Calcific tendinitis, while not the most prevalent shoulder condition, can lead to significant pain and discomfort when calcium deposits in shoulder tendons become inflamed. These deposits can occur in tendons throughout the body, including ankles and knees, but they are particularly troublesome in the shoulder, specifically affecting the rotator cuff tendon (supraspinatus) essential for lifting the arm. Recognizing the symptoms and understanding diagnostic tools like CT scans and preventive care strategies are crucial for managing this condition effectively.
What Triggers Calcific Tendinitis?
The precise origins of calcific tendinitis remain somewhat unclear. However, it is largely believed to be associated with degenerative changes linked to aging. Injuries from accidents or the cumulative effect of everyday wear and tear can also contribute. Minor injuries, potentially aggravated by exercise and sports activities, might also play a role. This condition typically affects individuals between 40 and 60 years of age and shows a higher incidence in women compared to men.
Recognizing the Symptoms of Calcific Tendinitis
In its initial stages, calcific tendinitis may present with no pain or only mild to moderate discomfort. The symptoms can manifest in various ways, including:
- Sudden onset of shoulder pain or stiffness
- Intensified pain during shoulder movements
- Severe pain disrupting sleep patterns
- Limited range of motion in the shoulder
A hallmark of acute calcific tendinitis is intense inflammation, which can cause pain and systemic symptoms resembling a shoulder infection, such as fever. This situation is considered a medical urgency requiring prompt attention.
Diagnosing Calcific Tendinitis: The Role of CT Scans and Other Tools
Diagnosing calcific tendinitis involves a comprehensive approach. A healthcare professional will conduct a physical examination of the shoulder, inquire about your symptoms, and review your medical history. To confirm the diagnosis and rule out other conditions, several diagnostic tools may be employed:
- X-ray Examination: Often the first-line imaging technique to visualize calcium deposits.
- Computed Tomography (CT) Scan: A CT scan, also known as a CAT scan, provides more detailed cross-sectional images of the shoulder. While X-rays are excellent for detecting dense calcium deposits, a CT scan can offer a more comprehensive view, especially in complex cases or when differentiating calcific tendinitis from other shoulder pathologies. Understanding the role of a CT scan in diagnosis is part of proactive preventive care, ensuring accurate and timely management of shoulder pain.
- Magnetic Resonance Imaging (MRI): MRI is useful for assessing soft tissues, including tendons and muscles, and can help evaluate the extent of inflammation and rule out rotator cuff tears.
- Ultrasound Examination: Ultrasound is a real-time imaging technique that can visualize calcium deposits and guide procedures like lavage treatment.
Treatment Strategies for Calcific Tendinitis
Treatment for calcific tendinitis is broadly categorized into conservative and surgical approaches.
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Conservative Treatment: Approximately 90% of patients experience improvement with non-surgical management. Conservative treatments include:
- Steroid Injections: Injections of corticosteroids directly into the affected area are highly effective in reducing inflammation and alleviating pain. While some patients are concerned about steroid use, physicians prescribe them judiciously when necessary.
- Oral Steroids: Steroid tablets might be prescribed in certain cases, but their use should always be under medical supervision.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Pain Relievers: These medications can help manage pain and inflammation, although they may not be as potent for calcific tendinitis as steroid injections.
- Physical Therapy, Shockwave Therapy, and Therapeutic Ultrasound: These modalities have shown positive results in some patients. However, if any treatment exacerbates pain, it should be discontinued, and a specialist should be consulted.
- Lavage Treatment: This procedure involves injecting saline solution into the calcium deposits to dissolve and facilitate their removal.
- Activity Modification: Limiting activities that stress the shoulder joint is crucial for recovery.
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Surgical Treatment: Arthroscopic surgery is the standard surgical method for removing calcium deposits. During the procedure, the surgeon can also repair any torn shoulder tendons. Surgery is generally not recommended during the acute inflammatory phase due to increased bleeding risk and potential tendon damage, which can complicate repair. Palliative care is preferred during acute inflammation, with surgery considered for chronic cases or when conservative treatments fail to provide relief.
Arthroscopic surgery is minimally invasive, and post-operative recovery typically takes around 6 weeks. Patients may need to wear a sling to immobilize the shoulder joint during the initial healing phase.
Recurrence of Calcific Tendinitis
While calcific tendinitis can recur, many patients experience symptom-free periods lasting months or even years following successful treatment.
Preventive Measures for Calcific Tendinitis in the Shoulder
Although complete prevention of calcific tendinitis may not be possible, adopting certain lifestyle habits can help reduce your risk. These include maintaining a healthy weight, engaging in regular exercise, and, importantly, addressing shoulder pain promptly. If you experience shoulder pain, avoid strenuous shoulder-related activities and seek timely consultation with a specialist for accurate diagnosis and management. Early diagnosis, potentially involving tools like CT scans if deemed necessary, is a key aspect of preventive care in managing musculoskeletal conditions.
Calcific tendinitis can significantly impact daily life due to pain and functional limitations. Therefore, persistent shoulder pain should not be ignored. Consulting a physician specializing in musculoskeletal conditions is essential to prevent potential complications such as rotator cuff tears or frozen shoulder.
At specialized centers like the Sports Medicine and Joint Center at Bumrungrad Hospital, a multidisciplinary medical team offers comprehensive care for musculoskeletal issues resulting from sports injuries, accidents, or age-related degeneration. These centers integrate sports medicine and orthopedic surgery expertise to ensure patients receive optimal care and achieve a swift return to a high quality of life. The goal is to prevent, diagnose, and treat musculoskeletal disorders and injuries using advanced capabilities, expertise, and technology.
Compiled by Dr. Wichan Kanchanatawan, Orthopedic Surgery, Sports Injuries, Sports Medicine Specialist and Chief of Sports Medicine & Joint Center at Bumrungrad International Hospital.
For further inquiries, please contact Bumrungrad Hospital.
Last modified: November 29, 2024
