Calcific Tendinopathy: Causes and Treatment

Calcific tendinopathy is a condition where calcium deposits form within the tendons of the rotator cuff, typically in the shoulder. It can cause significant pain and restrict shoulder movement. The condition is most common in individuals aged 30–60 and can be self-limiting or require intervention based on severity.

Causes of Calcific Tendinopathy

1. Tendon Degeneration:
   • Aging or chronic overuse can weaken the rotator cuff tendons, leading to calcium deposits as part of a failed healing response.
2. Poor Blood Supply to Tendons:
   • The rotator cuff tendons have areas with limited blood supply, which may predispose them to calcification.
3. Overuse or Repetitive Stress:
   • Activities involving repetitive shoulder motions (e.g., throwing, swimming) can stress tendons, triggering calcium deposition.
4. Metabolic Factors:
   • Imbalances in calcium or phosphate metabolism may contribute, though this is not fully understood.
5. Genetic Predisposition:
   • Family history of calcific tendinopathy may increase the likelihood of developing the condition.
6. Tissue Inflammation:
   • Chronic inflammation in the tendon may promote the formation of calcium deposits.
7. Hormonal Influence:
   • Hormonal changes, particularly in middle-aged women, may be associated with a higher incidence.

Symptoms of Calcific Tendinopathy

• Pain:
  • Sudden or gradual onset of intense shoulder pain, often worse at night.
  • Pain may be constant during the acute phase.
• Stiffness:
  • Difficulty moving the shoulder, especially in lifting or overhead motions.
• Weakness:
  • Reduced strength in the affected arm.
• Localized Tenderness:
  • Tenderness over the rotator cuff area.
• Intermittent Flare-Ups:
  • Symptoms can alternate between acute flare-ups and periods of mild discomfort or no pain.

Phases of Calcific Tendinopathy

1. Formative Phase:
   • Calcium deposits begin to form, often with no symptoms.
2. Resting Phase:
   • The deposits remain stable but may cause mild pain or stiffness.
3. Resorptive Phase:
   • The body starts breaking down the deposits, leading to inflammation and severe pain.

Treatment Options for Calcific Tendinopathy

Non-Surgical Treatments

1. Rest and Activity Modification:
   • Avoid activities that aggravate the shoulder to reduce strain on the tendon.
2. Pain Management:
   • NSAIDs (e.g., ibuprofen, naproxen) to control inflammation and pain.
3. Physical Therapy:
   • Stretching and strengthening exercises to improve shoulder mobility and support the rotator cuff.
   • Focus on scapular stabilization and proper biomechanics.
4. Extracorporeal Shock Wave Therapy (ESWT):
   • High-energy sound waves break down calcium deposits and promote healing.
5. Ultrasound-Guided Needle Aspiration and Lavage:
   • A minimally invasive procedure to remove calcium deposits using saline injections under ultrasound guidance.
6. Corticosteroid Injections:
   • Reduce inflammation and pain during acute phases.

Advanced Non-Surgical Options

• Platelet-Rich Plasma (PRP) Injections:
  • Emerging treatment to promote healing and reduce inflammation.

Surgical Treatment (For Severe or Refractory Cases)

1. Arthroscopic Surgery:
   • Minimally invasive removal of calcium deposits, often combined with rotator cuff repair if needed.
2. Open Surgery:
   • Rarely required, reserved for cases with significant complications or large deposits.

Recovery Timeline

• Non-surgical treatments may resolve symptoms within weeks to months.
• After surgical intervention, recovery typically takes 4–6 months, including physical therapy.

Prevention Tips for Calcific Tendinopathy

1. Maintain Shoulder Strength and Flexibility:
   • Regularly perform exercises to keep the rotator cuff strong and flexible.
2. Avoid Overuse:
   • Limit repetitive overhead activities, or ensure proper technique when performing them.
3. Warm-Up Before Physical Activity:
   • Proper preparation can reduce tendon strain.
4. Address Postural Issues:
   • Correct forward shoulder posture to reduce stress on the rotator cuff.
5. Early Management of Shoulder Pain:
   • Seek treatment for any shoulder discomfort to prevent progression to calcific tendinopathy.