Calcific Tendinopathy

Calcific tendinopathy is a condition characterised by the formation of calcium crystals in the rotator cuff tendons. It most commonly affects the supraspinatus tendon. Over time, the body reabsorbs the calcium, allowing the tendon to heal. This reabsorption phase can be intensely painful, often severe enough to disrupt sleep.

Symptoms

The majority of the patients with calcific tendinopathy often experience sudden, intense pain or a worsening of persistent discomfort. The pain is typically severe and sharp, accompanied by a deep, aching sensation. Shoulder movement usually aggravates it, with discomfort felt deep in the shoulder and extending to the upper outer arm. It is often worse at night and can significantly disrupt sleep.

Causes and Risk Factors

Calcific tendinopathy commonly affects individuals aged 30 to 60, with women being more susceptible. The exact cause of calcium deposition in the tendons is unclear. But it may be linked to hormones or tendon deterioration. Calcium crystals form within the rotator cuff tendon and later turn to liquid before being reabsorbed. Pain is triggered during this process.

Diagnosis

Doctors diagnose calcific tendinopathy through clinical evaluation and imaging. Diagnosis is confirmed using an X-ray or ultrasound. This detects calcium deposits in the rotator cuff tendons. MRI may also be used to assess associated inflammation or tendon damage.

Treatment

Non-surgical options

The first treatment approach for calcific tendinopathy includes rest, modifying activities and taking pain relievers and anti-inflammatory medication. These are options you’ve likely already tried.

A subacromial (or cortisone) steroid injection, along with dry needling of calcium deposits, are the next treatment options. This ultrasound-guided technique, performed while you’re awake, takes about 10 minutes. A needle is inserted repeatedly into the deposit to help decompress the calcified cavity. A cortisone injection into the inflamed bursal gap follows this. This method has up to 70% success rate within six months and often provides quick relief. The risk is minimal, though the procedure can be somewhat uncomfortable.

Surgical treatment

Surgery is usually considered if needling and injections fail to relieve pain. It is performed using a keyhole method under general anaesthesia. Sometimes, it is combined with a regional nerve block.

The procedure begins with a standard joint arthroscopy. This is followed by clearing inflamed bursal tissue in the subacromial space. The rotator cuff tendons are examined to locate the calcium deposit. Once located, the deposit is de-roofed to allow the calcium to escape. If impingement is suspected, decompression may be done at the same time.

Prognosis

The outlook is generally good, as calcific tendinopathy is often self-limiting. Cortisone injections and dry needling are 70% effective for persons with severe symptoms. If surgery is required, more than 80% of patients report satisfaction. However, a full recovery can take several months, similar to subacromial decompression.

If shoulder stiffness or mobility issues develop, physiotherapy may be necessary after treatment to restore movement and function.

Conclusion

Calcific tendinopathy is associated with significant pain and discomfort, but effective treatments are available. Many patients find relief through non-surgical options, and surgery remains a reliable solution when needed. With the right approach, most individuals achieve long-term improvement.

If you’re experiencing persistent shoulder pain and need expert care, schedule an appointment today to explore the best treatment options.