Calcific tendonitis of the shoulder is a common cause of aching pain that is made worse by shoulder activity. The pain often occurs at night and may persist for several months despite the lack of any specific injury or trauma. Clinical findings associated with calcific tendonitis include significant pain, reduced range of motion and radiographic evidence of calcium deposits.
Patients who present to the office for evaluation of shoulder pain have x-rays taken to assess the joint. In cases of calcific tendonitis, calcium deposits clearly visible on plain x-rays can be identified and confirm the diagnosis. Seventy percent of calcium deposits are located in the top (supraspinatous) portion of the rotator cuff tendon. The size, shape and characteristics of the calcium deposit are noted and a careful physical exam is performed to rule out any additional causes of shoulder pain such as a rotator cuff tear or arthritis.
Treatment of this condition generally begins with non-operative management using anti-inflammatory medication or occasionally, a cortisone injection. Adequate physical therapy is an integral part of the recovery. Range of motion and eventual muscle strengthening exercises are recommended. Many patient will often respond to this non-operative treatment and not require any surgery. Follow up appointments to repeat x-rays are important to monitor the calcium build-up. In a third of patients, the calcium deposits may undergo spontaneous resorption and disappear. Unfortunately, there is no way to know which patients are likely to have the calcium disappear or enlarge.
Dense, clearly outlined calcium deposits that do not respond to non-operative treatment can be treated with arthroscopic surgery. Arthroscopic surgery allows identification and removal of the calcium deposit through limited incisions. In addition, arthroscopy affords a thorough evaluation of the shoulder for complete identification and treatment of additional problems within the shoulder joint.
After the calcium deposit has been removed, the shoulder is thoroughly flushed with fluid and a bandage and sling are applied for comfort. As long as there isn’t any significant damage to the rotator cuff tendon, the sling may be safely discontinued after a few days to begin active exercises and formal physical therapy. Ice pack application and oral pain medication help keep the patients comfortable post-operatively.
Arthroscopic surgery is ideal for patients who fail to improve with non –operative measures. Greater than eighty percent success rates have been reported with arthroscopic removal of the calcific deposit. Proper identification of this shoulder condition is important in the diagnosis and management of the symptoms. With the appropriate treatment, orthopaedic surgeons can successfully decrease the pain and improve the function of these painful shoulders.
Luis M. Espinoza, M.D. is a Double Board Certified Orthopedic Surgeon practicing at the OCSM. Dr. Espinoza served as a consultant for the Miami Marlins AAA affiliate New Orleans Baby Cakes baseball team. The Orthopedic Center is a multi-specialty center dedicated to complete musculoskeletal care with focused expertise in shoulder, knee, hand/wrist and non-surgical spine care. Office is located in Metairie. For additional information call 504.217.5319 or visit us on our website at www.nolasportsmedicine.com