Calcific Tendinitis: Understanding Calcium Build-Up in the Shoulder, Symptoms, and Treatment

What is a calcium build up in the shoulder?

A calcium build-up in the shoulder, most commonly known as calcific tendinitis, is a condition characterized by the formation of a calcium deposit within the tendons of the shoulder, primarily those of the rotator cuff, leading to pain, stiffness, and restricted movement.

Understanding Calcium Deposits in the Shoulder

Calcium deposits in the shoulder are a relatively common condition, often presenting as significant shoulder pain. While the term "calcium build-up" is descriptive, the precise medical term for this condition when it affects tendons is calcific tendinitis. It involves the deposition of calcium hydroxyapatite crystals, the same mineral found in bone, within the soft tissues, specifically the tendons surrounding the shoulder joint.

Anatomy of the Shoulder Joint

To understand calcific tendinitis, it's crucial to grasp the basic anatomy of the shoulder. The shoulder is a complex ball-and-socket joint, renowned for its wide range of motion. Key structures involved include:

• Humerus: The upper arm bone.
• Scapula: The shoulder blade.
• Clavicle: The collarbone.
• Rotator Cuff: A group of four muscles (supraspinatus, infraspinatus, teres minor, subscapularis) and their tendons that surround the head of the humerus, providing stability and enabling a wide range of arm movements (lifting, rotating). It is within these tendons that calcium deposits most commonly form.
• Bursa: Fluid-filled sacs that reduce friction between bones, tendons, and muscles.

What is Calcific Tendinitis?

Calcific tendinitis is a self-limiting condition, meaning it often resolves on its own over time, but it can cause significant pain during its active phases. It typically progresses through several stages:

• Formative Phase: Calcium crystals are deposited within the tendon. This phase is often painless.
• Resorptive Phase: The body attempts to reabsorb the calcium deposit. This is the most painful phase, as the reabsorption process can trigger a significant inflammatory response. The pain can be severe and acute, often described as throbbing or burning.
• Post-Calcific Phase: The calcium deposit has been reabsorbed, and the tendon begins to remodel and heal. Pain typically subsides during this phase.

The supraspinatus tendon, one of the rotator cuff tendons, is the most frequently affected site due to its position and role in arm elevation.

Causes and Risk Factors

The exact cause of calcium deposits in the shoulder is not fully understood, but it is believed to be a multifactorial process rather than a result of dietary calcium intake. Several theories and risk factors have been identified:

• Age: Most commonly affects individuals between 30 and 60 years old.
• Gender: Slightly more common in women.
• Reduced Blood Supply: Areas of tendons with reduced vascularity (blood flow) may be more prone to deposit formation. The "critical zone" of the supraspinatus tendon is an example.
• Mechanical Stress: Repetitive microtrauma or chronic mechanical stress to the tendon may contribute, though this is debated as a primary cause.
• Genetic Predisposition: Some individuals may have a genetic tendency to develop calcific tendinitis.
• Metabolic and Endocrine Conditions: While not direct causes, certain conditions like diabetes or thyroid disorders have been associated with a higher incidence of calcific tendinitis.
• Cellular Changes: It's thought that certain cells within the tendon may transform into cartilage-producing cells, which then calcify.

Symptoms of Calcium Build-Up

The symptoms of calcific tendinitis can vary widely, from asymptomatic to severely debilitating pain.

• Pain: This is the hallmark symptom.
  • Acute Pain: Often sudden and severe, particularly during the resorptive phase. It can be sharp, throbbing, or burning.
  • Chronic Pain: A dull ache that worsens with activity or at night.
• Stiffness: Difficulty moving the arm, especially overhead or behind the back.
• Limited Range of Motion: Reduced ability to raise the arm or rotate it.
• Weakness: The affected arm may feel weak, especially during specific movements.
• Night Pain: Pain that disrupts sleep, often when lying on the affected side.

