Calcific shoulder (tendinitis calcarea)

The shoulder joint is formed by the head of the upper arm (humerus) and the socket, which is part of the shoulder blade (scapula). This joint is stabilized by 4 muscles called the rotator cuff. These muscles are located on the front and back of the scapula and surround the humeral head: supraspinatus muscle, infraspinatus muscle, teres minor muscle and subscapularis muscle.

Calcific tendinitis (tendinitis calcarea) is a painful, inflammatory disease of the shoulder caused by calcium deposits in the tendons of the rotator cuff. The tendon of the supraspinatus muscle (supraspinatus tendon) is most frequently affected by these calcifications.

Tendinitis calcarea is part of a symptom complex called subacromial pain syndrome (SAPS). The subacromial syndrome summarizes several diseases of the subacromial space. These include tendinosis/tendinitis calcarea with calcification in the tendons, the impingement syndrome with entrapment of soft tissue structures under the acromion in the subacromial space, or so-called bursitis (bursitis subacromialis).

Signs of calcified shoulder may include:

• Restricted movement in the affected shoulder
• Movement-dependent pain, also at rest and at night
• Signs of inflammation (overheating, swelling, redness of the shoulder region)

In calcareous shoulder, the spectrum of symptoms can range from no pain at all (tendinosis calcarea) to very severe pain (tendinitis calcarea).

The main symptom of this clinical picture is pain in the affected shoulder, which is aggravated by movements of the arm, especially by lifting the arm. The cause of this pain is calcium deposits in the tendon, which lead to increased pressure in this tissue.

The supraspinatus tendon is the tendon of the rotator cuff most frequently affected by calcification. Because the supraspinatus tendon runs in a narrow space under the acromion, calcium deposits in this tendon lead to painful impingement of the tendon with every movement of the arm. This leads to significantly restricted mobility in the affected shoulder joint.

In more advanced stages, shoulder pain persists at rest and at night.

If the tendon becomes inflamed in the further course (tendinitis), typical signs of inflammation such as overheating, swelling and redness of the shoulder joint region may become visible in addition to the pain.

If the inflammation of this tendon also spreads to the neighboring bursa (bursa subacromialis), this can also become inflamed (bursitis). The pain is then often so severe that a so-called pseudoparalysis (reduced movement) of the arm occurs: the arm can practically no longer be moved under its own power due to pain. Even any passive movement leads to severe attacks of pain.

Causes of calcified shoulder include:

• Unsettled

The exact causes of calcific shoulder are not fully understood at this time. It is assumed that a reduced blood supply in the area of the rotator cuff tendons leads to a conversion of the normal tendon cells into calcium-producing cells.

Our shoulder specialists will interview you in detail regarding your complaints. This will be followed by a functional examination of the affected shoulder, during which mobility will be checked.

To differentiate calcified shoulder from other painful diseases of the shoulder joint, further imaging diagnostics, such as an X-ray or magnetic resonance imaging (MRI), are recommended. The X-ray can reveal calcium deposits in the muscles, while the MRI examination provides evidence of inflammation of the tendon or bursa.

Conservative therapy

The following conservative therapies are available:

• Physical measures: Cold (cooling pads), electrotherapy TENS
• Drug therapy: painkillers, injections
• Shock wave treatment
• Needling

In most cases, satisfactory improvement can be achieved by means of conservative therapy. In cases of severe pain and/or acute inflammation of the shoulder joint, cold in the form of cooling pads can provide pain relief. It is important that the cooling pad is not placed directly on the skin, but wrapped with a kitchen towel. Acute inflammation can be recognized by typical signs of inflammation: The shoulder is reddened and swollen, the skin over the joint feels warm, and the pain in the shoulder joint is significantly stronger than usual.

Drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) not only reduce pain, but also inhibit the inflammatory response. In the case of severe pain that cannot be sufficiently relieved by these painkillers, it is possible to inject an analgesic specifically under the roof of the shoulder (acromion).

The shock wave therapy was originally used for the treatment of kidney stones. In this case, the ultrasound waves are supposed to lead to a "shattering" of the kidney stones. However, shock waves are now also used successfully in the treatment of several shoulder conditions. In the case of a calcified shoulder, shock wave therapy can lead to faster removal of the calcified foci. The inhibition of inflammation brought about by the shock waves should lead to a dissolution of the calcium deposit.

In needling, the shoulder region is locally anesthetized, and the calcium focus is then crushed using a syringe and then flushed out.

Operation

During the operation, the calcific focus is removed as far as possible by means of a joint endoscopy (arthroscopy). A camera with a light source and a working instrument are inserted into the joint through several small incisions on the shoulder. This allows a precise assessment of the shoulder joint and at the same time the removal of the calcium. The probability that the calcium can be removed by means of this operation is very high. In addition, concomitant diseases of the shoulder joint, as well as any tendon defects, can be treated during the operation.

OP at a glance:

• Surgery time: 60-90min
• Anesthesia: General anesthesia
• Hospitalization: outpatient or inpatient
• Fit for work: after approx. 4-6 weeks, depending on the extent of the operation.
• Return to sports (RTS): after 10-12 weeks

Immediately after surgical removal of the calcium deposits, the shoulder can be moved without restriction and without pain. If tendon co-treatment is necessary, immobilization in an abduction cushion may be required for 4-6 weeks.

Physiotherapeutic follow-up treatment should be started promptly after the operation. The main focus is on the free mobility of the shoulder joint, as well as the stretching and strengthening of the rotator cuff muscles.