Calcific Tendinitis of the Shoulder

Calcific tendinitis is the formation of calcium deposits, a few millimetres to a couple of centimetres across, inside the rotator cuff tendons of the shoulder, most often the supraspinatus. It mainly affects people between 30 and 60 and is more common in women.

The condition passes through stages. Deposits may sit quietly for years, then the body begins to reabsorb them, and that resorptive phase can be intensely painful for one to two weeks. In most people the deposits eventually clear, so treatment is about controlling pain and hastening the process when it stalls.

Symptome

• Sudden, severe shoulder pain, often waking you at night, during the resorptive phase
• Inability to lift the arm because of pain
• A longer-lasting dull ache on the outer upper arm
• Pain when lying on the affected side
• Catching pain on raising the arm between shoulder and head height
• Stiffness that can progress to frozen shoulder

Ursachen und Risikofaktoren

The cause is not fully understood. Tendon cells appear to change into cartilage-like cells that lay down calcium hydroxyapatite crystals, perhaps in response to a locally reduced oxygen supply. It is not caused by dietary calcium or supplements and is not the same as wear-and-tear tendon degeneration. Diabetes and thyroid disorders are associated with it and with a more prolonged course. Heavy use of the arm has not been proven to be a cause.

Wie es diagnostiziert wird

• Shoulder X-rays: Several views show the deposit, its size and its density. Fluffy, ill-defined deposits suggest the resorptive phase; dense, sharply outlined ones suggest the resting phase.
• Ultrasound: Locates the deposit within the tendon, assesses the cuff and guides needle treatment.
• MRI: Seldom needed. It is used when a rotator cuff tear or another diagnosis is suspected.
• Examination: Checks movement and strength and excludes neck-related pain and frozen shoulder.

Behandlungsmöglichkeiten

• Rest, anti-inflammatory medication and ice: For the acute painful phase, followed by gentle movement to avoid stiffness.
• Subacromial steroid injection: Eases severe pain for some weeks.
• Physiotherapy: Restores movement and shoulder blade control once pain permits.
• Extracorporeal shockwave therapy: Several sessions of focused shockwaves can break up dense deposits. Evidence supports it for chronic cases.
• Ultrasound-guided barbotage: Under local anaesthetic, a needle is used to wash out the calcium with saline, usually followed by a steroid injection. It takes about 20 to 30 minutes and helps most patients.
• Arthroscopic removal: Keyhole surgery for deposits that stay painful after six months of other treatment. Complete removal is not necessary for a good result.

Wenn es dringend ist

A hot, swollen shoulder with fever and feeling unwell needs urgent assessment to exclude joint infection. Shoulder or arm pain with chest tightness, breathlessness or sweating should be treated as a possible heart problem and needs emergency care.

Reisen nach Türkiye zur Behandlung

This is not a condition to cross borders for. The acute phase subsides within weeks, and shockwave treatment needs repeated sessions. If you happen to be visiting for other reasons, an assessment with ultrasound-guided barbotage can be completed in a single appointment. Arthroscopic removal for a stubborn case is a day-case procedure needing about a week before flying, and then two to three months of physiotherapy at home.

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