Calcific Tendonitis

Calcific tendonitis is a common condition where calcium deposits form in your tendons, most often in the rotator cuff tendons of your shoulder. This can cause significant pain and stiffness, especially when moving your arm. While the exact cause is often unknown, it usually resolves on its own over time, though treatments can help manage symptoms.

What is Calcific Tendonitis?

Calcific tendonitis is a condition characterized by the formation of calcium deposits within the tendons, which are the strong cords connecting muscles to bones. It most commonly affects the rotator cuff tendons in the shoulder, leading to pain and limited movement. These deposits can range in size and may cause symptoms when they form, grow, or dissolve.

Tendons are crucial for movement, allowing muscles to pull on bones. In calcific tendonitis, tiny calcium crystals build up within these tendons. This process is not fully understood but is thought to be part of a degenerative or reactive process within the tendon tissue itself. The shoulder's rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, helping you lift and rotate your arm. When calcific tendonitis affects these tendons, it can make everyday activities like reaching overhead or sleeping on your side very painful. While the shoulder is the most common site, calcific deposits can sometimes occur in other tendons throughout the body, such as those in the elbow, wrist, hip, or knee. However, these occurrences are much less frequent than in the shoulder. The condition typically progresses through stages: a pre-calcific stage where changes occur in the tendon, a calcific stage where deposits form and may grow, and a post-calcific stage where the body reabsorbs the calcium, which can be very painful.

Symptoms

The main symptom of calcific tendonitis is often severe pain in the affected area, most commonly the shoulder. This pain can come on suddenly or develop gradually, worsening with movement or at night. You might also experience stiffness, tenderness, and a reduced range of motion in the joint.

Pain associated with calcific tendonitis can range from mild to intense. It is often described as a dull ache that can become sharp with certain movements. Many people find the pain is worse when they try to lift their arm, reach behind their back, or sleep on the affected side. In addition to pain, you may notice a feeling of stiffness in your shoulder, making it difficult to move your arm fully. This reduced range of motion can impact daily tasks, such as dressing or brushing your hair. The area around the affected tendon might also feel tender to the touch. Symptoms can vary depending on the stage of the condition. During the formation stage of calcium deposits, pain may be mild or absent. However, during the reabsorption stage, when the body tries to break down and remove the calcium, the pain can become very severe and acute, often described as excruciating. Some people with calcific tendonitis experience no symptoms at all, and the calcium deposits are only discovered incidentally during imaging tests for other conditions. However, for those who do have symptoms, they can significantly impact quality of life.

Causes & risk factors

The exact cause of calcific tendonitis is not fully understood, but it is believed to be related to changes in the tendon tissue rather than injury or overuse. It is not typically caused by diet or calcium intake. Risk factors include age, with people between 30 and 60 years old being most commonly affected, and certain medical conditions like diabetes.

Calcific tendonitis is generally considered a degenerative process where tendon cells transform and lead to calcium deposition. It is not usually linked to trauma, repetitive strain, or sports injuries, although these can sometimes aggravate an existing condition. Unlike kidney stones or gallstones, the calcium deposits in tendons are not related to the amount of calcium in your diet or calcium supplements you might take. It's a localized process within the tendon itself, not a systemic issue with calcium metabolism. Age is a significant risk factor; calcific tendonitis most often affects adults between 30 and 60 years old. It is less common in younger individuals and older adults. Women may be slightly more affected than men, though this difference is not always significant across studies. Certain medical conditions have been linked to a higher risk of developing calcific tendonitis. People with diabetes, for instance, appear to have a higher incidence of the condition. Other less common associations include thyroid disorders and certain genetic predispositions, though more research is needed to fully understand these links.

How it's diagnosed

Calcific tendonitis is typically diagnosed based on your symptoms, a physical examination, and imaging tests. Your doctor will assess your pain, range of motion, and tenderness. X-rays are the primary tool for confirming the presence and location of calcium deposits, as they are clearly visible on these images.

During a physical exam, your doctor will ask about your symptoms, including when they started, what makes them worse, and what helps relieve them. They will then gently move your arm in various directions to check your range of motion and identify areas of pain or tenderness in your shoulder. X-rays are the most common and effective imaging test for diagnosing calcific tendonitis. Calcium deposits show up clearly as bright white spots on an X-ray image, allowing your doctor to confirm their presence, size, and exact location within the tendon. This helps rule out other shoulder conditions. Sometimes, other imaging tests may be used if the diagnosis is unclear or if your doctor suspects other issues. An ultrasound can also visualize calcium deposits and assess the surrounding soft tissues. Magnetic resonance imaging (MRI) is less effective at directly showing calcium but can help evaluate the overall health of the rotator cuff and rule out tears or other problems. Your doctor will use all this information to make an accurate diagnosis and develop a suitable treatment plan. It's important to share your full medical history and all symptoms to help guide this process.

Treatment options

Treatment for calcific tendonitis usually starts with conservative methods aimed at pain relief and reducing inflammation. These include rest, ice, pain medications, and physical therapy. If these don't provide enough relief, your doctor might suggest procedures like corticosteroid injections, needling, or shockwave therapy. Surgery is typically a last resort for persistent, severe cases.

