Calcific tendonitis of the shoulder
Oct 10, 2013 / 5:00 am
Calcifying tendonitis of the shoulder is a common, yet painful disorder, that is attributed to calcium deposits in the rotator cuff tendons of the shoulder. This calcific material is composed of calcium hydroxyapatite, which can be considered crystal in nature. Calcifications typically occur in the supraspinatus tendon (51-90%), while the least affected muscle in the rotator cuff is the subscapularis tendon (3%). The supraspinatus tendon is 2 to 3 cm in length and lies in a compartment below the acromion (tip of the shoulder). Most calcifications occur in a specific area of the tendon, which is approximately 1 to 2 cm from its insertion on the greater tuberosity (boney part) of the humerus (upper arm bone). The cause of calcific tendonitis of the rotator cuff is largely unknown, however recent research suggests that a lack of blood flow (hypovascularity) and necrosis (cell death) within the tendon may lead to its degeneration, ultimately resulting in calcification. There are 4 stages of this disorder, which include: 1. Pre-calcific stage, 2. Formative stage (calcium deposits form), 3. Resorptive stage (deposits disappear and are absorbed by the tissue), 4. Healing and rotator cuff repair. This is a natural cycle in which the tendon typically repairs itself, however, if the condition is chronic (i.e. ongoing symptoms), the cycle can be blocked in any one stage.
Approximately 2.7% to 6.8% of people who experience shoulder pain will have calcific tendonitis of the rotator cuff. In turn, only 50% of people with calcification have shoulder pain. People of 30 to 50 years of age are most likely to develop this condition and women are two times more likely than men to be affected. In 10% to 25% of cases, the condition is present in both shoulders (bilaterally). Calcific tendonitis is often seen in people who must sustain specific arm positions for long periods of time, such as shoulder abduction (arm out to the side away from the body) and internal rotation. This is often the case in assembly workers or those who type on a keyboard for long periods of time.
Recent literature suggests that conservative treatment of calcific tendonitis can be of benefit for this condition. A 2009 study recommended that 6 months of conservative treatment should be considered prior to surgical intervention. This study cited physical therapy (including manual therapy and modalities), pain medications, anti-inflammatories, and corticosteroid injections as conservative treatments. More specifically, physical therapy can help to reduce stiffness of the shoulder by performing passive range of motion exercises. When pain has decreased, active range of motion and strengthening of the shoulder can be implemented. In addition, the use of therapeutic ultrasound has also been shown to help dissolve calcifications of the shoulder. In a 1999 study, ultrasound was administered (25% duty cycle, 0.89 MHz, 2.5 W/cm2) to the rotator cuff tendons for 15 minutes for 24 treatments. The first 15 treatments were administered 5 days per week for the first 3 weeks, and the remaining 9 treatments were given 3 days per week over the last 3 weeks of the study. This double-blind study was composed of two groups of patients: one group that received the ultrasound therapy and a second group that received a sham therapy (ultrasound with no effectiveness). The researchers determined that the patients who received the therapeutic ultrasound had greater decreases in pain and greater improvements in quality of life than those who had received sham treatments. However, nine months following the study the differences between the two groups were no longer significant. These results indicate that ultrasound treatment can help to resolve calcific tendonitis of the rotator cuff and is associated with short term improvement in symptoms. Furthermore, a more recent study in 2007 also suggested similar results in that 100% of subjects showed significant decreases of pain and restoration of shoulder movements after 12 treatments of therapeutic ultrasound. Although this was a smaller study (only 26 participants), results indicate clinical improvement with the use of ultrasound.
Always check with your primary care provider to determine the best course of treatment. Diagnostic tests such as x-rays may help determine if you may have calcific tendonitis of the rotator cuff. Physiotherapy treatments, such as those listed above may be of benefit for symptoms of this condition.
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