What is Rotator Cuff Calcific Tendonitis
The rotator cuff is comprised of a group of four tendons that work together to stabilize the shoulder joint, as well as to move the shoulder in specific directions. These four muscles are known as the subscapularis, the supraspinatus, the infraspinatus and the teres minor. Each muscle is responsible for certain ranges of motion and movement in the shoulder. Each of the muscles is attached to the scapula, or shoulder blade, and has a tendon that subsequently attaches to the humerus, which is the long bone in the arm that goes from the shoulder to the elbow. The rotator cuff can be susceptible to damage and tears, and sometimes a condition called rotator cuff calcific tendonitis. This is a condition that causes the formation of a small, usually about 1-2 centimeter size, calcium deposit within the tendons of the rotator cuff. These types of calcium deposits are not always common, are usually found in patients over 30 years old, and can be more common in diabetics.
What Causes Calcinic Tendonitis
It is not fully understood why calcium deposits form in the rotator cuff. A few causes have been suggested:
- Lack of blood supply to the tendon, caused by immobility, lack of exercise and inflammation
- Aging of the tendon
- Delayed healing of an injury. In this case, the normal sequence of healing in a tendon involves action of fibroblasts, which regenerate the tendon tissue. If healing isn’t complete, fibroblasts are replaced by osteoblasts, or bone forming cells. These cells will stimulate the growth of calcium, or bone, within the tendon – thus creating a calcium deposit.
The sequence of events for the formation of calcinic tendonitis is as follows:
- In the asymptomatic precalcification stage, the area of calcification starts to experience cellular changes within the fibroblasts, which precedes the formation of the deposit.
- During the next stage, known as calcific stage, the calcium begins to be excreted from the cells and then merges into calcium deposits. This calcium resembles a murky, chalky consistency, as opposed to solid bone. Once the calcium deposit is formed, it goes into a resting phase that may last for a variable length of time.
- After the resting phase, comes the resorptive phase, which is also the most painful phase of calcific tendonitis.
- Finally, during the postcalcific stage, the calcium deposit disappears and the rotator cuff tendon resumes its usual state.
How to treat Calcinic Tendonitis of the Rotator Cuff
Rehabilitation via rest and physiotherapy is the only option for healing calcium deposits of the rotator cuff. Treat the condition with the following protocols:
- Anti-inflammatory and pain medications
- Physiotherapy that involves movements to retain strength and flexibility in the shoulder and it’s tendons
- Cortisone injections can help reduce inflammation and pain
- Application of moist heat via a warm washcloth or a heat bag, which is exceptionally helpful with the pain of calcinic tendonitis.
- An ultrasound-guided “barbatoge” upon which a saline solution is injected into the shoulder area and flushes out the calcium deposit. This is effective for calcium deposits that are causing a lot of pain and discomfort
- Surgery, which removes the calcium deposit completely. This will not prevent the deposit from returning though. Surgery is only recommended when symptoms won’t go away, regardless of treatment, and the pain interferes with everyday activities such as getting dressed etc.
If surgery is the only choice, the procedures may include needling or aspiration of the deposit. Needling is a surgical procedure that has to be performed while under sedation or general anesthesia. Your surgeon will place a large needle into the calcium deposit and attempt to remove via suction the majority of the calcium deposit. The calcium resembles toothpaste in this instance. Sometimes an injection of saline, novocaine or cortisone will be injected to help facilitate the healing. The procedure has little recovery time and the patient can usually resume activity shortly after the procedure.
Another surgical procedure involves a technique called excision. This is useful in cases of rotator cuff calcific tendonitis that is more chronic or involving a larger calcium deposit. Your surgeon will operate via a small incision in the shoulder or through arthroscopy. He or she will identify the calcium deposit and remove it. Physical therapy is often necessary after surgery, as it will assist with regaining strength and movement in the affected shoulder.