Calcium in the Shoulder Tendons (Calcific Tendonitis)

Introduction

There are 4 main tendons surrounding the shoulder joint,and collectively these are called the "rotator cuff".Collections of calcium in these tendons are common and do not always produce symptoms.The calcium usually gets absorbed by the body but this can take up to 2 years! It is at the stage when the calcium starts getting resorbed that the symptoms become severe.

Causes

There is no known cause,and specifically is not thought to be related to dietary calcium intake or conditions like osteoporosis. The most likely cause of calcific tendonitis is the presence of small tears in the tendon which arise from an area that has undergone “wear and tear”. The body in turn lays down calcium in order to try and heal the tendon.

Making the diagnosis

Figures vary from 2.7% - 20% of the general population (i.e without symptoms!). Women are affected more than men and in 2 large studies 43% of those affected were housewifes. The right shoulder is affected more than the left and roughly 20% of all patients are between 30 and 40. Approximately 65% occur in the tendon of supraspinatus, 30% infraspinatus, 3% subscapularis and 2% teres minor.

Pain is by far the commonest symptom and is usually localised to the shoulder itself. In cases where subscapularis is involved, neurological-type symptoms may occur down the arm. This is due to the close association of the brachial plexus to the tendon. Stiffness can also occur in all forms of calcific tendonitis, which can either be due to pain or the presence of frozen shoulder.

Treatment

There are 3 treatment options

Medication only(pain killers and anti inflammatories eg voltaren,celebrex). Injection of cortisone and local anaesthetic into the space around the tendon(symptomatic relief only – does not get rid of the calcium!!) Arthroscopic removal of the calcium – this is usually reserved for patients who have not responded to options 1) and 2) and patients with very large deposits(which take a long time to resorb). Recovery after surgery usually takes 4 weeks but can take up to 3 months!

Note

In general this treatment protocol is applied from numbers one to four in patients under 50 with milder forms of arthritis.In older patients with advanced disease,a Total Shoulder Replacement is the treatment of choice.The golden rule of joint replacement anywhere in the body,is to try and manage the arthritis conservatively for as long as is comfortably possible BEFORE resorting to replacing the joint,as this operation has a finite life-span(10-15 years).

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