Calcific Tendonitis of the Rotator Cuff

What is calcific tendonitis?

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Calcific tendonitis is a condition that causes the formation of a small, usually about 1-2 centimeter size, calcium deposit within the tendons of the rotator cuff. These calcium deposits are usually found in patients middle aged patients (age 30-60 years). Calcium deposits are more common in women (about 70%), more common in the right shoulder than the left, and more common in patients who have endocrine disorders (such as hypothyroidism or diabetes).

Patients who have associated endocrine abnormalities tend to have worse symptoms, and tend to require more invasive treatments.

The calcium deposits are not always painful, and even when painful they will often spontaneously resolve. The deposits typically have the consistency of chalk or toothpaste, not the pebble that many patients expect.

Cause of Calcific Tendonitis

The cause of calcium deposits within the rotator cuff tendon is not entirely understood. Different ideas have been suggested, including blood supply and aging of the tendon, but the evidence to support these conclusions is not clear.

Calcific tendonitis usually progresses predictably, and almost always resolves eventually without surgery. The typical course is:

  • Precalcification Stage
    Patients usually do not have any symptoms in this stage. At this point in time, the site where the calcifications tend to develop undergo cellular changes that predispose the tissues to developing calcium deposits.
  • Calcific Stage
    During this stage, the calcium is excreted from cells and then coalesces into calcium deposits. When seen, the calcium looks chalky, it is not a solid piece of bone. Once the calcification has formed, a so-called resting phase begins, this is not a painful period and may last a varied length of time. After the resting phase, a resorptive phase begins--this is the most painful phase of calcific tendonitis. During this resorptive phase, the calcium deposit looks something like toothpaste.
  • Postcalcific Stage
    This is usually a painless stage as the calcium deposit disappears and is replaced by more normal appearing rotator cuff tendon.

Patients usually seek treatment during the painful resorptive phase of the calcific stage, but some patients have the deposits found as part of their evaluation for rotator cuff tendonitis.

One of the most common questions I hear from patients is if they should eat less calcium rich foods. It is important to note that calcium consumed from the diet has not been shown to have any effect on the formation or resolution of calcium deposits in the shoulder tendons. Therefore, the calcium deposit is not from drinking milk or eating cheese, and you should not alter your dietary intake of calcium to try to get rid of your calcific tendonitis.

Treatment of Calcium Deposits

Treatment of calcific tendonitis usually begins with some simple steps including rest, ice application, medications, and therapy. When these simple steps are ineffective, more invasive treatments, including possible surgical treatment, can be considered.

The good news, is that with appropriate treatment for enough time, most patients find relief without having to undergo shoulder surgery.

Sources:

Suzuki K, Potts A, Anakwenze O, Singh A. "Calcific tendinitis of the rotator cuff: management options" J Am Acad Orthop Surg. 2014 Nov;22(11):707-17. doi: 10.5435/JAAOS-22-11-707.

HK Uhthoff and JW Loehr. "Calcific Tendinopathy of the Rotator Cuff: Pathogenesis, Diagnosis, and Management" J. Am. Acad. Ortho. Surg., Jul 1997; 5: 183 - 191.

Daecke W, et al. "Long-term effects of extracorporeal shockwave therapy in chronic calcific tendonitis of the shoulder. " J Shoulder Elbow Surg. 2002 Sep-Oct;11(5):476-80.

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