Calcific tendonitis: A painful shoulder condition

Calcific Tendinitis: A Painful Shoulder Condition

   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 tyrauma. Clinical findings associated with calcific tendonitis include significant pain, reduced range of motion and radiograhic evidence of calcium deposits.

   Patients who presents to the office for evaluation of shoulder pain have x-rays taken to assess the joint. In case 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 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 patients will often respond to this non-operative treatment and not require any surgery. Follow-up appointment 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 surgrey allows identification and removal of the calcium deposits 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 deposits 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 orla 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 reporteed with arthoscopic removal of the calcific deposits. Proper identification of this shoulder condition is important in the diagnosis and management of the symptoms. With the appropriate treatment, orthopedic surgeon can successfully decrease the pain and improve the function of these painful shoulder.

   Luis M. Espinoza M.D. is a board certified orthopedic surgeon practicing at the Orthopedic Center for Sports Medicine. Dr. Espinoza served as a consultant for the AAA affiliate New Orleans Zephyrs/Babycakes baseball team. The Orthopedic Center is a multi-specialty center dedicated to complete musculoskeletal care with focused expertise in shoulder, knee and non-surgical spine care. 

 

Author
Luis M. Espinoza MD Dr. Espinoza served as the AAA Team Doctor for the the New Orleans Zephyrs/BabyCakes since joining the Orthopedic Center for Sports Medicine in 2003. He is double board certified in General Orthopedic Surgery and Sports Medicine.

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