Calcific Tendinopathy

Calcific tendinopathy refers to the deposit of calcium in a tendon, most often in those of the rotator cuff muscles of the shoulder. The most commonly affected tendon is the Supraspinatus which is observed in 80% of cases (Serafini et al., 2009).

Typically, calcific tendinopathy will come on gradually with relatively low severity shoulder pain which typically worsens overnight and can limit shoulder movement.

There are 3 stages of clinical presentation:

• Chronic (silent) Phase – usually asymptomatic, present for several years.

• Acute Painful Phase – explicitly painful (particularly at night) with reduced function.

• Mechanical Phase – may present with tendon ‘impingement’ and pain is commonly less severe.

Typical Symptoms:

• Pain at night which impacts sleep.

• Constant dull ache.

• Exacerbated when moving the shoulder.

• Reduced movement and/or stiffness.

• Palpation tenderness localised to the affected tendon.

(Fusaro et al., 2011; Gimblett et al., 1999)

The exact cause of calcific tendinopathy is unclear; however, several have been suggested including reduced blood flow, excessive compression, those with a metabolic disorder and with local degeneration. Calcific tendinopathy can be present in 2.5-7.5% of asymptomatic shoulders, it is seen significantly more commonly in females (70% of cases) and those in their 40’s.

Your Physio will ask for a history of your symptoms proceeded by carrying out a clinical examination so that a precise and timely diagnosis can be given to ensure the most effective treatment can be put in place immediately. Your Physiotherapist will work closely with you to set individualised treatment goals for you to aim at and will regularly re-assess you to measure your progress and make any necessary modifications in your treatment.

Your Physio will explain the condition and educate you on self-management strategies in the early stages before the condition has progressed to a chronic issue. This may include recommending medicine to control pain, activity modification techniques which will keep you functional in ways that avoid irritation and avoidance of aggravating activities. As you recover, you will be given ongoing support and advice so that you can manage by yourself and prevent re-occurrence.

Physiotherapy input will allow a progressive rehabilitation to be implemented to strategically load the affected tendon and will help restore full shoulder movement and function. Manual therapy techniques including joint and soft tissue mobilisations may be used to support recovery. All of these modalities will help increase blood flow to the associated structures to allow natural re-absorption processes to take place.

Medical management usually is that of non-steroidal anti-inflammatory drugs or a steroid injection but there is little evidence that they promote reabsorption of calcium deposits.

Ultrasound-guided needle aspiration under local anaesthetic has been previously employed to remove some of the calcium deposits with favourable outcomes up to 2 years. This is most effective when performed early in the condition’s development when the deposits can be removed easier.

Surgical removal through arthroscopy is an option for patients in chronic cases when the calcium deposits are harder. It is also thought that the surgical procedure stimulates the body’s calcium reabsorption system which is desirable (Lam et al., 2006).

Fusaro, I., Orsini, S., Diani, S., Saffioti, G., Zaccarelli, L., & Galletti, S. (2011). Functional results in calcific tendinitis of the shoulder treated with rehabilitation after ultrasonic-guided approach. Musculoskeletal surgery, 95(1), 31-36.

Gimblett, P. A., Saville, J., & Ebrall, P. (1999). A conservative management protocol for calcific tendinitis of the shoulder. Journal of manipulative and physiological therapeutics, 22(9), 622-627.

Lam, F., Bhatia, D., Van Rooyen, K., & de Beer, J. F. (2006). Modern management of calcifying tendinitis of the shoulder. Current Orthopaedics, 20(6), 446-452.

Serafini, G., Sconfienza, L. M., Lacelli, F., Silvestri, E., Aliprandi, A., & Sardanelli, F. (2009). Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle US-guided percutaneous treatment—nonrandomized controlled trial. Radiology, 252(1), 157-164.