Rotator Cuff Calcific Tendonitis Treatment
Calcific tendonitis produces some of the most severe shoulder pain in orthopedics, and it is also one of the few shoulder conditions that reliably resolves on its own. Calcium deposits form within a rotator cuff tendon, sit there quietly for months or years, and then the body begins reabsorbing them, which is when the pain arrives and why it arrives so suddenly.
Calcific tendonitis resolves without surgery in the large majority of cases, and knowing when to wait is as much of the expertise as knowing when to operate. Steven Struhl, MD is board certified in orthopedic surgery and holds separate board certification in sports medicine, has practiced in New York since 1991, and serves on the faculty of NYU School of Medicine as a Fellow of the American Academy of Orthopaedic Surgeons.
What Calcific Tendonitis Is
Calcium hydroxyapatite crystals deposit inside a rotator cuff tendon, most often the supraspinatus, the tendon running across the top of the shoulder. Why this happens is not fully understood, though it is not caused by dietary calcium and it is not a sign of a systemic problem.
- Precalcific Stage: the tendon tissue changes in ways that permit deposits to form.
- Formative Stage: calcium accumulates gradually, frequently with no symptoms at all.
- Resorptive Stage: the body reabsorbs the deposit, and this is when severe pain appears.
- Postcalcific Stage: the tendon remodels and heals as the deposit clears.
The sequence explains something patients find confusing, which is why the pain gets dramatically worse at the point the condition is actually resolving. Resorption is the healing process, and it is intensely inflammatory.
Calcific Tendonitis Symptoms
- Sudden Severe Pain: often described as worse than any prior shoulder pain, arriving over hours.
- Night Pain: difficulty sleeping, with patients frequently unable to lie on that side at all.
- Marked Motion Loss: the shoulder guarded and held still because movement is intolerable.
- Visible On X Ray: unlike most tendon conditions, the deposit shows on plain film.
That last point is useful. Most shoulder tendon problems require MRI to characterize, while a calcium deposit is visible on a standard X ray, which frequently makes this a same visit diagnosis.
Treatment
- Anti Inflammatories: the first line during the acutely painful resorptive phase.
- Subacromial Injection: corticosteroid to control the inflammatory response.
- Physical Therapy: maintaining motion, introduced as pain allows rather than pushed early.
- Ultrasound Guided Needling: the deposit is punctured and lavaged under imaging guidance.
- Shockwave Therapy: extracorporeal shockwave used to break up resistant deposits.
- Arthroscopic Removal: reserved for deposits that resist everything else.
Needling under ultrasound guidance deserves particular mention. It is done in the office, it allows the calcium to be aspirated directly, and for a patient in the acute phase it can shorten a genuinely miserable period considerably.
What to Expect
Most cases resolve over weeks to months as the body finishes reabsorbing the deposit. The acute phase is the worst of it and it is self limiting, which is worth knowing when the pain is at its peak and surgery starts to sound appealing.
Surgery is uncommon here, and it is reserved for patients whose deposits persist and whose symptoms have not responded to a genuine trial of the measures above.
Schedule a Shoulder Evaluation in New York City
Shoulder pain that arrived suddenly, without an injury, and is severe enough to prevent sleep is worth an X ray early, because a calcium deposit is one of the few shoulder problems visible on a plain film and one of the few that can be treated in the office the same day. Dr. Struhl evaluates calcific tendonitis at his Manhattan and White Plains offices. Contact the practice to schedule an appointment.
