“Why did I develop calcific tendinitis so early?” Many patients are astonished when the diagnosis is "calcification" of the shoulder, since they relate a calcification to the hardening of the arteries - atherosclerosis. Calcification of the shoulder is, however, a widespread disease that is not related to atherosclerosis.
Definition: Calcified shoulder
A calcified shoulder means that there are deposits of calcium crystals in tendons that attach to the humeral head of the shoulder joint (rotator cuff). The calcium deposits can more or less form large deposits that often cause shoulder pain.
Causes: Calcified shoulder
The cause of calcification is a decreased blood flow around certain tendons that over time forms calcific deposits. Another cause may be that the tendons (tendon degeneration) fail to heal properly as a part of the normal aging process and consequently form calcific deposits.
Symptoms: Calcified shoulder
Calcium deposits at the shoulder joint do not always cause pain. Excessive calcium deposits, however, often result in painful inflammation of the bursa in the shoulder joint.
Initially the pain is only felt with certain movements, especially with overhead activities and rotary movements of the arm. Over time, the pain increases and becomes acute even at night or during resting periods. This pain most often radiates into the upper arm.
The irritation in the joint also leads frequently to inflammation of the bursa in the shoulder joint. Occasionally there are quite severe pain attacks, and interestingly enough, these attacks happen when the calcium deposits drain spontaneously. Extreme changes in pain with acute exacerbations are typical of the condition.
Diagnosis: Calcified shoulder
The first step is a comprehensive physical examination. An ultrasound examination of the shoulder can usually clarify whether the shoulder is indeed calcified. A diagnosis is most often possible after these examinations. Additional X-rays might, however, be necessary, to show the extent of the calcification more clearly. There is no strict correlation between the size of the calcium deposit and the amount of pain.
Conservative treatment: Calcified shoulder
Treatment should at any rate start with conservative – nonsurgical measures. First attempts are cooling and anti-inflammatory drugs (ointments, tablets or injections), to relieve the pain.
Electrotherapy and ultrasound therapy should stimulate the metabolism to a point that in the best case scenario, the deposits are broken up. The partially still propagated shock wave therapy, in which the calcification is bombarded with high-energy ultrasound waves, is according to recent study less successful, meaning it only rarely brings about the desired long-term results.
With a broad range of conservative therapies it is often possible to control the symptoms up to the point that the patient is at least temporarily free of pain. In some patients the calcium deposits form back even without any therapy. However, whether calcification recurs and for what length of time, is not predictable.
Surgical treatment: Calcified shoulder / shoulder arthroscopy
Dr_Lages_PatientinPatients who do not benefit from symptomatic therapies, should be treated causally. This means that the calcification should be surgically removed and the often-concurrent narrowness under the acromion (impingement) should be corrected. These types of surgical procedures have been successful. The shoulder arthroscopy is a minimally invasive surgical technique, i.e. an intervention without major incisions and without substantial trauma to the patient.
Shoulder arthroscopy is a minimal invasive surgical technique, in which during the surgery a mini camera is inserted through two or three small incisions, about 3mm in length. Simultaneously, the surgeon removes the calcium deposit with appropriate small surgical instruments.
In calcifications that are of a more creamy texture (such as toothpaste), the tendon will be carefully cut lengthwise so that the deposit can be loosened and vacuumed. The cut in the tendon does not need further treatment since it heals easily.
In calcifications that have a more crystal-like character, the body itself must do the main work of the breakdown. During the operation, these depots are "needled”, meaning they are scored with fine needles to start the repair process and to stimulate the blood circulation. Because of the increased circulation, the calcifications will resolve over the following weeks.
Quite often there is next to the calcification of the tendon a certain narrowness of the space under the acromion into which the tendons slide into the arm when the arm is moved (impingement syndrome). If there is such a restriction, the sliding space of the tendons should be extended in the same surgical procedure to prevent an otherwise impending tendon rupture (rupture rotator cuff).
Post operative treatment: Surgery calcified shoulder
After an arthroscopic removal of a calcium deposit, the shoulder needs rest, however, the patient should be moved gently as soon as possible. It is not necessary to fully immobilize the arm in a sling.
Also beneficial is an accompanying physical therapy and exercises the patients can do on his/her own at home. Since complications of arthroscopic techniques are very rare, they are a safe and effective alternative to the otherwise not controllable pain of calcific tendinitis (also tendonitis). In the initial phase following the surgery, it is recommended to administer medication reducing the swelling as well as ant-inflammatory drugs such as ibuprofen 3x 600 mg per day or diclofenac 2 x 75mg per day.
For pain management, it is helpful to apply cold packs. Long-term medicinal treatment to relief pain, is not necessary. Generally, daily activities, including driving, can be continued two to three days after the surgery.
Prognosis: Surgery calcified shoulder
If treated by an orthopedic shoulder specialist, the calcium deposit and the underlying cause can be safely and permanently removed through arthroscopic surgery.
As follow-up studies showed, 90% of patients were pleased with the outcome of shoulder arthroscopy and reported long-term success. A recurrence of calcification of the shoulder is not to be expected. Complications as a result of arthroscopic surgeries are very rare.
Experts: Calcified shoulder
For an optimal treatment of an impingement syndrome, the knee experts at the Klinik am Ring are particularly well-qualified. Stefan Preis, M.D. and Jörg Schroeder, M.D., senior physicians at the Practice and Department of Orthopedics and Sports Traumatology at the Klinik am Ring in Cologne, specialize together with their team in the treatment of knee and shoulder disorders. In 2004, they founded the WEST GERMAN SHOULDER KNEE & CENTER, Cologne. The team consisting of eight specialists treats more than 10,000 patients per year. The team performs more than 2500 surgeries per year of which are about 500 arthroscopic surgeries of a calcified shoulder.