Continue
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 at least 30-40 years old, and are more common in diabetics. The calcium deposits are not always painful, and even when painful they will often spontaneously resolve after a period of 1-4 weeks.
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 impingement syndrome.
The following are the most common symptoms of shoulder tendonitis. However, each individual may experience symptoms differently. Symptoms may include:
The symptoms of shoulder tendonitis may resemble other conditions or medical problems. Always consult a doctor for a diagnosis.
Rest: The first step toward recovery is to avoid overhead activity.
Ice: Apply cold packs for 20 minutes at a time, several times a day, to keep swelling down. Do not apply ice directly to the skin.
Nonsteroidal Anti-Inflammatory Medicines: Drugs like ibuprofen and naproxen reduce pain and swelling.
Steroid Injections: Steroids, like cortisone, are very effective anti-inflammatory medicines. Injecting steroids into the tendon can relieve pain. Your doctor will use these cautiously. In rare circumstances, steroid injections can further weaken the already injured tendon, causing it to tear.
Physical Therapy: Specific stretching and strengthening exercises will restore range of motion and strengthen your shoulder.
If your condition does not improve with nonsurgical treatment, your doctor may suggest surgery. Surgery may also be necessary if you have other shoulder problems.
Surgery for biceps tendonitis is usually performed arthroscopically. During arthroscopy, your doctor makes small incisions around your shoulder. He or she then inserts a small camera and miniature instruments through the incisions. This allows your doctor to assess the condition of the biceps tendon as well as other structures in the shoulder. In many cases, the biceps tendon can be repaired and strengthened where it attaches to the shoulder socket (glenoid).
Biceps Tenodesis: In some cases, the damaged section of the biceps is removed, and the remaining tendon is reattached to the upper arm bone (humerus). This procedure is called a biceps tenodesis. Removing the painful part of the biceps usually resolves symptoms and restores normal function.
Depending on your situation, your surgeon may choose to do this procedure arthroscopically or through an open incision.
Tenotomy: In severe cases, the long head of the biceps tendon may be so damaged that it is not possible to repair or tenodese it. Your surgeon may simply elect to release the damaged biceps tendon from its attachment. This is called a biceps tenotomy. This option is the least invasive, but may result in a Popeye bulge in the arm.
Woodworth Orthopedics and Sports Medicine will help you decide how to best treat calcific tendonitis. Call Dr. Woodworth today at (702) 545-6194 for an appointment.
Go Back