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What is it?
Calcific tendinitis is a condition when calcium accumulates within the substance of the tendon. Although it can occur in any tendon, the most common area is around the shoulder.
There are number of theories which try and explain why this occurs. However, I do believe that one explanation does not fit all. The most likely explanation is that there is a combination of poor blood flow and intermittent compression of the vulnerable tendon. This results in internal damage to the tendon resulting in bleeding and this may work like a nidus over which calcium accumulate like a pearl forming in an oyster.
Although a build-up of calcium can be painful, severe pain occurs when this calcium leaks out of the tendon. The pain from the leaked calcium is intense and relentless and has even been compared to the child birth - except there is no obvious end to it. In addition,with the accumulation of the calcium there is increase in the thickness of the tendon which in turn gets pinched even more easily in the subacromial space thus adding to the problem.
Treatment options:
A calcium deposit is treated in the same way as impingement syndrome in the initial stages. Activity modification, anti-inflammatory tablets, physiotherapy and an injection in the
bursal sac can all help. If the calcium is in a ‘liquid’ state, then ultrasound guided injection into the calcium can be done (the barbotage treatment) . In some cases this has excellent results but in others it can worsen their symptoms. If all conservative treatment options fail, surgery is indicated.
Operation
The aim of the operation is similar to arthroscopic decompression in that more space is created for the tendons to glide, thus aiming to avoid pinching of the tendons during movements. In addition an rather extensive partial bursectomy is done. On probing, if the calcium is found to be leaking, then the calcium is emptied from the tendon usually via a ‘mini-open approach’. I advocate this as it allows me to clear the tendon well and also to repair the area where the tendon was disturbed.
The operation is usually performed as a day case procedure under general anaesthetic. The wound is closed with sutures, steristrips and water resistant dressing is applied. This is covered with a further layer of pressure dressing. The arm is then placed in a sling. You will be given information regarding wound care and information regarding various exercises you need to do. Physiotherapy will be arranged taking care to protect the tendon repair in the first 2 weeks especially sideward lifting (abduction) and then it will focus on regaining range of movement. .
| Ultrasound scans |
| MRI scans |
| A S D + D C E |
| Impingment syndrome - Picture |