What is supraspinatus calcific tendonitis and why does it occur?
This occurs when there is a build up (deposition) of calcium with the rotator cuff tendon. This results in an increase in pressure within the tendon as well as a chemical irritation causing an extremely severe “eye watering” pain in the shoulder.
There are many theories regarding why it occurs of which some suggest that it may be related to an alteration of blood supply to the tendon with age.
Who gets supraspinatus calcific tendonitis and what are the symptoms?
It frequently occurs in patients in their 40s but may affect wider age groups and is seen more often in diabetics. Pain is usually extremely severe and considered one of the worst types of shoulder pain. Pain is made worse with any movement and present at rest. It affects sleep regardless of position.
How is supraspinatus calcific tendonitis diagnosed?
This is on the basis of symptoms, a physical examination and X-rays sometimes in conjunction with an ultrasound or MRI scan.
How is supraspinatus calcific tendonitis treated? Surgical VS non-Surgical management
It is considered a self-limiting condition which may last from several weeks to several years.
Initial treatment is with analgesia and anti-inflammatories to treat symptoms followed by a course of physiotherapy to prevent stiffness.
Shockwave therapy has been shown to be successful in the treatment of longstanding calcific tendonitis. It is thought that by producing microtrauma it stimulates blood flow to the affected tendon and causes the breakdown of the calcific deposits.
Barbotage. This is a technique in which the calcific deposit is flushed with a large volume of normal saline (salt water) and then the calcium solution is aspirated via a syringe. This requires repeat flushing and aspiration (suction) and multiple irrigations to try to remove the calcium. It may be performed under ultrasound guidance or arthroscopically (keyhole surgery)
Surgery is performed if conservative measures have failed or if the pain is extremely severe including night pain, symptoms interfere significantly with activities of daily living or continue to deteriorate. Arthroscopic (keyhole) removal of calcium is performed with the visual removal of calcium and a subacromial decompression also performed to increase the subacromial space to allow the smooth gliding of the rotator cuff tendon.
Post-operatively the shoulder may be immobilised in a sling for a short period for comfort, then the patient commenced on a special physiotherapy rehabilitation programme with a specialist shoulder physiotherapist and under the supervision of the surgeon.