Calcific tendonitis: Symptoms, causes, diagnosis and treatment of calcific tendonitis

Calcific tendonitis, also known as tendinosis calcarea, is a painful condition of the shoulder joint caused by calcium deposits in the rotator cuff tendons. These calcium deposits can lead to inflammation and severe pain, limiting arm mobility.

Early diagnosis and treatment are crucial to alleviating symptoms and improving the quality of life of those affected. The following explains the symptoms, causes, and various treatment approaches in detail.

Symptoms of calcific tendonitis

Common complaints

The most common symptom of calcific tendonitis is shoulder pain, which can occur suddenly and worsen over time. The pain often radiates into the arm. Shoulder pain can occur both at rest and during movement and is often described as stabbing or dull. Many patients also complain of pain at night, especially when lying on the affected shoulder.

Pain progression and intensity

The course of pain associated with calcification of the shoulder can vary greatly. In some cases, the condition begins with mild discomfort that gradually increases, while in others, the pain develops suddenly and severely. The intensity of the pain can range from mild discomfort to unbearable pain that severely interferes with daily life. The pain often depends on the stage of calcification and the associated inflammation.

Restricted movement

Restricted movement is another common symptom of calcific tendonitis. The pain causes affected individuals to move their arm less, which can lead to stiffness of the shoulder joint. In particular, raising the arm above head height or externally rotating the arm can be very painful and restrictive. Shoulder stiffness can develop, which further complicates conservative treatment and increases the need for surgery.

Causes of calcific tendonitis

Calcification in the shoulder

The main cause of calcific tendonitis is calcification of the shoulder tendons, particularly the supraspinatus tendon. These calcium deposits form at the tendon insertion points and can lead to calcific tendinosis.

The exact mechanisms that lead to this calcification are not yet fully understood. It is suspected that impaired blood circulation in the tendon tissue plays a role. Calcification can vary in severity and progress through different stages, which also affects the symptoms.

Factors for tendinosis calcarea

There are several factors that can increase the risk of calcific tendinosis, including:

• A genetic predisposition

• Metabolic diseases such as diabetes mellitus

• Hormonal changes

Overloading the shoulder due to repetitive movements or strenuous physical work can also promote the formation of calcium deposits. However, the exact combination of these factors varies from individual to individual, making the investigation of the cause complex. An orthopedic specialist can provide more detailed information.

Injuries and overload

Injuries and overuse of the shoulder can also play a role in the development of calcific tendonitis. Microtrauma caused by repetitive movements or unusual stress can lead to inflammation and, subsequently, calcium deposits in the shoulder tendons.

Sports that place high demands on the shoulder joint, such as throwing or swimming, can increase the risk. Timely diagnosis and treatment are important to prevent chronic problems.

Diagnosis of calcific shoulder

Imaging techniques

Various imaging techniques are used to diagnose calcific tendonitis. These include the following methods:

• X-rays : These are often the first choice for visualizing calcium deposits. X-rays allow for a clear assessment of the size, shape, and location of the calcium deposits.

• An ultrasound : This can be helpful to examine the rotator cuff tendons and detect inflammation or fluid accumulation, such as bursitis.

In some cases, an MRI (magnetic resonance imaging) may also be necessary to rule out other causes of shoulder pain.

Clinical examination

The clinical examination is an important part of diagnosing calcific tendonitis. The doctor will assess the mobility of the shoulder joint and perform specific tests to locate the painful areas. They will also check for accompanying symptoms such as bursitis or shoulder stiffness.

The medical history, i.e., a discussion with the patient about their symptoms, the progression of pain, and possible triggers, provides valuable clues for diagnosis. Pain at night or when lying on the affected shoulder is also important information.

Diagnostic procedures in detail

In detail, the diagnosis of calcific tendonitis involves a combination of medical history, clinical examination, and imaging techniques. The medical history records the type and duration of the pain, possible triggers, and pre-existing medical conditions. During the clinical examination, specific tests are performed to identify the affected tendon and rule out other causes of shoulder pain.

X-rays or ultrasound examinations confirm the diagnosis and provide information about the size and location of the calcium deposits. This allows the doctor to accurately classify the clinical picture and initiate the appropriate treatment for calcific tendonitis.

Conservative treatment of calcific shoulder and surgery as an option

Conservative treatment options

Treatment of calcific tendonitis typically begins with conservative measures. The goal of conservative treatment is to relieve pain and restore mobility to the shoulder joint. Various therapeutic approaches are used, such as painkillers, anti-inflammatory medications, and physical therapy.

Physical therapy includes targeted exercises to strengthen the rotator cuff muscles and improve mobility. Cooling compresses can also help reduce inflammation. Many patients find this conservative therapy effective, especially in the early stages of the disease.

Shock wave therapy

Another option for treating calcific tendonitis is shock wave therapy (ESWT). This therapy involves directing high-energy sound waves at the affected area to liquefy and break down the calcium deposits. Extracorporeal shock wave therapy can improve blood flow in the area of the supraspinatus tendon, thus promoting the healing process.

Often, several sessions are necessary to achieve significant improvement in symptoms. ESWT is a non-invasive method and represents a good alternative to surgical treatment, especially when conservative therapy is insufficient.

Surgical treatment

If conservative treatment options and shock wave therapy do not lead to sufficient improvement, surgical treatment of calcific tendonitis may be considered. During this procedure, the calcium deposits are removed from the tendon. This can be performed either arthroscopically, i.e., minimally invasively, or through open surgery.

The goal of the surgery is to remove the painful calcium deposits and restore the function of the rotator cuff. After the surgery, intensive physical therapy is required to regain mobility and strength in the shoulder joint.

Aftercare and rehabilitation

Rehabilitation after treatment

After treatment of calcific tendonitis, whether conservative or surgical, rehabilitation plays a crucial role. Physiotherapy is a central component of rehabilitation. Targeted exercises help strengthen the rotator cuff muscles, improve shoulder mobility, and relieve pain.

It's important to perform the exercises regularly and under the supervision of a therapist to ensure optimal recovery. Early arm mobilization is important to avoid shoulder stiffness.

Long-term prognosis and risk of relapse

The long-term prognosis after successful treatment of calcific tendonitis is generally good. Many patients experience a significant reduction in pain and an improvement in their quality of life. However, there is a certain risk of recurrence. To minimize this risk, it is important to avoid overloading the shoulder and to perform regular exercises to strengthen the muscles.

Good posture and ergonomic workplace design can also help prevent recurrence of problems. Regular check-ups with an orthopedic specialist are advisable.

Tips for prevention

There are various measures you can take to prevent calcific tendonitis. Generally, you should take care of your health, for example, by:

• A balanced diet and sufficient exercise are important for the health of tendons and joints.

• Regular stretching and strengthening exercises for the rotator cuff muscles to reduce the risk of calcification of the shoulder tendons.

In addition, one-sided strain and overload of the shoulder joint should be avoided. Maintain good posture and an ergonomic workplace. At the first signs of shoulder pain, consult a doctor for early diagnosis and treatment of calcific tendonitis.