Calcific Tendonitis is also known as calcifying tendonitis or calcified tendonitis.
Calcific tendinitis is inflammation of a tendon triggered by calcium deposits. The rotator cuff tendons of the shoulder are the most common location for this condition. Deposits may occur in one or both shoulders.
Causes of Calcific Tendonitis
The causes of calcific tendonitis are not clear. More is known about what does not cause this condition than what does cause it. This condition is not caused by excess calcium in the diet. The calcium level in the blood is usually normal. Restricting calcium will not help, and in fact, the body will leach calcium from the bones if calcium intake in inadequate. (Very rarely, there may be a metabolic condition that makes calcium deposits more likely to form or a kidney problem that causes high calcium levels) Overuse or traumatic injury to the rotator cuff is not believed to cause calcific tendonitis, unlike rotator cuff tendonitis (without calcium deposits).
Age-related degenerative changes in the tendons appear to play a role, as calcium deposits are rare in people under the age of thirty.
Symptoms of Calcium Deposits in the Rotator Cuff
Calcium deposits do not always cause symptoms, especially when they are deep within the tendons. There may be intermittent pain or discomfort when a large calcium deposit in a rotator cuff tendon becomes pinched between bones of the shoulder joint when raising the arm overhead (see shoulder impingement). Depending on the size and location of a calcium deposit, gradual damage to part of the rotator cuff may occur.
Shedding of calcium crystals may occur and trigger an acute inflammatory response in the tendons. Many people are not aware they have calcium deposits until they have such an attack. Calcium deposits often are reabsorbed by the body and it is during this stage that inflammation and pain occur.
Symptoms of Acute Calcific Tendonitis Attack
The symptoms develop rapidly. It may be too painful to move the shoulder, yet resting the shoulder does not relieve the pain. It may be difficult to sleep because of the pain. Symptoms often resolve within a week or two.
Note: See a doctor immediately for acute shoulder pain. Blood tests may be taken to rule out infection. Most people will not need prompting to see a physician for the intense pain experienced during an acute attack of calcific tendonitis.
Calcium deposits can be seen on an x-ray. There may be one or many deposits, small or large. They are often about a half-inch in diameter. The severity of the symptoms of an acute calcific tendonitis attack does not always correlate with the size of the deposits.
Treatment of Calcific Tendonitis
Acute calcific tendonitis usually resolves on its own within a couple of weeks. Anti-inflammatory medication and applying ice can reduce both pain and inflammation. Strong painkillers may be prescribed. Range-of-motion exercises may help prevent frozen shoulder but may not be possible until the pain subsides.
Other treatments can shorten the duration of the attack. A steroid (cortisone) injection into the area to relieve inflammation often brings quick relief. Injecting the cortisone delivers it directly to where it is needed and only a small amount is absorbed into the bloodstream. Many physicians will not inject cortisone into the same site over three times as overuse of cortisone causes a weakening of the tissues.
Sometime the deposits can be broken up with a hypodermic needle and sucked out with a syringe. This procedure often relieves pressure on the tendon and brings quick relief. Normal function is often restored within a couple of days.
The majority of people do not need surgery. When conservative treatment fails to bring relief and calcium deposits cause frequent bouts of pain, surgery to remove the deposit may be recommended. Surgery may also be recommended when a very large calcium deposit interferes with movement of the shoulder. A large calcium deposit may have to be removed through arthroscopic surgery or occasionally, open surgery.