Calcific tendonitis is a painful condition affecting the rotator cuff of the shoulder, due to a build up of calcium within the tendons, sometimes called calcium deposits. There is also associated inflammation of the bursa around the tendons that contributes to the pain. The exact cause of calcific tendonitis is unknown. It is thought to be related to wear and tear of the tendons. It is more common in patients with other calcium-related disorders, such as kidney stones or gallstones. Calcium can build up in other tendons around the body, but the shoulder is the most common place the deposits are found. Specifically, the supraspinatus tendon of the rotator cuff is the most common site in the shoulder.
What are the signs and symptoms?Calcific tendonitis can be one of the most painful conditions of the shoulder and can send patients to Accident and Emergency. Pain is often felt over the top of the shoulder radiating down the arm, and is worse with lifting the arm away from the body. This pain is very similar to subacromial impingement pain as there is associated inflammation in the bursa around the tendons that becomes impinged, or trapped, as the arm lifts away from the body. At its worst, the pain can disrupt sleep and have a knock-on effect the following day.
How is calcific tendonitis diagnosed?Calcific deposits are seen on standard X-rays of the shoulder. Calcium can also be picked up on ultrasound and MRI scans.
How is it treated?
Simple painkillers can help with the pain and inflammation in the shoulder. If the pain is severe enough, painkillers can be prescribed by a doctor/GP.
Injections of local anaesthetic and steroid can be placed around the inflamed tendon, into the subacromial bursa. Steroid is a potent anti-inflammatory that will settle the inflammation and improve the pain. This can be helpful in the short term at relieving pain, but if it recurs then intervention can be discussed.
Ultrasound-guided barbotage is a procedure that aims to break up or suck out calcium from within the tendons under local anaesthetic. The ultrasound will locate the deposit and a needle is placed into the calcium in an attempt to remove it into a syringe. Following the procedure the local anaesthetic and steroid are placed around the tendon to help settle pain and inflammation. The risks are low and repeat treatment may be necessary in some patients.
Shockwave therapy can be used to break up a calcific deposit and allow the body to resorb the calcium. A probe is used to send shockwaves through the skin; a course of treatment is performed as an outpatient. There is evidence to support shockwave therapy, but often the barrier to treatment is the availability of the machine that is used. There are few adverse effects, though pain, preventing further treatment, can be experienced.
If other options are not working, arthroscopic (keyhole) excision of calcific deposits can be performed. The procedure is performed under general anaesthetic and a camera (arthroscope) is placed into the shoulder to fully assess it, before locating the calcium. The deposit is released and the shoulder is thoroughly washed through. If required, the inflamed bursa around the tendon is also removed, and a small area of bone is shaved from the under surface of the shoulder to decompress or expand the area around the tendon. The results of surgery are good. The literature reports, and our own results confirm, 90% success rates. Generally, 60% of patients are better within six weeks, and 80-90% within three months, but some patients can take longer to fully settle down following surgery.
What are the potential complications?The risks of injections, barbotage or shockwave treatment are low. With injections there is always a small risk of infection. The other “risk” is the need for further intervention. The risks of surgery are low, with very low risks of infection, bleeding, and nerve injury. There is a small risk (4-5%) of stiffness following surgery that tends to resolves with time and, while the vast majority of patients benefit from surgery, a small group never fully settle and may occasionally need further surgery.
A big thank you to Simon and his team for their care, patience and perseverence looking after me through all stages of both shoulder and elbow surgery.
Since the shoulder stabilisation I have continued my sailing and fitness training without the worry that my shoulder might dislocate; and I don’t have to think twice whether my ulnar nerve will hinder any progression in my sports.
With their amazing help, I’ve been able to get back to sailing competatively and am now a double National champion.
After multiple shoulder dislocations Charlie helped me set a route for recovery, which has been nothing but smooth sailing. Surgery went successfully and I am well on my way to playing the sports I was previously. Would highly recommend.
Simon successfully operated on my frozen left shoulder in 2012 with fantastic results. This year he has overseen and advised treatment for my frozen right shoulder (via hydrodilation injection). His unrivalled experience in orthopaedic shoulder treatments, coupled with his reassuring bedside manner and excellent results, gave me huge confidence throughout. I’m hugely grateful to have my quality of life back and wouldn’t hesitate to recommend his services. Thank you Simon.
I had suffered with a painful shoulder and pins and needles for three years following a right shoulder fracture and failed half joint replacement prior to meeting Mr Pennington. He explained the situation in a way I could relate to and I’m delighted to say my revision shoulder replacement has gone well and for the first time in years I can use my arm and am pain free. I was even able to walk my daughter down the aisle 3 months after surgery! Many thanks.
I would like to thank Charlie Talbot and his team for the operations performed on both my shoulders and also the aftercare put in place after my operations. I have played golf since I was 12 years of age and thought at one point that I would never get back to playing again. Charlie was always very positive and told me that he would get me playing golf again. Well, I have now been playing golf for nearly 2 years. Before surgery I had a handicap of 12 and I am now down to 9, not bad at the age of 68. So many many thanks.
I had PRP injections into my right elbow last year and within 3 months I was pain free, a year on it is more or less 100% better. Fabulous I would recommend it to anyone with Tennis Elbow, in fact I have gone back again this year to get my left elbow done. Thanks Simon.
Mr Pennington I really wanted you to know how very thankful I am for the excellent care & treatment you and your staff gave me. It really meant a lot that you were so clear, friendly & professional and listened to me – so thank you again.
After more than four decades of shoulder problems with a total of three surgeries the full shoulder replacement surgery by Mr. Talbot has changed my life beyond expectations. I am now able bodied for the first time in years and pain free.
Thank you to Mr Boyle and team for the excellent care and attention both before and after Replacement Shoulder surgery, using the Tornier Simpliciti procedure. After very many months of severe pain and lack of movement I was pain free from day one. Now, after nine weeks, the shoulder and arm movement continues to improve, beyond expectation, with physiotherapy and exercise. I am extremely grateful for all the continuing care.
Following two years of recurrent problems with my left shoulder I was recommendedto Consult Mr Neil Pennington. I had the opportunity to have my surgery quickly and at my convenience, this fitted well around my professional and home commitments. The surgery was carried out as a day case procedure and Mr Pennington visited me following the surgery to explain everything. My operation was a minimally invasive procedure so my recovery was straightforward with only a few restrictions; in fact I was encouraged to keep my shoulder moving. I was driving and back to work after 2 weeks – after 2 years of pain and sleep disturbance I found this operation to be life changing! I found Mr Pennington to be a very professional and compassionate surgeon and he is surrounded by a whole team of professionals that gave me the utmost confidence in the care and treatment I received.
I would like to thank Mr. Talbot and the amazing team of nurses, physiotherapists and support staff for their care and support during my recent visit to the Duchy Hospital, Harrogate, for a replacement shoulder. The care and attention I received was unparalleled. The pain free movement I now have has changed my life.