Calcific Tendinitis of the Rotator Cuff
synonyms: calcific tendinitis, calcifying tendinitis, hydroxyapatite deposition disease, HADD
Calcific Tendonitis of the rotator cuff tendons is due to idiopathic calcium deposition (accumulation of basic calcium phosphate crystals (hydroxyapatite) within the rotator cuff. Calcific tendonitis procedes through two phases; a formative(most painful) and a resorptive phase.
It affects women more often than men and typically occurs in people in their 40's. It occurs in both shoulders 22% of the time and occurs more commonly in overweight individuals or those who do not drink alcohol. Calcific tendonitis has been associated with endocrine (hypothyroidism), autoimmune and hormone-related gynecologic disorders. People with associated disorders have poorer outcomes than those without an associated disorder.
Calcific Tendonitis mainly causes shoulder pain which can lead to decreased motion in the shoulder. Even if untreated calcific tendonitis can resorb spontaneously on its own. Treatment options for calcific tendonitis include both non operative techniques such as conservative observation, extra corporeal shock waves therapy, percutaneous needle aspiration and operative treatments. Studies have shown that 72.7% of patients treated non-operatively are satisfied with the outcome of their shoulder and 85.4% of patients treated with operative excision are satisfied with the outcome. Non-operative treatment fails in 46.9% of patients with endocrine disorders and in 22.7% of patients without endocrine disorders.
Initial treatment is generally conservative observation. Pain can frequently be improved with sub-acromial steroid injection, pain medications and gentle exercises. Treatments such as extracorporeal shock wave therapy have been shown to be 70% successful.
The operative treatment for Calcific tendonitis is Arthroscopic Excision of the Calcium deposits. The potential complications of arthroscopic excision include but are not limited to: Residual calcium deposits with continued pain, rotator cuff tear, Infections, Stiffness ,CRPS, Nerve injury, Fluid Extravasation, Chondrolysis, Hematoma, Chondral Injury / arthritis, DVT/PE, and the risk of anesthesia including heart attack, stroke and death. Complications are uncommon and most patients are satisfied with the results of surgery.
Following arthroscopic excision patients are generally placed into a sling with early elbow/wrist/hand active and passive range of motion exercises as well as shoulder pendulum range of motion exercises. Patients follow-up with Dr. Grutter 10-14 days after surgery and begin physical therapy. Depending on their findings at surgery patients may wear the sling for 6 weeks. Physical therapy gradually progresses into strengthening exercises with a gradual return to normal activities over 3-6 months.
Further information about Calcific Tendonitis of the rotator cuff can be found at the following sites:
Every person and their particular circumstances are different so the treatment for your shoulder may be different than those discussed. Please read this information carefully. Write down any questions that you have about your shoulder and its treatment and discuss them with your orthopaedic surgeon. Working together you and your orthopaedic surgeon will determine the best treatment for you.