Calcific tendonitis is one of the most painful shoulder conditions.  The pain from calcific tendonitis can make it difficult to sleep, and difficult to use your shoulder for normal daily activities.  There are effective non-surgical treatments to address your shoulder pain due to calcific tendonitis. Most patients with calcific tendonitis can avoid shoulder surgery.

No one knows what causes the calcium to deposit inside your rotator cuff.  If you have very severe shoulder pain and you were told that you have calcium on your shoulder X-ray then you are likely suffering from calcific tendonitis of the rotator cuff.

What is Calcific tendonitis ?

calcific tendonitis of the shoulder
Note the comma shaped calcium deposit above the humerus

Most patients found to have calcific tendonitis have a very similar story.  They did not injure themselves.  They noted a dull ache one day.  Over time that dull ache became a very intense pain.  Eventually your ability to sleep is affected if the pain is severe enough. Calcific tendonitis is one the most common reasons why you will find it too painful to move your arm.

Calcific Tendonitis is a condition where an x-ray shows that calcium is actually  inside the rotator cuff tendon itself. We are not sure why the calcification occurs.  It does not mean that you have any rare diseases.  The calcium causes pressure within the rotator cuff.  The pain starts when your body tries to remove or reabsorb the calcium.  The body removes the calcium by using white blood cells.  Those cells release a lot of chemical when they are eating away at the calcium.  Those chemicals are inflammatory and cause a lot of pain.

Calcific tendonitis of the rotator cuff usually causes profound pain.  For some, the pain is mild. For many of you the pain in your shoulder can be very severe. The pain is usually on the top or the side of your shoulder.  That is because this is the most common location for a calcium deposit in your shoulder. Calcific tendonitis of the rotator cuff is common in people between the ages of 40-65.

Why Do I Have Calcium in My Shoulder?

We do not know why most people develop calcium deposits in their shoulder.  It does not mean you are drinking too much milk or taking too many calcium supplements. It does not mean that you have any rare diseases.

How Do You Treat Calcium in The Shoulder?

Calcific tendonitis can be extremely painful.  Most patients are miserable and are looking for a “quick fix”.   Patients with calcific tendonitis are usually easy to pick out of a crowd of shoulder pain patients. They look tired from not sleeping, they can not sit still and they are always grabbing their shoulder.

Shoulder ice/compression sleeves can help when the pain of calcific tendonitis is severe. If the pain is tolerable then it is  OK to pursue a treatment course of “observation.” Many cases of calcific tendonitis will resolve spontaneously. Yes.. in many, the calcium will dissolve and go away. It might take months to do so, but the calcium will dissolve away in most patients.

If, however,  your pain is very severe, one of the most effective ways to alleviate your pain is for us to send you to a radiologist who will perform an ultrasound.  Not all Radiologists are trained at this technique.  Your Orthopedic Surgeon should know who the go-to radiologists are in your area.

The Radiologist identifies the calcium deposit in your rotator cuff using an ultrasound machine. After the calcium in your rotator cuff is identified they will numb your skin with local anesthesia.  When the skin is numb, the radiologist can place a needle into the calcium deposit and “wash it out.”In the majority of people the calcium deposit has the feel of toothpaste, making it relatively easy for a radiologist to wash it out of your rotator cuff. It is usually not a hard deposit like bone.  Although rare, in a few people the calcium deposit will be too hard to wash out.

The pain relief is usually noticed within a day or two.     After the procedure you will be sore for a few days, but the pain should be much different. Usually with a week or so most of you are feeling much better.  The inflammation found in calcific tendonitis can also cause stiffness in many shoulders.  After the injection some people will need physical therapy to improve your shoulder motion and help you return to normal strength and function.

Do I Need Surgery For Calcium in my Rotator Cuff?

Surgery for calcific tendonitis of the shoulder is rarely necessary.  This is because the ultrasound guided washouts have been so successful.  The key is to find a surgeon / radiologist team that works together and is very good at this technique.   The ultrasound guided washout is a small procedure performed in the office.  It is performed using local anesthesia in your skin.

On occasion the calcium which was washed out of the rotator cuff will cause an intense bursitis, or inflammation within the shoulder.  If this happens, and you do not respond to ice and anti-inflammatories then there is a chance that you will require keyhole or arthroscopic surgery to remove the inflamed tissue.  This is a very rare instance.

The recovery from an ultrasound guided “washout’ for calcific tendonitis is usually quick.  Most people will notice soreness for a day or two afterwards.  Within a week the most severe pain you were having is gone.  You might be left with a dull ache that will improve further with exercise and physical therapy.


About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very “social” patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles — all geared to improve your quality of life.
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