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Calcific Tendinitis of the Rotator Cuff (CTRC)

Calcific Tendinitis of the Rotator Cuff (CTRC)

Mar 13, 2025

Calcific tendinitis of the rotator cuff (CTRC) is the accumulation of calcium phosphate within a tendon and is often chronic and recurrent. The majority of CTRC cases are located within 1–2 cm of the insertion of the supraspinatus, leading to a restricted range of motion in the shoulder and potentially causing severe pain (Maja et al., 2023). Interestingly, CTRC commonly occurs between the ages of 30 and 50 and is twice as likely to affect women (Kim et al., 2020). There are two proposed theories regarding the formation of CTRC: the degenerative theory and the reactive theory. The degenerative theory suggests that age-related changes in the tendon lead to a reduction in blood vessel distribution. This results in a hypoxic environment, causing necrosis and/or tendon tearing, which can subsequently lead to calcification (Kim et al., 2020). The reactive theory, on the other hand, describes three phases of calcification: the precalcific phase, the calcific phase, and the post-calcific phase. The precalcific phase involves the ‘transformation of the tendon into fibrocartilaginous tissue’ (Maja et al., 2023), facilitating calcium deposition. The calcific phase is when the actual deposition of calcium occurs, while the post-calcific phase involves the remodelling of the tendon around the calcium deposit. However, neither theory has been definitively proven (Maja et al., 2023). Secondary complications such as bursitis and synovitis are common in CTRC due to the chemical irritation caused by calcium deposits. Treatment for CTRC can be either conservative or surgical. Conservative management has a success rate of 30–80%. Non-steroidal anti-inflammatory drugs (NSAIDs) provide effective pain relief, and corticosteroid injections are beneficial during the resorptive phase. Barbotage has been shown to relieve pain in 70% of patients due to its decompression effects. Ultrasound therapy has also been found to improve quality of life and pain relief; however, it requires regular attendance over a six-week period. Extracorporeal shockwave therapy (ESWT) has the highest success rate for chronic calcific tendinitis and achieves results comparable to surgery (Kim et al., 2020). ESWT is effective in improving function and reducing pain, with greater efficacy when combined with physiotherapy (Maja et al., 2023). Therefore, conservative treatment should be prioritised and implemented for at least six months before considering surgical intervention (Maja et al., 2023). If you are experiencing symptoms of calcific tendinitis, it is important to seek professional medical advice. Booking an appointment with sports medicine doctor Dr David Porter (link to bio) can help you explore a range of treatment options tailored to your specific condition. Early intervention and expert guidance can significantly improve your recovery and long-term shoulder health.

Reference List

Kim, M.-S., Kim, I.-W., Lee, S. and Shin, S.-J. (2020). Diagnosis and treatment of calcific tendinitis of the shoulder. Clinics in Shoulder and Elbow, [online] 23(4), pp.203–209. doi:https://doi.org/10.5397/cise.2020.00318. Маја Manoleva, Erieta Nikolic Dimitrova, Koevska, V., Biljana Mitrevska, Marija Gocevska Gjerakaroska, Cvetanka Savevska, Biljana Kalchovska Ivanovska, Lidija Stojanoska Matjanoska, Gecevska, D., Jugova, T. and Liljana Malinovska Nikolovska (2023). Comparison of Immediate Effects of Extracorporeal Shockwave Therapy and Conventional Physical Therapy in Patients with Calcific Tendinitis of the Shoulder Rotator Cuff. Academic Medical Journal, 3(1), pp.99–109. doi:https://doi.org/10.53582/amj2331099m.
A New Approach to Managing Osteoarthritis: The Role of Stem Cell Therapy and Regenerative Medicine

A New Approach to Managing Osteoarthritis: The Role of Stem Cell Therapy and Regenerative Medicine

Feb 21, 2025

Understanding Osteoarthritis and Its Impact

Osteoarthritis (OA) is one of the most common joint conditions, affecting millions of people worldwide. It develops when the protective cartilage that cushions the joints gradually wears away, leading to pain, stiffness, and reduced mobility. Over time, the condition can significantly impact daily activities, making tasks such as walking, climbing stairs, or even getting out of bed challenging.

