What is Calcific Tendinopathy?
Calcific tendinopathy is a painful shoulder condition in which calcium deposits develop within one or more of the rotator cuff tendons, most commonly the supraspinatus tendon. These deposits can irritate the surrounding tissues, leading to inflammation, shoulder pain, stiffness and restricted movement. Although the exact cause is not fully understood, the condition is believed to result from changes within the tendon itself rather than excessive calcium intake or the normal ageing process.
Calcific tendinopathy most commonly affects adults between the ages of 30 and 60. In some people, the calcium deposits remain symptom-free for years, while in others they cause sudden, severe pain as the body begins to break down and reabsorb the deposits. The condition can make everyday activities such as reaching overhead, lifting objects, dressing or sleeping on the affected shoulder increasingly difficult.
What are the Causes of Calcific Tendinopathy?
Although the precise cause of calcific tendinopathy remains unclear, several factors are thought to contribute to the formation of calcium deposits within the rotator cuff tendons. These include:
- Degenerative changes within the rotator cuff tendons
- Reduced blood supply to the tendon tissue
- Repetitive overhead movements or overuse of the shoulder
- Chronic inflammation affecting the rotator cuff
- Age-related changes in tendon health
- Metabolic changes that affect tendon healing
- Certain endocrine conditions, including diabetes and thyroid disorders
- A possible genetic predisposition
Rather than resulting from excessive dietary calcium, calcific tendinopathy is believed to develop through a complex biological process involving tendon degeneration, calcium deposition and the eventual reabsorption of the deposits.
What are the Symptoms of Calcific Tendinopathy?
Symptoms can vary depending on the size of the calcium deposit and the stage of the condition. Some people experience very few symptoms, while others develop severe pain and significant loss of shoulder function. Common symptoms include:
- Shoulder pain that develops gradually or occurs suddenly
- Sharp pain when lifting or reaching overhead
- Pain when lying on the affected shoulder
- Night pain that disrupts sleep
- Reduced range of movement
- Shoulder stiffness
- Weakness when lifting or reaching
- Tenderness over the affected rotator cuff tendon
- Difficulty carrying out everyday activities, such as dressing or reaching behind the back
Pain is often at its worst during the resorptive phase, when the body naturally begins to break down the calcium deposits.
How is Calcific Tendinopathy Diagnosed?
Diagnosis begins with a detailed medical history and a thorough physical examination. Your consultant orthopaedic shoulder specialist will discuss your symptoms, assess your shoulder strength and range of movement, and identify any movements that reproduce your pain.
Imaging studies are then used to confirm the diagnosis and determine the size and location of the calcium deposits. X-rays are the primary investigation, as they clearly demonstrate calcium deposits within the rotator cuff tendons. Ultrasound provides additional information about the tendons and surrounding soft tissues and may also be used to guide minimally invasive treatments such as ultrasound-guided needle lavage (barbotage). In some cases, an MRI scan may be recommended to assess the condition of the rotator cuff tendons and identify associated tendon tears or other shoulder conditions.
An early diagnosis allows appropriate treatment to begin before symptoms significantly affect shoulder function and quality of life.
What are the Treatment Options for Calcific Tendinopathy?
Treatment depends on the severity of your symptoms, the size of the calcium deposits and the extent to which the condition affects your daily activities. Many patients improve with conservative treatment, while others may require minimally invasive procedures or surgery.
Treatment options may include:
- Activity modification to reduce stress on the shoulder
- Non-steroidal anti-inflammatory medicines (NSAIDs) to relieve pain and inflammation
- Physiotherapy to improve flexibility, strength and shoulder mechanics
- Corticosteroid injections to reduce inflammation and relieve pain
- Ultrasound-guided barbotage (needle lavage) to break up and remove calcium deposits
- Extracorporeal shockwave therapy (ESWT) to fragment calcium deposits and stimulate the body's natural healing response
- Arthroscopic shoulder surgery to remove persistent calcium deposits and repair any damaged rotator cuff tendon when non-surgical treatment has not been successful
With appropriate treatment, most patients experience significant pain relief, improved shoulder movement and a successful return to normal daily activities, work and sporting pursuits.