Calcific Tendinopathy - When toothpaste grow inside your tendons!
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What is Calcific Tendinopathy?
Calcific Tendinopathy is one of the more unusual conditions we see, and occurs when calcium deposits accumulate in the tendons, leading to inflammation and pain. These deposits are typically composed of a substance called calcium hydroxyapatite (a chalk like substances that is similar to bone), and can vary in size and consistency. The exact cause of calcific tendinopathy is not fully understood, but it's though to involve a cell-mediated process where calcium is deposited and later resorbed by the body. However, this natural resorption process can be disrupted, leading to persistent symptoms.
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What causes Calcific tendinopathy?
Calcific tendinopathy is most common in people aged 30 to 60, where females are more likely to get it than males. It's estimated to occur in 2.5% to 20% of healthy shoulders, with about 10-20% of cases being bilateral. The condition is not typically related to physical activity, and its prevalence in the general population suggests a potential link to biological and genetic factors.
The Stages of Calcific Tendinopathy
Calcific tendinopathy progresses through several stages, each characterised by different symptoms and levels of pain:
- Formative Phase: Calcium deposits begin to form within the tendons. This phase is often asymptomatic, and the deposits may not cause any noticeable discomfort.
- Resting Phase: The calcium deposits remain stable within the tendon. Patients may experience mild discomfort or no symptoms at all during this stage.
- Resorptive Phase: The body attempts to reabsorb the calcium deposits, leading to inflammation and severe pain. This stage is often the most painful and can significantly impact sleep and daily activities.
- Post-Calcific Phase: The calcium deposits have been resorbed, and the tendon begins to heal. Pain and inflammation decrease, and normal function gradually returns.
Imaging and Diagnosis
Diagnosis of calcific tendinopathy is primarily made through imaging techniques:
- X-rays: These are the most common imaging method used to identify calcium deposits in the shoulder. X-rays can show the size, shape, and location of the deposits.
- Ultrasound: This imaging technique provides a more detailed view of the soft tissues and can help assess the extent of inflammation and the precise location of the calcium deposits.
- MRI: Although not typically required, an MRI can be used to evaluate the condition of the rotator cuff tendons and the surrounding structure.
Role of Exercise in Management
Exercise plays a crucial role in the management of calcific tendinopathy. A well-structured physical therapy program can help improve shoulder function, reduce pain, and prevent stiffness. Key components of an exercise program include:
- Range of Motion Exercises: These exercises help maintain joint mobility and prevent stiffness.
- Strengthening Exercises**: Targeting the rotator cuff and scapular muscles can improve shoulder stability and function.
- Scapular Stabilisation:: Addressing scapular dyskinesia can reduce impingement and alleviate pain.
Treatment Options
Several treatment options are available for managing calcific tendinopathy, ranging from conservative approaches to surgical interventions.
Non-Surgical Treatments
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These medications help reduce pain and inflammation associated with calcific tendinopathy.
- Corticosteroid Injections: Administered directly into the sub-acromial space, these injections can provide rapid pain relief and reduce inflammation.
- Extracorporeal Shock Wave Therapy (ESWT): This non-invasive treatment uses sound waves to break down calcium deposits and stimulate healing. It is particularly effective in the formative and resting phases but may have complications such as transient bone marrow oedema.
- Ultrasound-Guided Needle Lavage: This procedure involves using a needle to break up and aspirate the calcium deposits, providing relief from pain and improving shoulder function.
Surgical Treatments
Surgery is considered when conservative treatments fail to provide relief. The most common surgical procedure is arthroscopic decompression, which involves removing the calcium deposits and cleaning the joint. Surgery is typically reserved for chronic cases and requires a rehabilitation period post-operation.
Take home message
Calcific tendinopathy of the shoulder is a common condition that can cause significant pain and disability. Understanding the stages of the condition, the role of imaging in diagnosis, and the various treatment options available can help patients manage their symptoms effectively. While many cases resolve spontaneously, persistent symptoms may require medical intervention, including exercise therapy, injections, shockwave, or surgery. Early diagnosis and a comprehensive treatment plan are essential for achieving the best outcomes for individuals with calcific tendinopathy.
So if you think you have these symptoms or have recently been told you have calcific tendinopathy, see one of our Physiotherapists or Chiropractors at Blacktown Health today. To make a booking, call us on 02 8662 0496 or book an appointment online now.
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