Calcific tendinitis of the shoulder

Anatomy

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of your upper arm bone fits into a rounded socket, known as the glenoid, in your shoulder blade. A combination of muscles and tendons, known as the rotator cuff, keep your arm bone centered in your shoulder socket. The rotator cuff covers the head of your upper arm bone and attaches it to your shoulder blade.

Within the shoulder joint, there are small, fluid-filled sacs known as bursae (also called bursa). Their purpose is to provide a cushion between your joints, which helps reduce friction between the muscles and bones in the joint.

About

Calcific tendinitis of the shoulder is when calcium deposits build up in your shoulder muscles and tendons, also known as the rotator cuff. It is one of the most common causes of shoulder pain. You’re more likely to be affected if you perform a lot of overhead motions, such as heavy lifting, or play sports like basketball or tennis.

Other factors can also cause this condition, such as:

• Genetic predisposition
• Abnormal cell growth
• Abnormal thyroid gland activity
• Bodily production of anti-inflammatory agents
• Metabolic diseases, such as diabetes

This condition is typically seen in adults between 40 and 60 years old, and women generally are more likely to be affected than men.

Symptoms

When calcific tendinitis of the shoulder first begins, the symptoms are very mild and generally include:

• Minor pain that is present both with activity and when at rest
• Pain radiating from the front of the shoulder to the side of the arm
• Sudden pain when lifting or during reaching movements
• Athletes in overhead sports may have pain when throwing

As time passes and the injury worsens, the symptoms may worsen into:

• Pain at night
• Loss of strength and motion
• Difficulty doing activities that place the arm behind the back, like buttoning or zippering

Diagnosis

Your Florida Orthopaedic Institute physician will take a look at your symptoms, medical history, and overall health, followed by a physical examination. You may be asked to lift your arm or make arm circles to observe any limitation in your range of movement.

Your physician may recommend you take some tests to check for calcium deposits and that your symptoms are not caused by a different injury. X-rays are one of the most common tests to confirm calcific tendinitis of the shoulder because they show dense structures such as calcium deposits. An ultrasound is also a useful test as it can help your doctor locate any smaller deposits that the X-rays may have missed.

Treatment

There are both non-surgical and surgical treatments available to get you back to your daily activities. Nonsurgical treatments will be recommended to you first. If these treatment options do not work, then surgical treatment options will be considered.

Nonsurgical

There are several nonsurgical treatments available to help get you back on your feet as quickly as possible. These treatments include:

• Rest – Keep all weight off of your shoulder and avoid any strenuous movements to give the shoulder time to heal.
• Medications – Medications such as Advil/Motrin (ibuprofen), Aleve (naproxen), and aspirin work to reduce pain and swelling.
• Physical therapy – Physical therapy can restore normal motion to your shoulder. Stretching exercises to improve range of motion are very helpful in healing your injury.
• Steroid injection – If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can relieve pain.

Surgical treatments

If nonsurgical treatments are unsuccessful, then you may need to get surgery. Typically, the surgical procedure will be performed arthroscopically and consists of creating more space for the rotator cuff. To do this, your surgeon will remove the inflamed part of the bursa.

Additionally, your surgeon may treat other conditions present in the shoulder at the time of surgery. These can include arthritis between the clavicle (collarbone) and the acromion (acromioclavicular arthritis), inflammation of the biceps tendon (biceps tendonitis), or a partial rotator cuff tear.

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