Dr Graeme MacDougal

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Calcific Tendinitis

Calcific tendinitis refers to a condition where a calcium crystal deposition may occur within the rotator cuff tendon in the shoulder region. The calcium crystals are usually hydroxyapatite crystals. The shoulder is a common site of occurrence of this particular problem.
Calcific Tendinitis
It is commonly seen in patients between the age of 30 and 50, and rarely recorded in people over 70 years of age. It is more common in women and occurs bilaterally in up to 25% of cases. It should be noted that not all calcium deposits identified on x-ray are due to this condition and may relate to deposits from old trauma or dystrophic calcification.

The collection itself varies in size and can be of a chalky and speckled nature and occasionally can be in a liquid form.

The natural history of the condition is interesting and it goes through a number of phases including a Pre-Calcifying phase, where the tenocytes or tendon cells change into cartilage-producing chondrocyte cells. The next phase is the Formative phase where the calcium is deposited in a chalky consistency. Occasionally this can be painful but often is not producing symptoms at all, and can be an incidental finding on x-rays. It may block movements or cause other symptoms with repetitive activities.

Next is the final Resorptive phase, which is usually the most painful phase of this condition, where there is an inflammation and active resorption of calcium by the body. In this phase the collection is often forms a toothpaste-like consistency.
Severe pain may occur at this time and lead to hospital admission or urgent assessment by local doctors and shoulder surgeons. Once the Resorptive phase is completed much of the calcium disappears, but residual collections may continue to produce pain, stiffness and irritability.

Conservative management of this condition includes the control of pain in the inflammatory phase and ultrasound guided needling and aspiration may be of value by the Radiologist.

Should these measures not control the symptoms, an arthroscopic calcium release can be performed along with a bursectomy, and occasionally associated acromioplasty.

There may be a need for the acute intervention is the severe painful Resorptive phase and is best performed with an arthroscopic release of the collection.

Should your shoulder be affected by this condition further information can be obtained from Dr MacDougal.
  Any surgical or invasive procedure carries risks. Should you wish to discuss your calcific tendinitis further with Dr MacDougal, please make an appointment to do so in order that your individual treatment needs can be prescribed for your particular situation.

Graeme MacDougal Shoulder and Elbow Surgeon