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.
