What causes calcific Tendinitis?

The exact cause of calcific tendinitis is not known however the disease is known to progress through set phases:

• During the formative phase the calcium is deposited from the blood stream into the tendon. This phase is associated with very mild symptoms only.

• The resorptive phase occurs when the calcium breaks up and dissolves. This causes an acute inflammatory reaction and the pain can be severe, so much so that those affected are often incapacitated. In this phase some patients can tolerate no shoulder movement at all and the arm is held firmly against the chest.

• The reparative phase occurs once the calcium has dissolved and the tendon heals with new tissue.

How is a calcific tendinitis diagnosed?

Usually Mr Moverley can diagnose calcific tendinitis with a combination of clinical examination and a careful assessment of the history of your symptoms. 

Further diagnostic tests are used for confirmation and to plan treatment.

• X-rays can obtained on the day of your consultation and may demonstrate calcium sitting above the humeral head (ball) of the shoulder joint.

• Ultrasound is useful as it can show the location and size of the calcium deposit. Often ultrasound is combined with a steroid injection to provide initial treatment at the same time.

• MRI is not usually required but may be requested if the diagnosis is uncertain.

Treatment options

Mr Moverley will tailor your treatment specifically to the phase of your symptoms and the size of the calcium deposit, whilst taking into account your expectations and medical history.

Non-operative Management

Non-operative treatment should always be exhausted before considering any form of surgery.  The vast majority of patients will respond well to non-operative treatment. Possible non-operative options include:

• Rest, activity modification, and simple pain relief can provide good benefit, particularly early after the onset of symptoms. 

• Steroid injections are often used to provide short-term relief, which can then allow you to participate in physiotherapy to help regain movements. Repeated injections should not be given as a long-term solution as they may cause damage to the rotator cuff tendons. 

• Ultrasound guided barbotage: Under local anaesthetic a needle is repeatedly passed into the calcium deposit to help it disperse.

Surgical Management

Surgery is an option if despite one or two injections you are still experiencing pain that is causing you problems. 

Shoulder arthroscopy

The operation for calcific tendinitis is called an arthroscopic excision of calcium. This is a ‘key-hole’ procedure where the calcium is located within the tendon and removed using a needle and a small shaver. At the same time inflamed tissue is removed from the subacromial bursa and shaving away a small amount of the acromion increases the size of the space for the rotator cuff tendons allowing them to heal.