Calcific tendonitis of the shoulder is a common cause of aching pain that is made worse with 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 on 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 tears or arthritis.
Treatment of this condition begins with non-operative management using anti-inflammatory medication or occasionally, a cortisone injection. Adequate physical therapy is an intergral part of the recovery. Range of motion and eventual muscle strengthening exercises are recommended. Many patients will often respond to this treatment regimen. Repeat x-rays can be done in cases where patients do not improve to see if the calcium buildup persists or enlarges.
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.
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 exercise and formal physical therapy. Large calcium deposits may require rotator cuff repairs after debridement and need to be rehabilitated more cautiously with physical therapy to allow for the rotator cuff tendon to properly heal.
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 mangement of the symptoms. With the appropriate treatment, orthopaedic surgeons can successfully decrease shoulder pain and improve the function of these painful conditions.
