Calcific Tendinopathy (CT) of the Shoulder

Calcific shoulder, also known as calcific tendonitis, is a painful and often frustrating condition that primarily affects the rotator cuff tendons within the shoulder.

This condition occurs when calcium deposits build up in the tendons, typically in the supraspinatus tendon, leading to pain, inflammation, and restricted movement. Calcific shoulder can be confusing to manage and diagnose, especially because its symptoms often overlap with other shoulder conditions, such as frozen shoulder and rotator cuff tears. In this article, we’ll dive deeply into what calcific shoulder is, explore its symptoms, stages, treatment options, and discuss both traditional and alternative therapies, including massage and manual therapy approaches.

Understanding Calcific Shoulder

Calcific shoulder is a specific type of calcific tendonitis where calcium deposits accumulate within the rotator cuff tendons, causing irritation, inflammation, and often severe pain. This condition is more commonly seen in adults, typically between the ages of 30 and 60, and is more frequent in women than men. The precise cause of calcific shoulder remains unclear, though it is believed that factors like decreased oxygen levels in the tendons, repetitive use, and age-related degeneration may play a role.

There are two primary types of calcific tendonitis:

- Degenerative Calcification: Typically occurs with age or chronic degeneration of the tendons.
- Reactive Calcification: This form appears spontaneously, without clear signs of prior tendon degeneration, and seems to have more active inflammation and symptoms.

In most cases, calcific deposits are reabsorbed by the body over time, but during the active stages, pain and discomfort can become quite intense.

Symptoms of Calcific Shoulder

Symptoms of calcific shoulder can vary depending on the stage of the calcium deposit. Typically, the condition presents with the following symptoms:

Pain: The most common symptom, ranging from mild to severe. This pain may become worse at night, especially if lying on the affected shoulder.
Limited Range of Motion: Movement, especially lifting the arm overhead or behind the back, may become difficult and painful.
Swelling and Stiffness: Inflammation may cause the shoulder to feel stiff and swollen.
Localized Tenderness: The affected area may be tender to the touch, and clients may report a deep, aching sensation around the shoulder.

These symptoms often mimic those of rotator cuff tears, impingement syndrome, and frozen shoulder, which can make diagnosis a bit tricky.

The Stages of Calcific Tendonitis

Calcific shoulder follows a natural progression through three main stages:

Pre-calcification Stage: This initial stage is typically asymptomatic. Changes are occurring within the tendon, but calcium deposits have not yet formed.

Calcific Stage: During this stage, calcium deposits form and solidify within the tendon. This stage has three sub-phases:

 

 

- Formative Phase: The calcium deposit begins to develop within the tendon. Pain may begin but isn’t always severe at this stage.
- Resting Phase: The calcium deposit becomes stable, and symptoms may temporarily subside.
- Resorptive Phase: The body begins to break down and absorb the calcium deposit, often causing intense pain and inflammation. This is typically the most painful stage.

Post-calcific Stage: The tendon gradually returns to its normal state, and symptoms generally subside as the calcium deposit is fully reabsorbed.

Diagnosing Calcific Shoulder

A thorough assessment by a healthcare professional is essential for accurately diagnosing calcific shoulder. The process generally includes:

Physical Examination: An assessment of the shoulder’s range of motion, strength, and specific pain points can help identify possible calcific tendonitis.
X-rays: Calcific deposits are visible on X-rays and are often the primary method for confirming the presence of calcification in the tendons.
Ultrasound: This imaging can provide more detailed views of the soft tissue and may reveal the exact size and location of the calcium deposits.
MRI: Though less commonly used, MRI can show tendon inflammation, damage, or other underlying conditions that may be contributing to the symptoms.

Treatment Options for Calcific Shoulder

Treatment for calcific shoulder can vary based on the stage and severity of the condition. In some cases, conservative approaches like physical therapy, medication, or steroid injections may be sufficient, while more advanced cases may require invasive options. Below are the main treatments available:

1. Conservative Treatments

Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to manage pain and reduce inflammation.
Corticosteroid Injections: Injections can provide relief by reducing inflammation, though they do not directly affect the calcium deposits.
Physiotherapy: Strengthening and stretching exercises help improve shoulder mechanics and restore function.

2. Shockwave Therapy

Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment that uses acoustic waves to break down the calcium deposits. Research suggests that shockwave therapy can be effective in breaking down calcific deposits and promoting healing in the surrounding tissue. However, it can be painful, and multiple sessions are typically needed for full effectiveness.

3. Needle Aspiration

In this procedure, a specialist uses ultrasound to guide a needle into the calcium deposit, breaking it down and flushing it out with saline solution. Needle aspiration can be an effective way to remove calcium deposits without surgery, providing significant relief for many patients.

4. Surgery

For severe or persistent cases that do not respond to conservative treatments, arthroscopic surgery may be recommended. During the procedure, the surgeon removes the calcific deposits and repairs any damaged tendons.

Massage Therapy for Calcific Shoulder

Massage therapy can play a supportive role in the management of calcific shoulder, especially for pain relief and maintaining mobility. While massage won’t directly remove the calcific deposits, it can help reduce muscle tension, improve circulation, and alleviate the referred pain often associated with calcific tendonitis. Below are some massage techniques commonly used:

Trigger Point Therapy: Trigger points in the rotator cuff muscles, particularly the infraspinatus and supraspinatus, can contribute to shoulder pain. Gently applying pressure to these trigger points can relieve muscle tension and referred pain.
Myofascial Release: This technique helps release restrictions in the fascia, enhancing mobility and reducing muscle tension around the shoulder.
Effleurage and Petrissage: These light to moderate pressure strokes can be used to promote relaxation, reduce muscle tension, and increase blood flow to the affected area.

Alternative Therapies for Calcific Shoulder

Several alternative therapies may offer symptomatic relief for those with calcific shoulder:

Acupuncture: By stimulating specific points in the body, acupuncture may reduce pain and inflammation.
Cupping Therapy: Cupping can increase blood flow, reduce muscle tension, and alleviate pain, making it a potential adjunct therapy for calcific shoulder.
Ultrasound Therapy: Therapeutic ultrasound uses sound waves to promote healing and reduce pain, which can be beneficial in managing calcific tendonitis.

Importance of Self-Care and Lifestyle Modifications

In addition to professional treatments, incorporating self-care practices can make a meaningful difference in managing calcific shoulder. Ice packs can help reduce inflammation and numb the area, particularly after exercise or therapy. Heat therapy may help loosen tight muscles around the shoulder joint, though it should be used cautiously during the inflammatory phases.

Final Thoughts

Calcific shoulder is a challenging condition that requires a multifaceted approach to manage effectively. From conservative measures like physical therapy and shockwave therapy to more targeted interventions like needle aspiration or surgery, there are a variety of options to explore. Alternative therapies like massage and acupuncture offer additional ways to manage pain and maintain mobility.

Disclaimer

This article is for informational purposes only and should not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before beginning any new treatment or therapy, especially if you have a medical condition.

References

Uhthoff, H. K., & Loehr, J. W. (1997). Calcific tendinopathy of the rotator cuff: Pathogenesis, diagnosis, and management. Journal of the American Academy of Orthopaedic Surgeons, 5(4), 183-191.
Speed, C. A., & Nichols, N. (2010). Shoulder pain. BMJ, 341, c5010.
Ebenbichler, G. R., Erdogmus, C. B., Resch, K. L., et al. (1999). Ultrasound therapy for calcific tendinitis of the shoulder. The New England Journal of Medicine, 340(20), 1533-1538.