Treatment of Calcific Tendonitis

What is Calcific Tendonitis?

Calcium deposits in tendons that commonly occur in the shoulder rotator cuff causing pain, irritation and inflammation in the area. Most often found in the supraspinatus, infraspinatus and subscapularis tendon.

What Causes Calcific Tendonitis?

Calcific tendonitis is one of the most common causes of non-traumatic pain in the shoulder. However the underlying causes are still poorly understood. It predominantly affects individuals between the age of 40 and 60.

The following list has been identified as possible causes

• Limited blood flow (hypovascularization)
• Compression
• Metabolic factors (e.g. hyperthyroidism)
• Local degenerative changes

Clinical Presentation of Calcific Tendonitis

Depending on the stage of the condition, you may experience different signs and symptoms.

Pre calcification phase	Minimal to no pain, but cellular changes predisposing the tendons to developing calcific deposits
Calcific phase 3 substages	1. Forming of calcific deposits (no pain or pain with movement only 2. Resting phase (no pain) 3. Reabsorption (most painful, typically lasting 2 wks)
Post Calcific Phase	Variable symptoms, deposit reabsorbs, and replaced by regular tissue. May lasts for months

 

The chief complaints:

• Night pain, causing discomfort and loss of sleep
• Constant dull ache
• Pain increases considerably when moving the arm
• Decrease in range of motion, or complaint of stiffness
• Radiating pain up into the neck, or down into the fingers

Differential diagnosis may be needed, as some of these symptoms may be indicative other shoulder pathologies, such as rotator cuff tears and adhesive capsulitis.  Our physiotherapists and chiropractors can perform a thorough assessment to determine the best course of treatment.

Treatment of Calcific Tendonitis

Conservative

According to literature, about 90% of people with the condition are successfully treated without surgery. There are a number of treatment options available to treat calcific tendonitis.

Shockwave therapy

According to studies shockwave therapy improves symptoms of calcific tendonitis resulting in decreased pain and improved function and use of the joint.

Shockwave uses focused high frequency sound waves directed to the affected tendon. The exact mechanism of action on calcific tendonitis is unknown. It is theorized that it prompts a tissue response in order to absorb the calcium deposit. More recently it has been suggested it also has a role in affecting the neural processes involved in pain memory leading to permanent healing instead of a temporary fix.

To read more about shockwave therapy, please read our post on “Will Shockwave Therapy by Helpful for Me”

Manual therapy

Manual therapy can help regain movement by mobilizing soft tissue (muscle and fascia) and the joint capsule. It also aids in modulating pain, reduces soft tissue swelling, restore muscle function, and induces relaxation.

Exercise therapy

Individualized targeted exercise therapy that aims to decrease pain, restore range of motion, shoulder and scapular strength has been found to improve symptoms.

Load and capacity management

Proper load and capacity management is the cornerstone of optimal recovery. When a tissue is loaded beyond its capacity injuries can occur. During the rehabilitation process the goal is to improve tendon capacity with progressive loading.

Physiotherapists can help you manage gradual exercise progressions, and give you suggestions how to temporarily modify certain activities.

The use of anti-inflammatory medication or local steroid injections

Sport medicine doctors can guide you along and prescribe proper imaging and medication if required.

Surgery/Excision

Some cases are resistant to conservative treatment and surgery may be a viable option for them.  Following surgery, a course of physiotherapy rehabilitation is recommended for the best results.

If you have shoulder pain and would like to improve your symptoms, book an appointment with one of our physiotherapists. Contact us today to set up an initial consultation.

References:

1. Kachewar SG, Kulkarni DS. Calcific Tendinitis of the Rotator Cuff: A Review. Journal of Clinical and Diagnostic Research?: JCDR. 2013;7(7):1482-1485. doi:10.7860/JCDR/2013/4473.3180.
2. Mangone G, Veliaj A, Postiglione M, Viliani T, Pasquetti P. Radial extracorporeal shock-wave therapy in rotator cuff calcific tendinosis. Clinical Cases in Mineral and Bone Metabolism. 2010;7(2):91-96.
3. http://www.physio-pedia.com/Calcific_Tendonitis_of_the_Shoulder#cite_note-Wainner-0