Traditional treatments for OA include pain relief medications, physiotherapy , steroid injections, and, in severe cases, joint replacement surgery. While these treatments help manage symptoms, they do not address the underlying cause, cartilage loss. This has led to growing interest in regenerative medicine, an emerging field focused on helping the body repair itself.

One area of regenerative medicine that has gained attention in recent years is stem cell therapy . Although this treatment is still undergoing research and development, early findings suggest it may offer a new approach to joint health by supporting tissue repair and reducing inflammation.

What Are Stem Cells?

Stem cells are special types of cells that have the potential to develop into different cell types in the body. This ability makes them important for healing and regeneration. The human body contains various types of stem cells, but mesenchymal stem cells (MSCs) are of particular interest when it comes to joint health.

MSCs can be obtained from several sources, including:

  • Bone marrow (from inside bones)
  • Adipose tissue (fat cells)
  • Umbilical cord tissue (from donated umbilical cords after birth)

Among these, umbilical cord-derived MSCs (UC-MSCs) have been widely studied for their potential role in joint repair.

How Can Stem Cells Help in Osteoarthritis?

While osteoarthritis is typically considered irreversible, ongoing research is exploring how stem cells might help slow its progression, reduce symptoms, and potentially support cartilage repair.

The Role of UC-MSCs in Joint Health

Umbilical cord-derived mesenchymal stem cells (UC-MSCs) are being studied for their ability to:

  • Reduce inflammation in the joint – Inflammation plays a key role in osteoarthritis and contributes to pain and stiffness.
  • Support cartilage maintenance – While research is ongoing, UC-MSCs are believed to release factors that encourage cartilage cells to survive and function.
  • Improve joint lubrication – UC-MSCs may help enhance the quality of synovial fluid, the natural lubricant in joints, improving movement.
  • Modulate the immune system – Osteoarthritis has been linked to immune system activity. UC-MSCs have the potential to balance immune responses in the joint.

Research into UC-MSCs is still ongoing, and while early results are promising, more studies are needed to determine their long-term effects and optimal use.

What Does the Latest Research Say?

Over the past few years, several studies have explored the potential of umbilical cord-derived stem cells in osteoarthritis treatment. Some notable findings include:

  1. Potential for Knee Cartilage Repair
    A review published in Medicine (2025) examined the use of UC-MSCs for knee osteoarthritis. The study found that these cells may contribute to reduced pain, improved function, and potential cartilage preservation. (Liao et al., 2025).
    📄 Read More: LWW Journal
  2. Stem Cell-Based Hydrogels for Cartilage Support
    A study in ACS Biomaterials Science (2025) investigated biodegradable hydrogels combined with UC-MSCs to enhance cartilage repair. The findings suggested improved joint function and reduced inflammation. (Ghosal et al., 2025).
    📄 Read More: ACS Publications
  3. Exosome Therapy for Osteoarthritis
    Scientists are also studying exosomes—tiny particles released by UC-MSCs – which may have anti-inflammatory and regenerative effects. A study in Advanced Functional Materials (2025) showed that exosomes from UC-MSCs supported cartilage repair and joint function in osteoarthritis models. (Lv et al., 2025).
    📄 Read More: Wiley Online Library
  4. UC-MSCs and Joint Injections
    Clinical trials published in Stem Cell Research & Therapy (2025) evaluated the safety and effects of UC-MSC injections for knee OA. The study noted improvements in pain, mobility, and joint function after six months. (Lei et al., 2025).
    📄 Read More: Springer

These studies represent a growing body of research exploring how stem cells may contribute to joint health and osteoarthritis management.

Important Considerations

While the idea of regenerative treatments for osteoarthritis is exciting, there are a few important points to keep in mind:

1. Research is Ongoing

Stem cell treatments, including those using umbilical cord-derived stem cells, are still being researched. Scientists continue to investigate their effectiveness, best application methods, and long-term safety.

