Calcific tendinitis

calcification tendiniteAlso called calcific tendonitis, tendonitis calcifying, calcified tendonitis, calcareous tendonitis, tendinosis calcarea, hydroxyapatite deposition disease and calcific periarthritis.

The calcium deposits are not always painful, and even when painful they will often spontaneously resolve after a period of 1-4 weeks, but not always.

Sometimes calcific tendinitis is an incidental finding when the Tendonitis Practice ask to takes an x-ray for the examination.

Calcific tendonitis in a tendon most often in those of the rotator cuff.

The cause of calcium deposits within the tendon is not entirely understood. Different ideas have been suggested, including blood supply and aging of the tendon, but the evidence to support these conclusions is not clear.

Calcific tendonitis usually progresses predictably, and almost always resolves eventually without surgery.

The typical calcific tendonitis course is :

Precalcification Stage
 – chronic silent phase

Patients usually do not have any symptoms in this stage. At this point in time, the site where the calcifications tend to develop undergo cellular changes that predispose the tissues to developing calcium deposits.

Calcific Stage

During this stage, the calcium is excreted from cells and then coalesces into calcium deposits. When seen, the calcium looks chalky, it is not a solid piece of bone. Once the calcification has formed, a so-called resting phase begins, this is not a painful period and may last a varied length of time.

After the resting phase, a resorptive phase begins

Patients usually seek treatment during the painful resorptive phase of the calcific stage, but some patients have the deposits found as part of their evaluation for impingement syndrome. During this resorptive phase, the calcium deposit looks something like toothpaste.

Pathologies which present similar to Calcific Tendonitis of the Shoulder :

– Subdeltoid Bursitis

– Subacromial Impingement

– Rotator Cuff Tears

– Adhesive Capsulitis

– Gout

The treatment of calcific tendonitis

Treatment of calcific tendonitis usually begins with some simple steps including rest, ice application, medications, and therapy. In some situations, if symptoms persist, surgical intervention is considered.

However, the standard treatment of a calcium deposit does not require surgery.

Other treatments available for calcific tendonitis :

Over the last decade, several reports have shown successful treatment of chronic calcific tendonitis with the use of shockwave therapy. Shockwave therapy is thought to work by inducing so-called ‘microtrauma’ and stimulates blood flow to the affected area. Most reports on this method of treatment of calcific tendonitis show guarded success–perhaps 50-70% of patients improving after one or two high-energy shockwave treatments.

This treatment of calcific tendonitis can be painful, and usually requires anesthesia in order for it to be tolerated by the patient.

There is a very low complication rate from shockwave therapy. Most patients will develop a hematoma from the calcific tendonitis treatment, but otherwise there are few complications.

Wainner R, Hasz M, “Management of acute calcific tendinitis of the shoulder” Journal Of Orthopaedic, Sports Physical Therapy, March 1998;27(3):231-237

Loew M, Sabo D, Wehrle M, Mau H, “Relationship between calcifying tendinitis and subacromial impingement: a prospective radiography and magnetic resonance imaging study”, Journal Of Shoulder And Elbow Surgery / American Shoulder And Elbow Surgeons, July 1996;5(4):314-319

Calcific tendonitis treatment