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.