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Calcific Tendonitis

Calcific tendonitis in the shoulder commonly involves the supraspinatus tendon of the rotator cuff, and less commonly the infraspinatus or subscapularis tendon. It is unclear why some patients develop irritation in the shoulder alone and some people develop irritation with calcium deposits. The calcium is soft, and it sits in the rotator cuff under pressure. This causes pain with overhead activities, as well as aching pain. Many of these deposits are asymptomatic and are noted on routine x-rays. However, when greater than 1 cm., the deposits may become symptomatic and cause pain.

There are two general presentations for calcium deposits. In the first presentation, the patients present with severe pain, and label the pain as intense as a kidney stone or childbirth. They have limited motion in the shoulder. This is often seen as the calcium deposit is starting to resolve, and many of these patients will do well after a corticosteroid injection. If the calcium deposit resolves completely and the patient remains asymptomatic, then no further treatment would be required. Other patients have persistent pain after an acute episode, or more commonly present with chronic aching type pain in the shoulder. These patients have chronic calcium deposits. Initial treatment is with exercises, and possibly a corticosteroid injection or anti-inflammatory medication. If these patients fail to respond, then it is sometimes necessary to proceed with shoulder arthroscopy with removal of the calcium deposit. If there is a large gap of the rotator cuff tendon, then this may need to be repaired at the same time. Sometimes a subacromial decompression is necessary if there is evidence of rubbing of the acromion on the area of the calcium deposit.

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