2. Treatments Are Not Yet Widely Approved

While some countries have introduced regenerative medicine into clinical practice, regulatory authorities such as the UK’s MHRA (Medicines and Healthcare products Regulatory Agency) are still assessing these treatments. Opus, unlike many other clinics, is the UKs only licenced and regulated provider. It is essential to stay informed and seek advice from medical professionals before considering any new treatment options.

3. Every Patient is Different

Osteoarthritis can vary widely between individuals, meaning that treatment responses may differ. What works for one person may not work in the same way for another.

4. A Holistic Approach is Best

Stem cell therapy, if proven to be effective in the future, is unlikely to be a standalone cure for osteoarthritis. It is always best considered alongside other approaches such as:

  • Maintaining a healthy weight to reduce joint strain.
  • Engaging in regular, low-impact exercise (such as swimming or cycling).
  • Using joint-friendly supplements (such as glucosamine and omega-3 fatty acids).
  • Following a balanced diet to support joint health.

 

The Future of Regenerative Medicine

Research into umbilical cord-derived stem cells for osteoarthritis is advancing rapidly, with promising early results. Scientists are also exploring combination therapies, including:

  • Stem cells with growth factors to enhance repair.
  • 3D-printed cartilage scaffolds to create personalised joint implants.
  • Gene editing to enhance stem cell performance.

As research continues, the goal is to develop treatments that not only relieve symptoms but also support the long-term health of joints.

Conclusion

Osteoarthritis remains a challenging condition, but advances in stem cell research and regenerative medicine are opening up new possibilities. While umbilical cord-derived stem cells are still being studied, they hold promise as a potential tool for reducing inflammation, supporting joint function, and promoting cartilage health.

For now, education and staying informed about scientific advancements are key. As more research emerges, individuals seeking alternative approaches to joint care will have a better understanding of the options available.

If you are considering different ways to manage osteoarthritis, always consult a healthcare professional for personalised advice.

 

References

  1. Liao, Z.K. et al. (2025). Clinical research progress of umbilical cord blood mesenchymal stem cells in knee articular cartilage repair. Medicine.
    📄 Read More
  2. Lei, J. et al. (2025). Therapeutic efficacy of intra-articular injection of UC-MSCs in knee OA. Stem Cell Research & Therapy.
    📄 Read More

 

Osteoarthritis

Calcific Tendinitis of the Rotator Cuff (CTRC)

Calcific Tendinits of the rotator cuff

Feb 19, 2025

Calcific Tendinits of the rotator cuff (CTRC) is the accumulation of calcium phosphate within a tendon and is often chronic and recurrent. Majority of CTRC are located within 1-2cm from the insertion of the supraspinatus causing limited range of motion in the shoulder and can cause severe pain (Maja et. al, 2023). Interestingly, CTRC commonly occurs during the age of 30-50 years and twice as likely to occur in women (Kim et. al, 2020).

There are two proposed theories on the formation of CTRC: degenerative and reactive. Degenerative theory suggests changes in the tendon accumulate with age which causes a decrease in distribution of blood vessels. This leads to a hypoxic environment causing necrosis and/or tearing in the tendon which then can develop into calcification (Kim et. al, 2020). The reactive theory suggests that there are 3 phases of calcification: precalcifying phase, calcifying phase and post calcifying phase. Precalcifying phase is the ‘transformation of the tendon into fibrocartilaginous tissue’ (Maja et. al, 2023) which allows the calcium to be deposited more easily. The calcifying phase is the actual deposition of calcium, and the post calcifying is the remodeling of the tendon around the calcium deposit. However, no theory has been proven (Maja et. al, 2023). Secondary complications such as bursitis and synovitis are common with CTRC due to the chemical irritation caused by calcium deposits.

