Welcome to Hicksville Physical Therapy’s patient resource about Calcific Tendonitis of the Shoulder!
Calcific tendonitis of the shoulder forms due to the buildup of calcium deposits in the tendon. If too much calcium builds up, the tissues can become inflamed and cause intensive shoulder pain. The specific cause of this phenomenon is unknown but it can occur anywhere in your body, though it commonly affects the shoulder. It most prevalently affects people over 40, thus doctors believe age is a factor. Fortunately calcific tendonitis can disappear on its own, but this can take years to happen if healing naturally.
Our article will address:
Which parts of the shoulder are affected?
Calcium deposits can build up everywhere in the body, but most commonly occur in the shoulder joint. In the shoulder joint, calcific tendonitis affects the tendons that attach bones and muscles in the rotator cuff. The rotator cuff consists of several tendons that let your muscles latch onto your humerus, the long bone of your upper arm that runs from shoulder to elbow. Finally, the tendon most affected by calcific tendonitis is the supraspinatus tendon of the rotator cuff.
Two types of calcific tendonitis, called degenerative calcification and reactive calcification, can be the cause of your extensive shoulder pain. Degenerative calcification is believed to be caused by aging, as blood flow to the shoulder’s rotator cuffs starts to decrease as we get older, making tendons become weaker. Our shoulders start to unravel like a fraying rope the more we use our shoulder, leading for calcium deposits to form in an attempt to heal the wear and tear.
NHowever, reactive calcification is a bit more confusing; its cause is relatively unclear, though the pain felt by reactive calcification is seemingly worse than its degenerative counterpart. Reactive calcification can be thought of in three stages: in the pre-calcific stage, calcium deposits are more likely to form due to changes in the tendon. Secondly, in the calcific stage, calcium crystals are deposited in the tendons and after begin to disappear, reabsorbed by the body. Pain is most likely to be felt during this stage. Finally, in the post-calcific stage, the body attempts to heal the tendon, and the tendon is reconfigured with new tissue. It is unknown why the body reabsorbs the deposits, but once this happens and the tissue is reformed, pain will decrease or even disappear completely.
Why did I develop calcific tendonitis?
Truthfully, the cause of calcific tendonitis is still relatively unknown. Overuse, wear and tear, aging, or a culmination of all these factors seem to be involved in degenerative calcification. Researchers have come to different conclusions regarding the cause of the formation of calcium deposits: some believe that because blood flow decreases as you age, the tendons don’t receive the oxygen they need. Others believe that putting pressure on the tendons damages them and leads to calcium deposits forming. Mysteriously, reactive calcification seems to affect younger patients more, and even goes away on its own in most cases.
What are the symptoms of calcific tendonitis?
During the early calcific stage when calcium is deposited, pain may just be mild and go up moderately, or even nonexistent. However, pain may shoot up when the calcium deposits are reabsorbed. Lifting the arm may be painful, and your shoulder may become stiff and cause loss in mobility. In severe cases, pain may interfere at night when you sleep.
What tests will my doctor run?
You’ll need to get several x-rays to keep track of how the calcification of your shoulder progresses. By tracking the changes, your doctor will determine if the condition goes away on its own, or if your shoulder will need surgery.
Some patients may need to be referred to another specialist for further diagnosis. Once your examination is complete, the Physical Therapists at Hicksville Physical Therapy will work with you on treatment to speed up recovery and allow for you to return to an active lifestyle.
When visiting Hicksville Physical Therapy, your doctor will intake your medical history and do an extensive physical examination to your shoulder. An X-ray is needed to confirm the presence of calcium deposits, and will help locate where the deposits are. Calcific tendonitis can be confused with other shoulder conditions, thus an X-ray is essential to ensure proper diagnosis.
Non-surgical Rehabilitation
Our first goal at Hicksville Physical Therapy is to help you control your pain and inflammation. Initial treatment is usually rest and taking anti-inflammatory medication (NSAIDs) like ibuprofen to control your pain. Your doctor may also suggest a cortisone injection if your pain worsens, as it can be very effective in temporarily relieving inflammation and swelling.