Diagnosis

Diagnosis of calcific tendinitis typically involves a combination of clinical assessment and imaging:

• Physical Examination: A healthcare professional will assess your shoulder's range of motion, strength, and identify areas of tenderness.
• Imaging Studies:
  • X-rays: The most common and effective method for visualizing calcium deposits, as calcium is radiopaque. X-rays can show the size, shape, and location of the deposit.
  • Ultrasound: Can provide a dynamic view of the deposit, assess its consistency, and guide aspiration or injection procedures.
  • MRI (Magnetic Resonance Imaging): While not as good at directly visualizing the calcium deposit itself, MRI can rule out other shoulder pathologies like rotator cuff tears and assess inflammation around the deposit.

Treatment Approaches

Treatment aims to alleviate pain, restore function, and facilitate the reabsorption of the calcium deposit. Approaches range from conservative management to surgical intervention.

Conservative Management

• Rest and Activity Modification: Avoiding activities that aggravate the pain is crucial, but complete immobilization is generally discouraged to prevent stiffness.
• Pain Relief:
  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Over-the-counter or prescription NSAIDs can help manage pain and inflammation.
  • Ice/Heat Application: Can provide symptomatic relief.
• Physical Therapy: A structured program focusing on:
  • Range of Motion Exercises: To maintain and improve joint mobility.
  • Stretching: To address muscle tightness.
  • Strengthening Exercises: To improve rotator cuff and scapular stabilizer strength once pain allows.
  • Modalities: Therapeutic ultrasound, phonophoresis (ultrasound with medication), or iontophoresis (electrical current with medication) are sometimes used, though evidence for their effectiveness in dissolving deposits is mixed.
• Corticosteroid Injections: Injecting corticosteroids into the bursa or around the tendon can significantly reduce pain and inflammation temporarily, especially during acute flare-ups. This is usually not a long-term solution and does not remove the calcium.
• Dry Needling/Barbotage: This procedure involves using a needle to puncture the calcium deposit and aspirate (draw out) the calcium paste. It is often performed under ultrasound guidance and can provide significant relief.

Minimally Invasive Procedures

• Extracorporeal Shockwave Therapy (ESWT): This non-invasive procedure involves delivering high-energy sound waves to the affected area. It is thought to stimulate the body's natural healing process and potentially break down the calcium deposit, promoting reabsorption.

Surgical Intervention

• Arthroscopic Surgery: If conservative treatments fail to provide relief after 6-12 months, surgical removal of the calcium deposit may be considered. This is typically performed using an arthroscope (a small camera) inserted through tiny incisions. The surgeon directly visualizes and removes the calcium deposit, and may also address any associated bursitis or impingement.

Prevention and Long-Term Management

While preventing the initial formation of calcium deposits is challenging due to their unclear etiology, managing shoulder health can help reduce the risk of symptomatic flare-ups and promote recovery.

• Maintain Good Posture: Poor posture can alter shoulder mechanics and potentially increase stress on tendons.
• Ergonomic Adjustments: Ensure your workspace and daily activities support healthy shoulder alignment.
• Regular, Balanced Exercise: Incorporate exercises that strengthen the rotator cuff and scapular stabilizers, and maintain full shoulder range of motion. Avoid sudden increases in intensity or volume.
• Listen to Your Body: Address minor aches and pains promptly to prevent them from escalating.
• Proper Lifting Techniques: Use your legs and core, and keep objects close to your body when lifting.
• Warm-up and Cool-down: Always prepare your muscles for activity and aid recovery afterward.

Conclusion

A calcium build-up in the shoulder, or calcific tendinitis, is a distinct condition involving the formation of calcium deposits within the rotator cuff tendons. While often painful, especially during the body's attempt to reabsorb the deposit, it is generally a self-limiting condition. Diagnosis relies on clinical examination and imaging, primarily X-rays. Treatment strategies are focused on pain relief, restoring function, and encouraging the body's natural reabsorption process, ranging from conservative physical therapy and injections to advanced procedures like ESWT or, in persistent cases, surgical removal. Understanding this condition is key to effective management and maintaining optimal shoulder health.