Calcific Tendonitis of Shoulder

A common disorder which is manifested by the accumulation of calcium hydroxyapatite in one or more attendance in the vicinity of the shoulder joint. It is one of the most common causes of pain in the shoulder in middle-aged people. Up to now, the cause of this has not been fully understood. That disease has three basic phases. During the first, formative phase, the accumulation of calcium begins. With time, the calcium accumulation enlarges and with its size, it can start mechanically irritating the neighboring structures. In this phase the calcification looks like a blackboard chalk, and the pain is usually constant and moderate with sudden short-term worsenings and limited shoulder mobility. Such a calcification goes in the dormant phase which in most cases is painless. With time, the body tries to „melt“ the calcification with inflammation and the resorptive phase starts. The difficulty dramatically worsens up to the point that the patient who had periodical issues cannot move his/her hand because of great pain. In this phase the calcification is more liquid and looks like toothpaste. Depending on its size, the duration of the melting process can be variable, as well as the pain level. The resorption process has its natural way and the body melts the calcification completely. After the melting process and removal of classification finishes, so do the patient's difficulties.

Patients usually come to the physician during the resorption phase because of great pain. To confirm the diagnosis, the physician uses radiological procedures. Considering the body melts the calcification itself, the treatment is focused on relieving the patient of his/her pain. In the formation and dormant phase, different physical therapy modalities are available with a goal of further reducing pain and returning the patient's shoulder to full mobility.

During the resorptive phase and presence of pain, ice packs, analgesics and being inactive are helpful. So called „blockades“ are advisable. These are injections which contain corticosteroid and a local anesthetic. Such injections are given with help of ultrasound visualization of the calcifications. If the calcification is less condensed, sometimes this way the calcification can be removed prior to giving corticosteroids which reduces the length of pain. A more modern approach is the extracorporeal shockwave therapy (ESWT) which has its advantages by directly affecting the calcification and its resorption. Surgical treatment is very rarely necessary and almost only in cases if the difficulties are very long and tiresome and the calcification homogeneous and large. This type of surgery is open type or arthroscopic, i.e. minimally invasive. After surgery, the recovery is fast and the complete function of the shoulder is expected within 4 to 6 weeks.

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