Calcium building up in your rotator cuff tendons can cause calcific tendonitis, a condition that can lead to shoulder pain intense enough to make your eyes water. Learn about the condition and its symptoms, as well as the treatment options available at Sports Med London.
What Is The Rotator Cuff?
The rotator cuff prevents your upper arm bone from moving out of the socket. It is made up of four muscles that become the tendons that attach your upper arm bone to your shoulder blade. The four tendons are the supraspinatus, infraspinatus, subscapularis, and teres minor.
What Is Supraspinatus Calcific Tendonitis?
Supraspinatus calcific tendonitis is when calcium builds up within the rotator cuff tendons. The calcium deposit can increase the pressure within the tendon and produce a chemical irritation that leads to severe shoulder pain.
Calcific tendonitis also can reduce the amount of space that the rotator cuff tendon has for passing under the acromion, which causes subacromial impingement. The condition may be linked to age-related changes in the tendons’ blood supply.
The Condition’s Typical Symptoms
Supraspinatus calcific tendonitis occurs in various age groups, although it is seen most frequently in patients who are in their 40s. The condition also is seen frequently among people with diabetes.
Typical symptoms of the condition include:
- Severe pain when you move your shoulder
- Sudden pain
- Loss of range of motion in the shoulder
- Stiff shoulder
- Tenderness over the rotator cuff
- Decreased muscle mass
- Pain disturbs sleep
Supraspinatus Calcific Tendonitis Diagnosis
The first step of diagnosis is a consultation with a specialist at Sports Med London. After discussing your symptoms with you, the specialist will perform a physical examination of your shoulder. If need be, they may send you for an MRI or ultrasound scan.
Treatment For Calcific Tendonitis
Supraspinatus calcific tendonitis is thought of as a self-limiting condition that some patients live with the condition for several weeks, while others do so for several years.
Patients usually begin with non-surgical treatment, including painkillers (analgesia) and anti-inflammatories, followed by a physiotherapy course. Other non-surgical treatments include:
Shockwave therapy – This option has successfully treated longstanding calcific tendonitis, possibly by causing microtrauma that stimulates blood flow to the tendon, breaking down the calcium deposits.
Cortisone injections – This non-surgical treatment helps reduce pain and inflammation.
Barbotage – The specialist uses syringes to flush the calcium deposit with a large amount of salt water (saline) before sucking out the calcium solution. The procedure must be repeated several times, and it may happen with ultrasound guidance or via keyhole surgery (arthroscopy).
Our specialist may recommend surgery if the pain is severe and non-surgical treatments have failed:
Keyhole surgery – The specialist removes the calcium deposit and increases the subacromial space via a small incision. You may need to wear a sling for a few days after surgery, which will be followed by a physiotherapy rehabilitation program.
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.