Calcium in the Shoulder: Understanding Calcific Tendinitis, Symptoms, Diagnosis, and Treatments

What is calcium in the shoulder?

Calcium in the shoulder, medically known as calcific tendinitis, refers to the formation of calcium deposits, typically within the rotator cuff tendons, leading to pain, stiffness, and restricted shoulder movement.

Understanding Calcific Tendinitis

When people refer to "calcium in the shoulder," they are almost always referring to a condition called calcific tendinitis (or calcific tendinopathy). This condition is characterized by the formation of calcium crystal deposits, primarily within the tendons of the rotator cuff. These deposits can range in size and consistency, from toothpaste-like to chalky or hard.

The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, providing stability and enabling a wide range of motion. When calcium deposits form in these tendons, they can cause significant pain and dysfunction.

Anatomy of the Shoulder and Calcium Deposits

To understand calcific tendinitis, it's helpful to briefly review the shoulder's anatomy. The shoulder is a complex ball-and-socket joint comprising three main bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). Surrounding this joint are the rotator cuff tendons, which attach the rotator cuff muscles to the humerus.

Calcium deposits most commonly occur in the supraspinatus tendon, one of the four rotator cuff tendons, but can also affect other tendons of the shoulder. The presence of these deposits can irritate the surrounding tissues, including the bursa (a fluid-filled sac that reduces friction), leading to inflammation (bursitis) and pain.

Why Do Calcium Deposits Form?

The exact cause of calcific tendinitis is often idiopathic, meaning it develops spontaneously without a clear reason. However, several theories and contributing factors have been proposed:

• Tissue Degeneration: It's believed that calcific tendinitis may be part of a degenerative process where the tendon tissue undergoes changes, making it susceptible to calcium deposition.
• Metabolic Factors: Some research suggests a link to metabolic conditions or hormonal imbalances, though this is not definitively established.
• Genetic Predisposition: There may be a genetic component in some individuals, making them more prone to developing the condition.
• Decreased Blood Flow: Areas of the tendon with reduced blood supply might be more vulnerable to calcification.
• Repetitive Stress or Microtrauma: While not a direct cause, repetitive overhead activities or micro-injuries to the tendon might contribute to the degenerative process that precedes calcification.

Calcific tendinitis most commonly affects individuals between 40 and 60 years of age, with a slightly higher incidence in women. It is not typically associated with injury or trauma, although acute pain can be triggered by specific movements.

Symptoms of Calcific Tendinitis

The symptoms of calcific tendinitis can vary widely depending on the stage of the condition and the size and location of the deposits. They can range from mild discomfort to severe, debilitating pain.

Common symptoms include:

• Shoulder Pain: This is the most prominent symptom. It can be dull and aching, or sharp and intense, especially during acute flare-ups. The pain often worsens with movement, particularly overhead activities.
• Limited Range of Motion: Stiffness and difficulty moving the arm in various directions, such as lifting it sideways or reaching behind the back.
• Night Pain: Pain that disrupts sleep, especially when lying on the affected side.
• Weakness: A feeling of weakness in the affected arm, particularly during lifting or reaching tasks.
• Acute Flare-ups: Periods of sudden, excruciating pain, often described as throbbing or burning, which can last for days or weeks. These often occur as the body attempts to resorb the calcium.

Diagnosis of Calcium Deposits

Diagnosing calcific tendinitis typically involves a combination of a thorough clinical examination and imaging studies.

• Clinical Examination: Your healthcare provider will take a detailed medical history, asking about your symptoms, their duration, and any activities that worsen or alleviate them. They will also perform a physical examination of your shoulder, assessing your range of motion, strength, and tenderness.
• Imaging Studies:
  • X-rays: These are the primary diagnostic tool for calcific tendinitis, as calcium deposits are clearly visible on X-ray images. They can confirm the presence, size, and location of the deposits.
  • Ultrasound: Ultrasound can also visualize calcium deposits and is particularly useful for guiding procedures like injections or lavage. It can also assess the surrounding soft tissues.
  • MRI (Magnetic Resonance Imaging): While not typically needed to diagnose calcium deposits themselves, an MRI may be performed to rule out other shoulder conditions, such as rotator cuff tears, that can present with similar symptoms.

Treatment Approaches for Calcium Deposits

Treatment for calcific tendinitis aims to reduce pain, restore shoulder function, and, in some cases, remove the calcium deposits. The approach typically starts with conservative methods.

Conservative Management

• Rest and Activity Modification: Avoiding activities that aggravate the pain is crucial. This doesn't necessarily mean complete immobilization but rather modifying movements to reduce stress on the shoulder.
• Pain Management:
  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Over-the-counter or prescription NSAIDs like ibuprofen or naproxen can help reduce pain and inflammation.
  • Ice and Heat: Applying ice packs can help reduce acute pain and inflammation, while heat may relax muscles and improve blood flow in chronic cases.
• Physical Therapy: A structured physical therapy program is essential. It focuses on:
  • Pain-relieving modalities: Such as therapeutic ultrasound or electrical stimulation.
  • Range of motion exercises: To prevent stiffness and restore mobility.
  • Strengthening exercises: For the rotator cuff and scapular muscles to improve shoulder stability and function.
  • Posture correction: To optimize shoulder mechanics.
• Corticosteroid Injections: An injection of a corticosteroid (a powerful anti-inflammatory medication) into the bursa or around the tendon can provide significant, though often temporary, pain relief, especially during acute flare-ups.
• Extracorporeal Shockwave Therapy (ESWT): This non-invasive treatment uses high-energy sound waves directed at the calcium deposits. It's thought to stimulate the body's natural healing process and can help break down the deposits, making them easier for the body to resorb.
• Ultrasound-Guided Lavage (Barbotage): This minimally invasive procedure involves using a needle, guided by ultrasound, to puncture and aspirate (draw out) the calcium deposits. Saline is often injected to help break up and wash out the calcium. This can be highly effective in reducing symptoms and resolving the deposits.

Surgical Intervention

If conservative treatments fail to provide relief after several months, surgical removal of the calcium deposits may be considered.

• Arthroscopic Removal: This is the most common surgical approach. It's a minimally invasive procedure where a small incision is made, and a tiny camera (arthroscope) is inserted into the shoulder joint. Specialized instruments are then used to locate and remove the calcium deposits. This procedure also allows the surgeon to address any associated issues like bursitis or impingement.

Prevention and Long-Term Management

While there's no definitive way to prevent calcific tendinitis due to its often idiopathic nature, maintaining overall shoulder health can be beneficial.

• Regular Exercise: Incorporate exercises that strengthen the rotator cuff and scapular stabilizer muscles, promoting balanced shoulder mechanics.
• Flexibility and Mobility: Maintain good shoulder flexibility through stretching and range of motion exercises.
• Ergonomics and Posture: Be mindful of your posture, especially during prolonged sitting or repetitive overhead tasks, to minimize stress on the shoulder joint.
• Listen to Your Body: Avoid pushing through pain. If you experience persistent shoulder discomfort, seek professional medical advice early.

Conclusion

Calcium in the shoulder, or calcific tendinitis, is a common and often painful condition characterized by calcium deposits in the rotator cuff tendons. While the exact cause is frequently unknown, it's a treatable condition. A comprehensive approach, starting with conservative measures like physical therapy and pain management, and progressing to more invasive procedures if necessary, can effectively alleviate symptoms and restore shoulder function. If you suspect you have calcific tendinitis, consult with a healthcare professional for an accurate diagnosis and personalized treatment plan.