Initial treatments focus on managing pain and inflammation. Rest from activities that worsen your pain is important, along with applying ice to the affected area. Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, can help reduce pain and swelling. Physical therapy plays a key role in restoring shoulder function. A physical therapist can guide you through exercises to maintain or improve your range of motion and strengthen the muscles around your shoulder. This can help prevent stiffness and improve overall shoulder mechanics. If conservative treatments are not enough, your doctor may suggest other options. Corticosteroid injections directly into the affected area can provide temporary pain relief by reducing inflammation. However, these are typically used sparingly due to potential side effects. Other procedures include therapeutic ultrasound, which uses sound waves to break up calcium deposits, or extracorporeal shockwave therapy (ESWT), which uses high-energy sound waves to stimulate the body's healing process and dissolve deposits. Barbotage, a procedure performed under ultrasound guidance, involves using a needle to break up and remove calcium deposits. Surgery, usually arthroscopic (minimally invasive), is considered if symptoms are severe and persistent after at least six months of other treatments, to remove the calcium deposits directly.

Recovery & outlook

Most people with calcific tendonitis experience significant improvement with conservative treatments, and the condition often resolves on its own over time as the body reabsorbs the calcium deposits. Recovery can take several months to a year, but the outlook is generally good. Some individuals may experience recurring symptoms or require more advanced interventions.

The natural course of calcific tendonitis often involves the body gradually reabsorbing the calcium deposits. This process can be slow, sometimes taking several months or even a few years, but it typically leads to a resolution of symptoms for many individuals. Pain often lessens as the deposits shrink or disappear. Engaging in physical therapy and following your doctor's recommendations for pain management are crucial for a smoother recovery. Consistency with exercises helps maintain flexibility and strength, preventing the shoulder from becoming stiff or weak during the healing process. While most cases resolve without surgery, a small percentage of people may continue to experience persistent pain and limited function. For these individuals, procedures like shockwave therapy, barbotage, or surgical removal of the deposits can offer significant relief and improve long-term outcomes. Even after successful treatment or natural resolution, there's a possibility of calcific tendonitis recurring in the same or other tendons, though this is not common. Maintaining good shoulder health through regular exercise and avoiding overuse can help reduce the risk of recurrence.

When to see a doctor

You should see a doctor if you experience persistent or severe shoulder pain that interferes with your daily activities or sleep. Seek medical attention if your pain does not improve with rest and over-the-counter pain relievers, or if you notice a significant loss of motion or weakness in your arm.

It's important to consult a healthcare professional if your shoulder pain is new, worsening, or lasts for more than a few days. Early diagnosis and treatment can help manage symptoms and prevent the condition from becoming more debilitating. If you find that simple activities like lifting objects, reaching overhead, or even getting dressed become difficult or cause intense pain, it's a clear sign to seek medical advice. These symptoms can indicate calcific tendonitis or other underlying shoulder problems that require professional evaluation. Additionally, if you experience pain that wakes you up at night or prevents you from sleeping comfortably, this warrants a visit to your doctor. Night pain is a common complaint with calcific tendonitis and can significantly impact your quality of life. Do not try to self-diagnose or ignore severe symptoms. A doctor can accurately diagnose your condition and recommend the most appropriate treatment plan to help you find relief and restore function to your shoulder.

Frequently asked questions

Is calcific tendonitis the same as arthritis?

No, calcific tendonitis is not the same as arthritis. Arthritis involves inflammation or degeneration of the joint cartilage, while calcific tendonitis specifically refers to calcium deposits within the tendons, which are different structures that connect muscles to bones.

Can calcific tendonitis be prevented?

Currently, there are no known specific ways to prevent calcific tendonitis because its exact cause is not fully understood. It is not typically related to diet, exercise, or injury. However, maintaining good shoulder health and seeking early treatment for any shoulder pain may help manage symptoms.

How long does calcific tendonitis last?

The duration of calcific tendonitis can vary greatly. For many people, the condition resolves on its own as the body reabsorbs the calcium deposits, which can take several months to a few years. With treatment, symptoms may improve more quickly, but the underlying deposits still take time to resolve.

Does calcific tendonitis require surgery?

Most cases of calcific tendonitis do not require surgery. Initial treatment focuses on conservative methods like rest, pain medication, and physical therapy. If these are not effective, non-surgical procedures like shockwave therapy or barbotage are often tried before considering surgery as a last resort for persistent, severe symptoms.

Is calcific tendonitis related to calcium in my diet?

No, calcific tendonitis is not related to the amount of calcium in your diet or calcium supplements. The calcium deposits form due to a localized process within the tendon itself, not from systemic calcium levels in your blood or what you eat or drink.

Can calcific tendonitis affect other parts of the body besides the shoulder?

While calcific tendonitis most commonly affects the rotator cuff tendons in the shoulder, it can occasionally occur in other tendons throughout the body. Less common sites include the elbow, wrist, hip, or knee, but the shoulder remains the predominant location.

Sources

• MedlinePlus — Calcific Tendonitis
• Mayo Clinic — Calcific Tendonitis
• Cochrane Library — Calcific Tendonitis