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Q: I was recently diagnosed with calcium deposits in one of the rotator cuff tendons of my shoulder. How do you treat this?
A: Calcific tendonitis of the rotator cuff is not uncommon. It is typically seen in middle aged patients, more often in women than men. Of the 4 tendons that make up the rotator cuff, the one on the top of the shoulder, the supraspinatus, is the tendon most commonly affected by this condition.
Although the cause of calcific tendonitis is unknown, some people are more predisposed to developing it. For example, one study showed that patients with lower levels of thyroid hormone and other patients with estrogen imbalances were more likely to develop this. Tendon overuse also may play a role. Patients that do a lot of repetitive overhead work or overhead lifting may be at higher risk for the condition as this can lead to chronic inflammation in the shoulder and subsequently calcific tendonitis.
Patients who have calcific tendonitis of their shoulder’s rotator cuff tendon typically experience pain over the side of the shoulder, stiffness, and loss of motion. The pain is often worse with overhead lifting and overhead activity. For example, reaching to put on a seatbelt or a coat may cause pain. Patients often have pain that awakens them from sleep.
In the office, I perform a physical exam and assess a patient’s shoulder range of motion and shoulder strength. I also obtain shoulder xrays or radiographs which show if there are calcific deposits within one of the rotator cuff tendons. I may also obtain an MRI. In addition to showing the bone like an xray does, an MRI shows all of the “soft parts,” including the tendons, muscle, cartilage, and ligaments. In cases of calcific tendonitis, an MRI may show an associated rotator cuff tendon tear.
As for the treatment of calcific tendonitis, most cases can be effectively treated non-surgically unless there is an associated rotator cuff tear. Anti-inflammatory medications help decrease the pain. I also prescribe physical therapy in order to help restore range of motion and shoulder muscle strength. Your physical therapist might also use ultrasound and other modalities to help decrease pain. A steroid injection placed superficial to the tendon may be needed to further decrease pain and swelling so that a patient can fully participate in physical therapy.
In most cases, calcific tendonitis will spontaneously resolve over time with the body slowly breaking down and resorbing the calcific deposits in the tendon. However, it can take 3-5 months for the body to resorb these calcific deposits and for symptoms to resolve.
Unfortunately, not all cases of calcific tendonitis resolve after 3 months. Larger calcium deposits may not resorb and calcium deposits in certain locations within the rotator cuff tendons are less likely to resorb. For recalcitrant cases, arthroscopic surgery may be needed. Using 2-3 quarter inch incisions around the shoulder, a camera is introduced into the shoulder and the calcific deposits are localized. These deposits are then excavated from the tendon. These deposits often have the consistency of toothpaste. The deposits are then suctioned out of the shoulder. This may be all that is required but sometimes after removing a large deposit, there may be a large defect left in the rotator cuff tendon. If this is the case, then the hole in the rotator cuff tendon needs to be repaired with stitches. This is done arthroscopically, not through a big incision. Finally, any bone spurs that are impinging on the damaged tendon are removed with a small motorized burr. Patients are placed in a sling after surgery. If there is no tendon repair, the sling may only be required for a few days, but if there is a sizeable rotator cuff tendon repair, the sling may be required for up to 6 weeks. Postoperatively, physical therapy is restarted in order to help the patient regain shoulder range of motion and strength.
Dr. Rick Cunningham is a Knee and Shoulder Sports Medicine Specialist with Vail-Summit Orthopaedics. He is a Physician for the US Ski Team and Chief of Surgery at Vail Valley Medical Center. Do you have a sports medicine question you’d like him to answer in this column? Visit his website at www.vailknee.com to submit your topic idea. For more information about Vail-Summit Orthopaedics, visit www.vsortho.com.