DESCRIPTION AND SYMPTOMS
WHAT IS CALCIFIC TENDINITIS OF THE SHOULDER?
Calcific tendinitis of the shoulder is a disease caused by the formation of calcium deposits in the tendons of the shoulder.
The most frequently affected tendon is the supraspinatus, in its distal area, which represents 80% of cases of calcific tendinitis. Approximately 10% to 35% of patients presenting for shoulder pain will have calcification.
Although it can affect younger patients, it is more common in women between 40 and 50 years old.
The cause of calcification deposition of the shoulder rotator cuff is currently unknown, although it is generally believed to be caused by both genetic as well as environmental factors. Some hypotheses attribute it to alterations at the metabolic level, to the degenerative destruction of cells, to the precarious vascularization of the tendon due to repeated micro-traumas, and/or to other genetic causes.
Other shoulder injuries:
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WHAT ARE THE SYMPTOMS OF CALCIFIC TENDINITIS OF THE SHOULDER AND HOW IS IT DIAGNOSED?
The symptoms of calcific tendinitis will depend on the stage in which the disease is found, whose chronology is divided into 3 phases:
Pre-Calcification Phase: In this phase, patients usually have no or very mild symptoms as fibrocartilaginous metaplasia develops in the tissue. (Metaplasia is the transformation of a tissue into another of a different lineage.)- Calcification Phase: In this phase, the patient alternates phases of calcium formation and its re-absorption. The patient feels very intense pain.
- Post-Calcification Phase: In this phase, the granulation tissue matures and collagen is formed. The level of pain remains persistent but to a lesser degree.
Pre-Calcification Phase: In this phase, patients usually have no or very mild symptoms as fibrocartilaginous metaplasia develops in the tissue. (Metaplasia is the transformation of a tissue into another of a different lineage.)Read more
At the clinical level, it is characteristic to suffer moments of intense pain, occurring more frequently during nighttime hours. This pain prevents the patient from sleeping and greatly limits mobility. To combat these acute phases of pain, injections are sometimes necessary. In between these phases of intense pain, the patient usually suffers gradual or subtle pain in the anterior aspect of the shoulder.
It is unknown why some patients suffer these phases of acute pain very frequently and others remain asymptomatic.
Diagnosis of calcific tendonitis of the shoulder is clinical and radiological. It can be done by ultrasound and standard x-ray imaging.
IF THE INJURY IS NOT TREATED IN TIME
If the severity of tendonitis is not taken into account, the consequences can be considerably aggravated:
Work
Pain can prevent you from performing daily activities (such as raising your arms), which is why it should be treated if you want to continue your work activities normally.
Sport
Pain can be increasingly frequent and intense, and causes limitations in the practice certain sports such as tennis, swimming or carrying out a daily routine at the gym.
Pain
Loss of mobility and strength can occur, so early intervention will avoid possible pain and limitations that can affect the patient in all aspects of their life.
TREATMENT
HOW IS CALCIFIC SHOULDER TENDINITIS TREATED?
Initially, a conservative treatment is used, focused in taking anti-inflammatory drugs with gastric protection, with the aim of reducing tendon inflammation and pain.
Simultaneously, it is advisable to follow a rehabilitation program that is also aimed at increasing shoulder mobility and reducing pain. Physiotherapy ranges from an exercise program, the use of electrostimulation (TENS) techniques and, sometimes, the application of radiofrequency.
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If these treatments are unsuccessful, another second-line treatment is shock waves (the same technique used in lithotripsy) to break down the calcium noninvasively. Finally, if these treatments are ineffective, there also exists the possibility of using ultrasound-guided corticosteroid injections. And, if the pain persists, a technique called bubbling can be used.
Bubbling is an ultrasound-guided technique that is based on the removal of calcification by aspirating (removing) it with a needle and syringe under general anesthesia. In this process, the calcification is located with ultrasound and is removed by injecting serum in it in order to dissolve the calcification.
HOW IS AN ARTHROSCOPIC SURGURY FOR CALCIFIC TENDINITIS OF THE SHOULDER PERFORMED?
In the event that none of the previous treatments yield the desired results, and do not resolve the pain or loss of mobility, the surgical option must be chosen.
The surgery to be performed is a shoulder arthroscopy. It is a minimally invasive technique working through two or three 2-3 mm incisions around the shoulder joint. During it, the calcification is located and eliminated. Sometimes, depending on the size of the calcification, it is necessary to sew the tendon.
Typically, the patient is admitted to the hospital for 24 hours, going home with over-the-counter medications the arm immobilized in a sling.
FREQUENTLY ASKED QUESTIONS
How long does arthroscopic shoulder surgery for calcific tendinitis take?
The duration time varies depending on factors such as the surgeon’s experience, the type of injury being treated, and the characteristics of the patient. The average time ranges between 30 and 60 minutes.
What is the recovery like after arthroscopic shoulder surgery for calcific tendinitis?
After an arthroscopic intervention in the shoulder to treat calcific tendinitis, the postoperative period will vary depending on whether or not the tendon has been sutured.
In patients without a tendon suture, they will remain immobilized with a sling for 10 days and begin physiotherapy early. Recovery can range from 4 to 8 weeks.
In large calcifications, removing calcium creates a “hole” in the tendon that must be sewn. If this suture is performed, the immobilization time in a sling will be longer (4 weeks) and will imply a longer recovery time (3 – 6 months)
What are the possible complications from arthroscopic shoulder surgery for calcific tendinitis?
Infection in 3-5% of cases and postoperative discomfort are the most frequent short-term complications. In the long term, there exists the possibility of recurrence of the injury (appearance of new calcifications) and tendon rupture.
REFERENCES
Messina C, Sconfienza LM.Ultrasound-Guided Percutaneous Irrigation of Calcific Tendinopathy. Semin Musculoskelet Radiol. 2016 Nov;20(5):409-413. doi: 10.1055/s-0036-1594285. Epub 2016 Dec 21.PMID: 28002862
Louwerens JK, Sierevelt IN, van Noort A, van den Bekerom MP. Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2014 Aug;23(8):1240-9. doi: 10.1016/j.jse.2014.02.002. Epub 2014 Apr 26.PMID: 24774621
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