The stage of calcium deposit reabsorption may come with especially prolific pain, so your doctor may suggest trying to remove the deposit. They will do this by inserting needles into the area and rinsing with sterile saline, a saltwater solution, in a procedure called lavage. Lavage is done to break the calcium particles, in turn removing the deposits with needles to speed up the healing process. Even if lavage isn’t able to remove the calcium buildup, it reduces pressure in the tendon and will lead to less shoulder pain.
Hicksville Physical Therapy may have your physical therapist try heat, ice, or ultrasound treatments. Using an ultrasound has shown to reduce the size of the deposit and has helped people with their shoulder pain and arm function. However, the full benefits will only be seen if the ultrasound treatments are repeated, up to 24 times during a six-week time period.
Your physical therapist will also help you create a personalized program to strengthen and stretch your shoulder. Your rotator cuff helps control the stability of your shoulder, thus it’s integral to do these exercises to strengthen it; doing so may even decrease the pressure the calcium deposits put on your tendon. Your physical therapist can even evaluate your workstation or lifestyle activities and instruct you on proper posture and form, easing your pain and helping you avoid future problems.
Shockwave therapy is a newer type of nonsurgical treatment that uses a machine to generate shock pulses to the pained area. The pulses will help break the deposit so the body can have an easier time absorbing it, reducing the size of the deposit to help the pain. Patients can receive treatment once a week, up to three weeks.
However, if pain and mobility loss get worse despite treatment or continue to affect your daily life, you may need to consider surgery. Surgery for calcific tendonitis fortunately doesn’t need you to stay in the hospital overnight, but does require use of anesthesia.
Post-surgical Rehabilitation
Recovery time for each individual after surgery varies, but most people will need to attend physical therapy for around six to eight weeks, and can expect full recovery in about three to four months. Moving your shoulder again is integral to recovery, but you must also remember to protect your tissues in the process of healing.
Post-surgery may require sling support. Your physical therapist may also use ice or electrical stimulation to control your pain and swelling, or massage the area and try other hands-on treatments for muscle pain and spasms.
After a simple arthroscopic resection, physical therapy can soon begin. Your doctor will direct you gradually, starting off with range-of-motion exercises that transition into active ways to strengthen and stretch your shoulder. However, make sure to not overexert yourself. During a more intensive procedure like open surgery, however, you should wait two to three weeks before starting therapy as your muscles have been cut and stitched together. The first exercises you do will be passive; your physical therapist will move your shoulder while your muscles stay relaxed, and then gradually help you stretch your arm. The physical therapist may instruct you how to do these movements at home, with the help of your family or friends.
After a few weeks of passive therapy, at the four to six weeks mark is when you can begin active therapy. This is when you can start your range-of-motion exercises, like isometric strengthening to work your muscles without straining your healing tissues. Around six weeks or a little more is when you can attempt heavier strengthening, to improve the control of your rotator cuff muscles and the muscles surrounding your shoulder blade. The goal is retraining your muscles to keep the ball of the humerus in its socket, allowing stabilization and smooth mobility of your shoulder.
Hicksville Physical therapy is committed to returning you back to your previous lifestyle so you can work and exercise again with no problems, and to work with you and your healing shoulder for solutions that avoid future problems. Schedule an appointment today if you’re feeling pain, to be in the hands of doctors who care.
The surgeries most often used to correct calcific tendonitis of the shoulder are arthroscopic surgeries. A device called an arthroscope, a special TV camera, is used to locate the calcium deposit’s location in the rotator cuff. The arthroscope is inserted into the shoulder by making small incisions on the skin, along with other surgical instruments to help the procedure. When the deposit is found, the other instruments resect or remove the calcium deposits and then rinse the area. Loose calcium crystals are also removed as they irritate the tissues around the rotator cuff.
Open surgery is performed only in rare circumstances. During this procedure, the surgeon cuts through muscles and other tissues to reach the calcium deposit. The tendon itself must be cut to remove the excess calcium deposits and rinsed to eliminate calcium crystals, and then the muscles and skin are restitched together.
