• Calcific Tendonitis of the Shoulder

    Definition

    Hard calcium deposit can form on soft tissue, in this case tendons. Once the calcium deposits are formed, the tendons may become inflamed and cause pain. This inflammation and pain is called calcific tendonitis. This condition usually develops over time. Symptoms typically do not appear until after the calcium has formed. Shoulder pain develops once the calcium deposit begins to be reabsorbed by the body.
    Tendons of the Shoulder
    Rotator cuff labeled
    Copyright © Nucleus Medical Media, Inc.
    This condition may be treatable. If you suspect you have this condition, contact your doctor.

    Causes

    The exact cause is unknown. The condition occurs most commonly from wear and tear of the shoulder. Aging also plays a part in its development. It is more common among people over age 40.

    Risk Factors

    These factors increase your chance of calcific tendonitis. Tell your doctor if you have any of these risk factors:
    • Over age 40
    • Female

    Symptoms

    If you have any of these symptoms do not assume it is due to calcific tendonitis. These may be caused by other conditions. Tell your doctor if you have any of these:
    • Sudden onset of pain
    • Intense pain with shoulder movement
    • Stiffness of shoulder
    • Loss of shoulder range of motion
    • Pain that disrupts sleep
    • Tenderness over rotator cuff
    • Loss of muscle

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to a specialist. For example, an orthopedic surgeon specializes in bones.
    Tests may include the following:
    • Thorough physical evaluation—assessing your shoulder range of motion and stability
    • X-ray —test that uses radiation waves to form a picture of the body’s structures; used to view calcium deposit(s)

    Treatment

    Most cases of calcific tendonitis resolve over time. Talk with your doctor about the best plan for you. Options include the following:

    Medical Treatment

    Your medical treatment plan will likely include:
    • Nonsteroidal antiinflammatory drugs (NSAIDs)
    • Rest
    • Heat and/or ice
    • Physical therapy to strengthen muscles
    • A steroid (such as cortisone) shot directly into your shoulder—might be used to decrease inflammation and pain

    Physical Therapy

    Your doctor may send you to a therapist for treatment. A therapist will use different treatments to decrease the pain and inflammation. Possible treatments include:
    • Ice
    • Heat
    • Ultrasound—a device that uses high energy sound waves to decrease pain in soft tissue
    • Transcutaneous electrical nerve stimulation (TENS)—used to decrease muscle stiffness or spasms
    Once the symptoms have started to decrease, you will work with the therapist to strengthen your muscles and increase your range of motion.

    Lavage Treatment

    Lavage may help flush out the calcium deposits. A needle is placed directly into the shoulder. Normal saline is injected through the needles. The deposits are then broken up for removal.

    Shock Wave Therapy

    This therapy breaks up deposits by sending sound waves to the shoulder. The body can then reabsorb the smaller pieces. This should decrease symptoms.

    Surgery

    In some cases, surgery may be done to remove deposits. The procedure is called arthroscopy . It uses small incisions and instruments to view the joint and remove the deposits.

    Prevention

    There are no known ways to prevent this condition.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/home.asp

    Arthroscopy Association of North America http://www.aana.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/

    References

    Calcific tendonitis. Internet Society of Orthopaedic Surgery & Trauma website. Available at: http://www.orthogate.org/patient-education/shoulder/calcific-tendonitis-of-the-shoulder.html . Accessed November 12, 2008.

    Impingement of the shoulder. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00032 . Accessed November 12, 2008.

    Impingement syndrome of rotator cuff. DynaMed website. Available at: http://dynaweb.ebscohost.com/Detail.aspx?id=114840&sid=0df83b41-46fc-43a0-a992-4ca336531894@sessionmgr2 . Accessed November 12, 2008.

    Tintinalli JE, Kelen GD, Stapczynski JS. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide . 6th Ed. United States: The McGraw-Hill Companies; 2004; Chapter 283, Nontraumatic Musculoskeletal Disorders.

    Revision Information


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