What is calcific tendonitis? (subtitled)

Calcific tendonitis.
Calcific tendonitis can happen anywhere in your body.
The most common area it to develop is the rotator cuff, especially supraspinatus tendon.
Rotator cuff is the group of muscles and tendons that provide strength and stability to the upper arm and shoulder.
Calcific tendonitis occurs when calcium deposits build up in the tendon.
Causes.
The cause of the calcium build-up in the rotator cuff is not known.
Although it’s more common in people who play sports or routinely raise their arms up and down for work, calcific tendonitis can affect anyone.
This condition is typically seen in adults between 40 and 60 years old.
Women are also more likely to be affected than men.
There’s a link between calcium deposits in tendons and diabetes.
And also with thyroid disorders.
Symptoms.
About one-third of people with calcific tendonitis don’t experience any noticeable symptoms.
The most common symptoms are pain related to activity.
It may come on suddenly or build up gradually and can limit your range of movement.
Tenderness to palpation at the involved tendon.
The pain might also make it hard for you to sleep.
Diagnosis.
A doctor will ask about a person’s symptoms and medical history.
The doctor will perform a physical examination of the affected area to see whether the range of motion has changed and how severe the pain is.
A doctor will usually request An X-ray, which will reveal large buildups of calcium deposits or other abnormalities in the joint.
The standard AP x-ray will show calcium deposition within the tendon, usually 1.5 to 2cm away from the supraspinatus tendon insertion on the greater tuberosity.
An ultrasound can help your doctor locate smaller deposits that the X-ray missed.
Calcifications will likely be apparent on computed tomography (CT), but is not recommended routinely.
MRI can be used as well, though is not generally used for the evaluation of isolated calcific tendinitis.
Treatment.
Most cases of calcific tendonitis can be treated without surgery.
Your doctor will first want you to ease your pain with rest in a sling.
He may prescribe nonsteroidal anti-inflammatory drugs (N-saids), which can help to reduce pain and inflammation.
You may need a cortisone injection that reduces inflammation in the short term.
Extra-corporeal shock-wave therapy (ESWT) can be considered.
Your doctor will use a small device to deliver mechanical shocks to your shoulder, near the site of calcification.
These shocks can break up the deposits.
The body can then reabsorb the smaller pieces.
This therapy may be performed once a week for three weeks.
Therapeutic ultrasound.
Your doctor will use a device to direct a high frequency sound wave at the calcific deposit.
This is usually painless.
Percutaneous needling.
Your doctor will use a needle to make small holes in your skin.
This will allow them to manually remove the deposit.
This may be done in conjunction with ultrasound to help guide the needle into the correct position.
Once the symptoms have started to decrease, you will work with the therapist to strengthen your muscles and increase your range of motion.
Surgical treatment.
Surgical management should be considered after 6 months if symptoms progress or fail to improve with conservative management, or earlier if activities of daily living are significantly impacted.
Your surgeon will remove the calcium deposit and rinse the area arthroscopically.
Rehabilitation after surgery.
You will be advised to protect the shoulder by wearing a sling for 4 -6 weeks.
The pendulum stretch may be performed for five to ten minutes several times a day during the first few weeks of recovery.
You should also expect to attend physical therapy sessions for six to eight weeks.
You should be able to drive when you are no longer taking analgesic medications, and feel that you can control the wheel.
This is around 1-2 weeks.
In desk based jobs; you are able to return to work at around 1 month post-operatively,
but jobs requiring significant manual work require 6-8 weeks off work.
A return to sports activities that do not put any strain on the shoulder can be envisaged during the 2nd month.
You will have to wait until 4 months post-op before a full return to sports.