Treatment for CTRC can either be conservative management or surgical. There is a 30-80% success rate of conservative management. NSAIDs are effective for pain relief as well as a steroid injection during the resorptive phase. Barbotage has been shown to provide pain relief in 70% of patients due to its decompression effects. Ultrasound therapy has also been shown to improve quality of life and pain relief, however, requires regular attendance over a 6 week period. ESWT (extracorporeal shockwave therapy) has the highest success rate for chronic calcific tendinitis and has a similar success rate to surgery (Kim et. al, 2020). ESWT is effective in improving function and reducing pain and is more effective when combined with physiotherapy (Maja et. al, 2023). Therefore, conservative treatment should be prioritized and conducted for a minimum of 6 months before considering surgical treatment (Maja et. al, 2023).

Reference List

Kim, M.-S., Kim, I.-W., Lee, S. and Shin, S.-J. (2020). Diagnosis and treatment of calcific tendinitis of the shoulder. Clinics in Shoulder and Elbow, [online] 23(4), pp.203–209. doi:https://doi.org/10.5397/cise.2020.00318.

Маја Manoleva, Erieta Nikolic Dimitrova, Koevska, V., Biljana Mitrevska, Marija Gocevska Gjerakaroska, Cvetanka Savevska, Biljana Kalchovska Ivanovska, Lidija Stojanoska Matjanoska, Gecevska, D., Jugova, T. and Liljana Malinovska Nikolovska (2023). COMPARISON OF IMMEDIATE EFFECTS OF EXTRACORPOREAL SHOCKWAVE THERAPY AND CONVENTIONAL PHYSICAL THERAPY IN PATIENTS WITH CALCIFIC TENDINITIS OF THE SHOULDER ROTATOR CUFF. Academic Medical Journal, 3(1), pp.99–109. doi:https://doi.org/10.53582/amj2331099m.

The Role of Compression Therapy in Musculoskeletal Physiotherapy

The Role of Compression Therapy in Musculoskeletal Physiotherapy

Feb 5, 2025

Compression therapy is a widely used technique in musculoskeletal physiotherapy, offering benefits for both recovery and performance enhancement. It involves the application of controlled pressure to muscles, joints, or soft tissues using compression devices such as the Therabody Jet Boots we use here at OPUS. pneumatic compression pumps.

This therapy has been extensively utilised in injury management, post-surgical rehabilitation, and athletic performance optimisation. We are all well accustomed to seeing Premier League players posting the routine image of them with their feet up, in a set of these boots, watching the La Liga late kick off following their Saturday afternoon match. So there must be a reason why!

Compression Therapy

Mechanism of Action

Compression therapy works by enhancing circulation, reducing swelling, and promoting tissue healing. The applied pressure assists venous return, helping deoxygenated blood and metabolic waste products move back toward the heart more efficiently.

This improved circulation delivers oxygen-rich blood and essential nutrients to tissues, facilitating faster repair and reducing inflammation. Additionally, compression can support the lymphatic system, helping to prevent fluid accumulation in injured or overworked tissues.

Benefits for Recovery

  1. Reduction of Swelling and Inflammation One of the primary benefits of compression therapy is its ability to minimize swelling, a common symptom in musculoskeletal injuries such as sprains, strains, and post-surgical recovery. By applying pressure, excess fluid is prevented from accumulating in the injured area, reducing discomfort and expediting the healing process (Priego-Quesada et al., 2020).
  2. Pain ManagementCompression garments and bandages provide gentle pressure that can reduce pain by limiting excessive movement and stabilizing the affected area. This can be particularly beneficial for individuals recovering from ligament injuries, fractures, or joint surgeries, such as ACL reconstruction or total knee replacements (Born et al., 2013).
  3. Improved Muscle Oxygenation and Tissue HealingEnhanced blood flow through compression ensures an increased supply of oxygen and essential nutrients to the affected muscles and joints. This accelerates tissue regeneration, which is crucial in conditions such as tendinopathies and muscle tears. Faster healing times can reduce the risk of chronic issues and long-term disability (MacRae et al., 2012).
  4. Prevention of Deep Vein Thrombosis (DVT)For individuals undergoing prolonged immobilization following musculoskeletal injuries or surgeries, compression therapy can help prevent deep vein thrombosis. By promoting circulation in the lower limbs, it reduces the risk of blood clot formation, a serious complication in post-surgical patients (Brophy-Williams et al., 2017).

