CALCIFIC TENDONITIS: WHAT IS IT AND HOW IS IT TREATED?

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Calcific Tendonitis

Tendonitis is a commonly experienced condition when a person overuses or injures a tendon during an athletic activity or through physical labor. A tendon is tissue that attaches muscle to the bone. It is flexible, tough and fibrous and is able to withstand a lot of tension. Injury, overuse or loss of elasticity due to age, however, can leave you with the pain and inflammation associated with tendonitis.

Interestingly, you can also suffer from tendonitis without even having a sports-related injury or through overuse. Pain and inflammation of any one of your tendons can occur through a condition called calcific tendonitis.  

WHAT IS CALCIFIC TENDONITIS?

Calcific tendonitis is a disorder where calcium hydroxyapatite crystals deposit themselves in one of your tendons, mainly occurring in the shoulder and hip. Hydroxyapatite is the major component and essential ingredient in normal bone and teeth development. Furthermore, hydroxyapatite is what gives bones and teeth their rigidity.

In calcific tendonitis, hydroxyapatite molecules group together and crystalize to form calcified clumps or deposits. In other words, when these hard deposits form in your tendons, they become irritated, inflamed and painful. 

WHERE DOES CALCIFIC TENDONITIS OCCUR?

Calcific tendonitis can occur on almost any tendon in the body. The most common area for calcific tendonitis to occur, however, is in the rotator cuff of the shoulder. The rotator cuff houses the group of muscles and tendons that provide strength and stability to the upper arm and shoulder.  In addition, the hip is the next most common area to be affected by calcific tendonitis after the shoulder. Other common sites are the tendons of the hand, wrist, foot, ankle and neck.

WHO GETS CALCIFIC TENDONITIS?

On average, people between the ages of 30 and 60 are the most affected by calcific tendonitis. Also, the condition occurs slightly more frequently in women.

WHAT ARE THE SYMPTOMS OF CALCIFIC TENDONITIS?

The main symptoms of calcific tendonitis are pain and limited range of motion in the affected area. Although it is possible to have the condition without any symptoms, some people may experience severe issues, with pain worsening at night and interfering with sleep. Additionally, the pain may also occur spontaneously in the morning and be disabling throughout the day. This is a condition that develops over time. Pain and discomfort may also develop over time, as the calcium deposits go through their three different stages.

The three stages of calcific tendonitis are:

  1. Pre-Calcification Stage. The body begins to undergo cellular changes in the areas where the calcium hydroxyapatite crystals will eventually build up.
  2.  Calcific Stage. Calcium releases from the cells and begins to build up. This phase is the most painful and can be further subdivided into its own three stages:
    1. Formative – The calcium crystals are formed and deposited.
    2. Resting – The termination of calcium deposition.
    3. Resorptive – The calcium deposits are reabsorbed by the body. Severe, acute pain is typically associated with this phase.
  3. Post-Calcific Stage. The calcium deposits disappear, and a healthy tendon is formed to take the place of the damaged one.

WHAT CAUSES CALCIFIC TENDONITIS?

Experts can’t say for certain as to why some people are more prone to calcific tendonitis than others, but the buildup of calcium deposits may be linked to one of the following factors:

  • Aging
  • Damage to tendons
  • Lack of oxygen to tendons
  • Genetics
  • Abnormal thyroid gland activity
  • Abnormal cell growth
  • Chemicals produced by the body that fight inflammation
  • Metabolic diseases like diabetes

HOW IS CALCIFIC TENDONITIS DIAGNOSED?

When you visit your doctor, he or she will ask you about your symptoms and medical history. They will also perform a physical examination of the affected area to check the pain level and see whether your range of motion has changed. After that, you may be referred to a specialist, such as an orthopedic surgeon. If they suspect calcific tendonitis, imaging tests to reveal any calcium deposits should be requested.

Imaging tests may include:

  • Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Both may be used to rule out any other aggressive disorders that could be causing the pain.
  • X-Ray – Used to identify large build-ups of calcium deposits.
  • Ultrasound Scan – Used to reveal any smaller deposits that an X-ray may have missed.

The size of the calcium deposits found by these tests will affect the treatment plan.

HOW IS CALCIFIC TENDONITIS TREATED?

Although most cases of calcific tendonitis resolve over time, medication and physical therapy are the suggested treatments. In rare, severe cases, surgery may be required.

Common treatments for calcific tendonitis include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), heat and/or ice and prescribed corticosteroid injections that help relieve pain and swelling.

Other treatments that can help relieve the symptoms of calcific tendonitis include:

  • Ultrasound – A device that uses high energy sound waves to decrease the pain in soft tissue.
  • Percutaneous Needling – The use of a needle with lidocaine for numbing and removing the calcium deposits.
  • Transcutaneous electrical nerve stimulation (TENS) – Used to decrease muscle stiffness or spasms.
  • Lavage Treatment – Saline solution is injected through a needle and the calcium deposits are broken up and flushed out.
  • Shock Wave Therapy – Sound waves are sent to the affected area, breaking up the deposits so they can be reabsorbed by the body.
  • Platelet-Rich Plasma – Injections of platelet-rich plasma have been reported to resolve symptoms of calcific tendonitis.
  • Surgery – About 10% of the cases will require surgical removal of the calcium deposits. This is mainly done through arthroscopic surgery, where a small incision is made and a small camera is inserted to view the affected joint and remove the deposits.

WHAT IS THE OUTCOME FOR CALCIFIC TENDONITIS?

Calcific tendonitis is a potentially chronic and debilitating condition that can cause acute-onset pain at any time.  The pain from calcific tendonitis can cause discomfort and limit your range of motion in the affected joint. Therefore, this can greatly affect your quality of life.

When diagnosed properly, and after ruling out any more serious conditions, calcific tendonitis can usually be treated effectively with conservative treatment such as pain medication. Quick, simple procedures to clear out the deposits are also recommended. Surgery and physical therapy may also occur for more serious cases of the condition. Any or all of these can help heal the condition and relieve all symptoms.

Although calcific tendonitis can disappear on its own, ignoring the condition is not recommended. It could lead to more severe issues such as rotator cuff tears and frozen shoulder.

Once calcific tendonitis resolves itself, there is no evidence to suggest that it will return. If you have suffered from the condition, however, you should remain aware of the symptoms and report any new onset of pain to your doctor.

If you found this article on Calcific Tendonitis informative, you may also enjoy reading Could Your Knee Pain Be Patellar Tendonitis?