Calcific Tendonitis

What is it?

Calcific tendonitis is a build up of calcium in the tendons of the rotator cuff muscles around the shoulder (calcium deposits).

The calcium gradually builds up on the tendons and causes pressure on the tendons leading to pain. Also with the calcium build up it reduces the space between the tendons and the roof of the shoulder (acromion) which leads to nipping (impingement) between these causing further pain.

Calcific tendonitis gives pain in the shoulder that can move down into the arm. It is particularly sore at night time and when doing any over head activities.

How does this occur?

The true cause of calcific tendonitis is unknown although it is thought that a combination of repetitive tasks, wear and tear and the ageing process leads to this problem.

How can physiotherapy help?

Physiotherapy can help to work on the tight muscle structures around the shoulder, correct the postures of the shoulder and strengthen the weak  muscles which are all contributing factors to your pain.

Strengthening the rotator cuff muscles helps to decrease the pressure of the calcium deposits on the tendons. Evaluating and correcting your postures and positions in work and in different activities can help to ease your pain and prevent further problems or complications.

Barbotage injection

The areas of calcium in the tendons of the shoulder are localised by ultrasound scanning. A needle can then be precisely guided to these areas by the radiologist and the calcium deposits broken up or aspirated. Local anaesthetic is then injected to bathe the tendons and reduce pain. This technique has been reported to be successful in treating up to 70% of cases.

Surgery?

If the pain persists, despite physiotherapy and injection techniques, then surgery may be offered. This surgery is performed under general anaesthetic with a supplemental local anaesthetic block of the arm. Often the patient will be able to return home the same day as the procedure. The operation is performed using a “keyhole” technique (Shoulder arthroscopy)

Firstly the shoulder is assessed by a telescope (arthroscope) and no other injuries or problems are assessed and treated. The areas of the tendons in the shoulder with the calcium are then identified and small cuts in the tendons are made to release the calcium. If large areas are present, a repair of the tendons may be required.

Following the surgery your surgeon may ask you to wear a sling for 1 to 5 weeks, depending on the extent of the tendon damage. Physiotherapy is required to ensure good return of strength and movement. Recovery can take up to 6 months and several weeks of painkillers are often required. These will be prescribed for you.

Complications of the surgery include infection, stiffness (frozen shoulder) and reoccurrence of the calcium deposits, however all these are rare.