view of calcium deposit within rotator cuff
calcium deposit within rotator cuff

‘Chalky’ material removed from the calcium deposit
Chalky material removed from the calcium deposit

Intraoperative photo of calcium deposit
Intraoperative photo of calcium deposit

Some examples of calcium deposits on x ray
calcium deposits calcium deposits

calcium deposits calcium deposits

Arthroscopic removal of the toothpaste like material in calcifying tendinitis of the rotator cuff
Arthroscopic removal of the toothpaste like material in calcifying tendinitis of the rotator cuff

The information on this website does not replace medical advice. If you have a medical problem please see your doctor or consultant.