Benefits for Performance

  1. Enhanced Muscle Recovery Athletes and active individuals use compression therapy to recover faster after intense training sessions. Compression garments aid in reducing muscle soreness and fatigue by clearing metabolic waste, such as lactic acid, from the muscles more efficiently (Houghton et al., 2019).
  2. Improved Proprioception and Stability Compression sleeves and supports provide sensory feedback, improving proprioception—the body’s awareness of joint position and movement. This can be beneficial for injury prevention, as better joint stability reduces the risk of excessive strain and misalignment (Duffield et al., 2010).
  3. Reduced Muscle Oscillation and Fatigue During high-impact activities such as running or jumping, muscles experience micro-vibrations that contribute to fatigue. Compression gear minimizes these oscillations, reducing muscle fatigue and improving endurance over prolonged periods of activity (Hill et al., 2014).

Conclusion

Compression therapy can be a useful tool in musculoskeletal physiotherapy, aiding in both recovery and performance. Its ability to reduce swelling, alleviate pain, and enhance circulation makes it a valuable tool in injury management and rehabilitation.

Additionally, athletes and active individuals benefit from its performance-enhancing effects, including faster muscle recovery and improved stability. Whether used for acute injury management or long-term athletic optimisation, compression therapy remains an effective and accessible treatment modality in physiotherapy practice.

References

  • Born, D., Sperlich, B., & Holmberg, H. C. (2013). Bringing light into the dark: effects of compression clothing on performance and recovery. Sports Medicine, 43(6), 533-549.
  • Brophy-Williams, N., Driller, M. W., & Shing, C. M. (2017). Acute and chronic effects of compression garments on recovery from exercise-induced muscle damage. Journal of Science and Medicine in Sport, 20(6), 527-531.
  • Duffield, R., Cannon, J., & King, M. (2010). The effects of compression garments on recovery of muscle performance following high-intensity sprint and plyometric exercise. Journal of Science and Medicine in Sport, 13(1), 136-140.
  • Hill, J., Howatson, G., van Someren, K. A., & Gaze, D. C. (2014). The influence of compression garments on physiological and performance responses to exercise: a systematic review. Sports Medicine, 44(6), 791-803.
  • Houghton, L. A., Dawson, B., & Maloney, S. K. (2019). Effects of compression garments on recovery following exercise: A meta-analysis. Physiology & Behaviour, 210, 112671.
  • MacRae, B. A., Cotter, J. D., & Laing, R. M. (2012). Compression garments and exercise: garment considerations, physiology and performance. Sports Medicine, 42(10), 819-843.
  • Priego-Quesada, J. I., et al. (2020). Effects of compression garments on sports performance and recovery: A systematic review. Journal of Sports Sciences, 38(12), 1287-1304.

Calcific Tendinitis of the Rotator Cuff (CTRC)

Role of Compression Therapy in a MSK setting

Feb 4, 2025

Compression therapy is a widely used technique in musculoskeletal physiotherapy, offering benefits for both recovery and performance enhancement. It involves the application of controlled pressure to muscles, joints, or soft tissues using compression devices such as the Therabody Jet Boots we use here at Opus. This therapy has been extensively utilized in injury management, post-surgical rehabilitation, and athletic performance optimization. We are all well accustomed to seeing Premier League players posting the routine image of them with their feet up, in a set of these boots, watching the La Liga late kick off following their Saturday afternoon match. So there must be a reason why!

Mechanism of Action

Compression therapy works by enhancing circulation, reducing swelling, and promoting tissue healing. The applied pressure assists venous return, helping deoxygenated blood and metabolic waste products move back toward the heart more efficiently. This improved circulation delivers oxygen-rich blood and essential nutrients to tissues, facilitating faster repair and reducing inflammation. Additionally, compression can support the lymphatic system, helping to prevent fluid accumulation in injured or overworked tissues.

