What is calcific tendonitis ?
Calcification in a tendon occurs when calcium deposits accumulate within the tendon structure. The exact cause of tendon calcification is not fully understood and is thought to be an abnormal healing or repair response by the body in response to a combination of;
- mechanical stress
- repetitive microtrauma
- underlying metabolic abnormalities.
It most commonly affects the shoulder (rotator cuff tendons) and can also occur in the elbow, hip, and knee tendons.
What happens in calcification of the tendon ?
The process of calcification typically involves three stages:
- Pre-calcific Stage: In this stage, there is an initial inflammatory response within the tendon, which leads to the release of substances that attract calcium to the region.
- Calcific Stage: Calcium salts begin to accumulate within the tendon, forming deposits that can vary in size and density. These deposits can be visualized using imaging techniques such as X-rays or ultrasound.
- Post-calcific Stage: During this stage, the calcium deposits may undergo resorption or become organized into a more stable form. In some cases, the deposits can cause inflammation, leading to pain and further tendon damage.
Interestingly its the last stage when the calcification is resolving that appears to be the painful stage. So if you have a painful shoulder due to calcium deposits the chances are its on the way out.
Treatment Approaches for Calcification in Tendons:
The treatment of calcification in tendons aims to alleviate pain, improve function, and promote the resolution of calcium deposits. Here are some of the best treatment approaches:
- Physiotherapy for calcification.
- Reducing or modifying activities that aggravate the symptoms can help minimize pain and prevent further tendon problems. Its the old adage of settle it down then build it back up again.
- Specific exercises, especially strength based exercises, and manual therapy techniques can be employed to improve tendon strength and reduce risk of recurrance.
This is always best discussed with your GP who is best placed to advise you on medications that can help reduce pain and inflammation associated with calcific tendinitis. However, they do not address the underlying calcium deposits.
- Extracorporeal Shockwave Therapy (ESWT):
ESWT involves the application of high-energy sound waves to the affected tendon. It stimulates the healing process, reduces pain, and can help break down the calcium deposits. Find out more here
- Ultrasound-guided Needle Aspiration (Barbotage) and Lavage:
This procedure involves inserting a needle into the tendon under ultrasound guidance to aspirate or break up the calcium deposits. It is often followed by injecting a solution to wash out the debris.
- Surgical Intervention:
In severe cases or when conservative treatments fail to provide relief, surgical intervention may be considered. Procedures such as arthroscopic debridement, which involves removing the calcium deposits and addressing any underlying tendon damage, can be performed.
Despite calcification in tendons causing significant pain and functional limitations it does respond well to various interventions. Understanding the pathology of calcification and the available treatment options is essential for effective management. While conservative approaches, including rest, physical therapy, and medications, form the initial line of treatment, more advanced interventions like shockwave therapy, barbotage, or surgical intervention may be necessary in certain cases.