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What is calcific tendinitis?

Calcific tendinitis is a very painful condition caused by the build up of calcific deposits (calcium hydroxyapatite crystals) inside or around tendon tissue and commonly affects the rotator cuff tendons of the shoulder (e.g. supraspinatus) but can affect any tendons where there are high levels of demand (e.g. patellar tendon at the knee). The condition predominantly affects people between the ages of 40 to 60 with women more commonly affected than men. It is one of the conditions that can cause sub-acromial pain syndrome (SAPS) and by far the most fierce.

What are the symptoms?

It depends on the stage of the condition but calcific tendinitis can present quite dramatically with sudden onset of severe, disabling pain. The pain can be so severe that any kind of movement is excruciating and simple tasks like getting dressed can prove to be major challenge. Getting comfortable at night is also almost impossible There can be concomitant stiffness, giving rise to a frozen shoulder like clinical picture.

What causes it?

Although the condition is often associated with high levels of demand around the affected area, it is surprising that statistically, incidence is not higher in people engaged in heavy duty work or in the athletic population1. One study found that calcific changes in the rotator cuff tendons were observed in 8% of people who did not have any symptoms but this rose more than fivefold (42%) in patients with shoulder pain. The condition develops from a pre-clinical stage (where the patient has no symptoms) to a clinical stage when the symptoms often present dramatically and a post-clinical phase when the symptoms gradually resolve.2 Calcific tendinitis usually affects tendon tissue where there is some pre-existent ‘wear and tear’ changes and so, whilst the acute pain may resolve, patients often have to deal with on-going symptoms caused by these changes to the tendon tissue.

What is the treatment?

There are a number of treatment options but because the pain is so severe, the quickest and most effective treatment option is an ultrasound guided cortisone injection. This quickly reduces the inflammation that is causing the pain and can produce dramatic improvement over the space of a few days. The patient will need further physiotherapy treatment to restore normal movement and function but this can then be done without the awful pain! For more resistant and severe cases a different injection technique (barbotage) that involves aspirating the calcific deposits can be considered but in most cases this is not necessary.