Calcific Tendinitis

Calcific tendinitis is a common and often painful condition characterized by the accumulation of calcium deposits within the tendons, most frequently affecting the rotator cuff tendons of the shoulder. This condition can lead to significant discomfort, reduced mobility, and impaired function, impacting daily activities and quality of life. Understanding the causes, symptoms, diagnosis, and treatment options for calcific tendinitis is essential for effective management and recovery.

What is Calcific Tendinitis?

Calcific tendinitis, also known as calcific tendonitis, occurs when calcium phosphate crystals build up in the tendons, causing inflammation and pain. The most commonly affected tendon is the supraspinatus tendon, part of the rotator cuff in the shoulder, but calcific deposits can also occur in other tendons such as those in the wrist, hip, or Achilles tendon.

The exact cause of calcium deposit formation is not fully understood, but it is believed to be related to a process of tendon degeneration and repair. The condition typically progresses through three stages:

Pre-calcific stage: Tendon cells undergo changes that predispose them to calcium deposition.
Calcific stage: Calcium crystals accumulate within the tendon, often causing intense inflammation and pain.
Post-calcific stage: The body gradually reabsorbs the calcium deposits, and the tendon heals.

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Causes and Risk Factors

While the precise cause of calcific tendinitis remains unclear, several factors may contribute to its development:

Tendon degeneration: Repetitive microtrauma or wear and tear can weaken tendons, making them more susceptible to calcium deposits.
Metabolic factors: Abnormal calcium metabolism or disorders such as diabetes may increase the risk.
Age and gender: It most commonly affects adults between 30 and 50 years old and is slightly more prevalent in women.
Genetic predisposition: Some individuals may have a genetic tendency toward developing calcific deposits.
Poor blood supply: Tendons with limited blood flow may be more prone to degeneration and calcification.

Symptoms of Calcific Tendinitis

The symptoms of calcific tendinitis can vary depending on the stage of the condition and the size of the calcium deposits. Common symptoms include:

Severe shoulder pain: Often sudden and intense, especially during the calcific stage.
Limited range of motion: Difficulty lifting the arm or performing overhead activities.
Tenderness: Pain when pressing on the affected tendon.
Stiffness: Reduced flexibility and stiffness in the shoulder joint.
Night pain: Discomfort that worsens at night, interfering with sleep.

In some cases, the condition may be asymptomatic, with calcium deposits discovered incidentally during imaging for other reasons.

Diagnosis

Diagnosing calcific tendinitis involves a combination of clinical evaluation and imaging studies:

Physical examination: A healthcare provider will assess pain, tenderness, and range of motion.
X-rays: These are the most common imaging tool used to detect calcium deposits in the tendons.
Ultrasound: Useful for visualizing the size and location of calcium deposits and assessing tendon inflammation.
MRI: May be used to evaluate the extent of tendon damage and rule out other shoulder pathologies.

Early diagnosis is important to prevent chronic pain and tendon damage.

Treatment Options

Treatment for calcific tendinitis depends on the severity of symptoms and the stage of the condition. Many cases resolve spontaneously as the body reabsorbs the calcium deposits, but intervention may be necessary to relieve pain and restore function.

Conservative Treatments

Rest and activity modification: Avoiding activities that exacerbate pain can help reduce inflammation.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen or naproxen can alleviate pain and inflammation.
Physical therapy: Exercises to improve shoulder strength, flexibility, and range of motion are crucial for recovery.
Cold and heat therapy: Applying ice packs can reduce acute inflammation, while heat may help relax muscles and improve blood flow.
Corticosteroid injections: These can provide temporary relief by reducing inflammation around the tendon.

Minimally Invasive Procedures

If conservative treatments fail, more advanced interventions may be considered:

Needling and lavage (barbotage): Under ultrasound guidance, a needle is used to break up and aspirate calcium deposits, followed by saline lavage to flush out debris.
Extracorporeal shock wave therapy (ESWT): High-energy shock waves are applied to the affected area to stimulate healing and break down calcium deposits.
Platelet-rich plasma (PRP) injections: PRP may promote tendon healing by delivering growth factors directly to the damaged tissue.

Surgical Treatment

Surgery is typically reserved for severe or persistent cases that do not respond to other treatments. Surgical options include:

Arthroscopic removal: A minimally invasive procedure where calcium deposits are removed using small instruments inserted through tiny incisions.
Open surgery: In rare cases, open surgery may be necessary to excise large deposits or repair significant tendon damage.

Post-surgical rehabilitation is essential to restore shoulder function and prevent recurrence.

Prognosis and Recovery

The prognosis for calcific tendinitis is generally good, especially with timely and appropriate treatment. Many patients experience significant pain relief and improved function within weeks to months. However, recovery time can vary depending on the size of the calcium deposits, the severity of inflammation, and the treatment approach.

Some patients may experience recurrent symptoms or chronic shoulder pain, particularly if the condition is left untreated or if there is underlying tendon degeneration.

Prevention Tips

While it may not be possible to completely prevent calcific tendinitis, certain measures can reduce the risk:

Maintain good shoulder flexibility and strength through regular exercise.
Avoid repetitive overhead activities that strain the shoulder.
Use proper techniques during sports and physical activities.
Manage underlying health conditions such as diabetes.
Seek early medical attention for shoulder pain to prevent progression.

Conclusion

Calcific tendinitis is a painful condition caused by calcium deposits in the tendons, most commonly affecting the shoulder. Understanding its symptoms, causes, and treatment options can help patients manage the condition effectively. With appropriate care, most individuals recover well and regain full shoulder function. If you suspect you have calcific tendinitis, seek medical advice to receive a proper diagnosis and personalized treatment plan.

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