Benefits for Recovery

1. Reduction of Swelling and Inflammation

One of the primary benefits of compression therapy is its ability to minimize swelling, a common symptom in musculoskeletal injuries such as sprains, strains, and post-surgical recovery. By applying pressure, excess fluid is prevented from accumulating in the injured area, reducing discomfort and expediting the healing process (Priego-Quesada et al., 2020).

2. Pain Management

Compression garments and bandages provide gentle pressure that can reduce pain by limiting excessive movement and stabilizing the affected area. This can be particularly beneficial for individuals recovering from ligament injuries, fractures, or joint surgeries, such as ACL reconstruction or total knee replacements (Born et al., 2013).

3. Improved Muscle Oxygenation and Tissue Healing

Enhanced blood flow through compression ensures an increased supply of oxygen and essential nutrients to the affected muscles and joints. This accelerates tissue regeneration, which is crucial in conditions such as tendinopathies and muscle tears. Faster healing times can reduce the risk of chronic issues and long-term disability (MacRae et al., 2012).

4. Prevention of Deep Vein Thrombosis (DVT)

For individuals undergoing prolonged immobilization following musculoskeletal injuries or surgeries, compression therapy can help prevent deep vein thrombosis. By promoting circulation in the lower limbs, it reduces the risk of blood clot formation, a serious complication in post-surgical patients (Brophy-Williams et al., 2017).

Benefits for Performance

1. Enhanced Muscle Recovery

Athletes and active individuals use compression therapy to recover faster after intense training sessions. Compression garments aid in reducing muscle soreness and fatigue by clearing metabolic waste, such as lactic acid, from the muscles more efficiently (Houghton et al., 2019).

2. Improved Proprioception and Stability

Compression sleeves and supports provide sensory feedback, improving proprioception—the body’s awareness of joint position and movement. This can be beneficial for injury prevention, as better joint stability reduces the risk of excessive strain and misalignment (Duffield et al., 2010).

3. Reduced Muscle Oscillation and Fatigue

During high-impact activities such as running or jumping, muscles experience micro-vibrations that contribute to fatigue. Compression gear minimizes these oscillations, reducing muscle fatigue and improving endurance over prolonged periods of activity (Hill et al., 2014).

Conclusion

Compression therapy can be a useful tool in musculoskeletal physiotherapy, aiding in both recovery and performance. Its ability to reduce swelling, alleviate pain, and enhance circulation makes it a valuable tool in injury management and rehabilitation. Additionally, athletes and active individuals benefit from its performance-enhancing effects, including faster muscle recovery and improved stability. Whether used for acute injury management or long-term athletic optimization, compression therapy remains an effective and accessible treatment modality in physiotherapy practice.

Reference List

 

  • Born, D., Sperlich, B., & Holmberg, H. C. (2013). Bringing light into the dark: effects of compression clothing on performance and recovery. Sports Medicine, 43(6), 533-549.
  • Brophy-Williams, N., Driller, M. W., & Shing, C. M. (2017). Acute and chronic effects of compression garments on recovery from exercise-induced muscle damage. Journal of Science and Medicine in Sport, 20(6), 527-531.
  • Duffield, R., Cannon, J., & King, M. (2010). The effects of compression garments on recovery of muscle performance following high-intensity sprint and plyometric exercise. Journal of Science and Medicine in Sport, 13(1), 136-140.
  • Hill, J., Howatson, G., van Someren, K. A., & Gaze, D. C. (2014). The influence of compression garments on physiological and performance responses to exercise: a systematic review. Sports Medicine, 44(6), 791-803.
  • Houghton, L. A., Dawson, B., & Maloney, S. K. (2019). Effects of compression garments on recovery following exercise: A meta-analysis. Physiology & Behavior, 210, 112671.
  • MacRae, B. A., Cotter, J. D., & Laing, R. M. (2012). Compression garments and exercise: garment considerations, physiology and performance. Sports Medicine, 42(10), 819-843.
  • Priego-Quesada, J. I., et al. (2020). Effects of compression garments on sports performance and recovery: A systematic review. Journal of Sports Sciences, 38(12), 1287-1304.
Compression Therapy