Calcific tendonitis refers to a build-up of calcium in the rotator cuff (calcific deposit). When calcium builds up in the tendon, it can cause a buildup of pressure in the tendon, as well causing a chemical irritation. This leads to pain. The pain can be extremely intense. It is one of the worst pains in the shoulder (the other being Frozen Shoulder)
In addition to the chemical irritation and pressure, the calcific (calcium) deposit reduces the space between the rotator cuff and the acromion, as well as affecting the normal function of the rotator cuff. This can lead to subacromial impingement between the acromion and the calcium deposit in the rotator cuff when lifting the arm overhead.
The cause of the calcium build-up in the rotator cuff is not known. It tends to be more common in people between the ages of 30-60 years of age. It does eventually disappear spontaneously, but this can take between 5 to 10 years to resolve.
The calcific deposit can be seen on plain x-rays, however ultrasound scan is better to find small calcific deposits which can be missed on x-rays. Ultrasound also makes it possible to assess the size of the deposit in all directions. The clinician can also see the blood vessels around the calcific deposit.
Treatment of calcific tendinitis involves:
1. Painkillers and anti-inflammatory medications
2. Physiotherapy – keeps your shoulder strong and flexible and reduces the irritation
3. Ultrasound guided steroid injections – reduces inflammation and control the pain
4. Ultrasound guided Barbotage – under ultrasound guidance the calcific deposit is injected with a salt water solution and the calcium is also sucked out into a syringe. The area is then repeatedly washed.
5. Surgical excision