Calcific tendinitis is the result of calcium deposits that build up either in muscles or tendons of the body. This condition generally affects those in middle age, with women being more likely to suffer from calcific tendinitis than men. The most common location of calcific tendinitis is in the rotator cuff, a group of muscles and tendons that connects the upper arm to the shoulder. This can result in shoulder pain or discomfort, which is usually diagnosed during the chronic or vague phase rather than the most acute phase of symptoms.
What are the stages of calcific tendinitis?
There are three stages of calcification. The first is the pre-calcification stage where no symptoms are present; however, sites where calcification is likely to develop undergo changes at the cellular level. These changes make the tissues inclined to grow calcium deposits.
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The second stage is the calcific stage. When calcium emerges from cells, it forms as calcium deposits. There may not be any pain during the resting stage, but the resorptive phase will cause significant pain.
During the post-calcific stage, there is typically no pain. The calcium deposit has gone, and now a rotator cuff tendon that looks normal is what remains.
Calcific tendinitis: Common affected areas
The most commonly affected areas of calcific tendinitis involve the rotator cuffs and shoulders; however, it can occur in other areas of the body.
Calcific tendinitis of the rotator cuff
This is a common injury that can occur with repetitive stress to the rotator cuff. When there is an impingement, the rotator cuff tendon can suffer from inflammation or swelling. This is also known as rotator cuff tendinitis.
Calcific tendinitis of the shoulder
This occurs when calcium deposits form on shoulder tendons. When the tissues around deposits suffer from inflammation, this causes shoulder pain. Calcific tendinitis commonly affects those over the age of 40.
Calcific tendinitis of the elbow
Calcific tendinitis can occur in the elbows when calcium deposits build up in the elbow tendons.
Calcific tendinitis around the hip
Less has been studied regarding calcific tendinitis that afflicts the hip joint compared to calcific tendinitis in the rotator cuff. Surgery is not needed in most cases, however.
Calcific tendinitis in the hand and wrist
It is rare to have a diagnosis of acute calcific tendinitis in the hand and wrist, and the non-specific symptoms (pain, tenderness, edema, and erythema) of calcific tendinitis will make it harder to identify.
What causes calcific tendinitis?
At present, it is not completely understood what directly causes calcific tendinitis. Although different theories regarding the supply of blood or aging tendons have been circulated, these theories have yet to be confirmed.
Some have speculated that overuse over time due to activity might cause calcific tendinitis, along with the effects of aging. Others believe that a lack of oxygen to tendon tissue causes calcium deposits to form. Pressure on the tendons that causes damage has also been suggested as a reason why calcium deposits may form.
Other theories as to why calcific tendinitis include genetics, abnormal cell growth, irregular thyroid gland activity, production of anti-inflammatory agents, or metabolic diseases.
Symptoms of calcific tendinitis
Most people with calcific tendinitis are asymptomatic. When symptoms are exhibited, the main sign of calcific tendinitis is pain, usually occurring in the shoulder or near the joint area affected by calcific tendinitis. The pain might grow over time to greater levels of intensity.
Shoulder pain can become more severe with movement and impede the ability to lift the arm away from the body. Pain might also be so severe that it interferes with sleep patterns.
Complications of calcific tendinitis
Calcific tendinitis has five major complications:
Pain
In most people, calcific tendinitis is asymptomatic. When there are symptoms, the pain involved is usually quite severe. Pain can be caused by calcium causing irritation of the tissue; tissue swelling can cause pain from pressure; bursal thickening can cause impingement pain, and the glenohumeral joint can experience pain from chronic stiffness due to underuse.
Adhesive capsulitis
There are two forms of adhesive capsulitis, which is also known as frozen shoulder: primary and secondary. It isn’t understood if inflammation causes capsule abnormalities, or the other way around. After surgery, the incidents of frozen shoulder were 18 percent, thought to be caused by irritation of glenohumeral capsule by any leftover calcium debris.
Rotator cuff tears
There is evidence of 90 percent probability of rotator cuff tears in those aged over 40 years suffering from calcific tendinitis. When large calcium deposits rupture, they can lead to complete tearing of the rotator cuff.
Greater tuberosity osteolysis
Greater tuberosity osteolysis is an uncommon complication associated with calcific tendinitis. Osteolytic legions of tuberosities can lead to worse symptoms of calcific tendinitis that last longer. Calcium deposits in contact with tuberosities have been proven to produce cortical lesions.
Ossifying tendinitis
Considered extremely rare, ossifying tendinitis can be described as deposits of hydroxyapatite crystals forming a histological pattern on the lamellar bone. There may be more people afflicted with ossifying tendinitis than currently diagnosed.
How to diagnose calcific tendinitis?
Diagnosis of calcific tendinitis can be performed by your medical doctor. Initial steps will involve taking an inventory of your symptoms, as well as looking at your medical history. This will be followed by a physical exam where the doctor will examine your shoulder mobility through a range of different movements.
This can be followed up with tests such as an x-ray or ultrasound to reveal calcium deposits, or any other irregularities. An ultrasound will be more accurate in locating smaller calcium deposits.
How to treat calcific tendinitis?
Fortunately, the majority of people who have calcific tendinitis can be treated without the need for surgery. Physical exercises and painkillers can be very effective in restoring mobility and reducing pain.
Medication
The typical treatment used for calcific tendinitis is nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, naproxen, or celecoxib. Cortisone injections may also be utilized to give temporary relief from pain.
Other procedures
Doctors have access to other methods of treating calcific tendinitis such as extracorporeal shock-wave therapy, radial shockwave therapy, therapeutic ultrasound, or percutaneous needling.
Rehabilitation of calcific tendinitis
The symptoms of calcific tendinitis can affect the mobility of the joint, which is why range of motion exercises are important for rehabilitation. Either your doctor or a physical therapist can demonstrate specific exercises that will be helpful.
Stretching may be used to improve your range of motion. Shoulder-strengthening exercises can be useful because performing them will ultimately reduce the pressure on calcium deposits.
Examples of exercises utilized include isometric internal rotation, isometric external rotation, external rotation stretch, seated rotator stretch, and shoulder packing.
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Calcific tendinitis can potentially cause severe pain in people over the age of 40. Although the cause of calcific tendinitis is not completely understood, if you are a woman or a sedentary worker, your risk of getting calcific tendinitis is greater. A pain in the shoulders, or other joints, that starts gradually and increases with severity over time should be looked at by a medical doctor.
Some of the complications of calcific tendinitis include pain, developing a frozen shoulder, and other more rare complications. Using x-rays and ultrasound, a doctor can locate calcium deposits. Treatment from calcific tendinitis is usually done with a combination of physical therapy exercises, and the use of NSAIDs. Rehabilitation involves restoring range of motion and strengthening the shoulder.
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