Pain in the shoulder can have many causes. One of them is the so-called calcified shoulder, also called tendinosis calcarea (from "tendo" = "tendon" and "calcarea" = "calcified"). Calcareous shoulder is caused by calcium deposits in the tendons of the so-called rotator cuff. If these calcifications increase in size, they initially cause movement-dependent pain. In the course of time, this pain can also occur without exertion and disappear completely in the meantime.
What exactly is calcified shoulder and what are its causes?
Calcareous shoulder (lat. tendinosis calcarea) is a disease of the shoulder in which there are calcium deposits in the tendons of the rotator cuff. The rotator cuff is a group of four shoulder muscles that are responsible, among other things, for stabilising and certain movements of the shoulder. Most often affected (in over 90% of cases) is the supraspinatus tendon. This runs underneath the acromion. This is important because calcifications can cause the space below the acromion to narrow significantly, which can lead to entrapment of the tendon or the bursa (so-called impingement syndrome).
Thecause and trigger of the clinical picture of calcification in the muscle cuff covering the head of the upper arm (rotator cuff) is not yet known.
What are the symptoms of calcified shoulder?
Calcified shoulder disease is a cyclical, self-limiting clinical picture that progresses in three stages that follow each other in time. Stagnation or regression of the calcification with symptom-free intervals is also possible.
The disease leads to the formation of hydroxylappatite crystals in the tendon tissue, which then form a calcium deposit. When the calcium deposit is fully formed, there is a dull feeling of pressure and pain and the calcium can lead to painful inflammation and functional limitations of the tendons.
Secondary shoulder tendinitis can also result from the calcium deposit, which often triggers the so-called impingement syndrome. Since such calcium deposits do not normally occur in tendons, the immune system tries to break them down. This further inflames the tendons, which worsens the symptoms. Eventually, in many patients (about 70% of patients), the calcium deposit is dissolved by the immune system and the tendon can recover. In order to prevent too strong an inflammatory reaction from developing in the first place and to alleviate the symptoms, early diagnosis and treatment of calcified shoulder is important.
How can you successfully treat calcified shoulder?
If calcification has occurred in one of the tendons of the rotator cuff, there are various ways to treat it.
The first goal of therapy should be to improve the symptoms. The following therapy options are available for this purpose:
- Cooling and protection of the shoulder
- Pain therapy (with so-called non-steroidal anti-inflammatory drugs, e.g. ibuprofen or diclofenac).
- Physiotherapy (stretching and strengthening exercises for the shoulder)
Methods to alleviate the symptoms of calcified shoulder
If the symptoms are acute, it is first important to take it easy and relieve the pain. For this purpose, the shoulder is relieved by special bandages (e.g. Gilchrist bandage). Pain therapy with ibuprofen or diclofenac (so-called NSAIDs) serves not only to relieve the pain but also to provide anti-inflammatory therapy. Additional cooling of the shoulder can alleviate inflammatory reactions and swelling.
In order to ensure the shoulder's ability to bear weight in the long term and to prevent further injuries, physiotherapy is a decisive procedure in the therapy of calcific shoulder. Exercises to strengthen and stretch the shoulder muscles are practised under supervision. It is important for a successful physiotherapeutic treatment to perform these exercises regularly at home.
Imaging techniques to determine the appropriate therapy
For the second step of the therapy, it is essential to first assess where the calcium deposits are located in the tendon and how large they are. This is done with the help of imaging procedures such as X-ray or ultrasound examinations. This can be used to assess which procedure is suitable for removing or dissolving the calcium deposits.
The options for lime depot removal are:
- Focused extracorporeal shock wave therapy
- Arthroscopic calcium depot removal
- With the help of the so-called focused extracorporeal shock wave therapy, especially smaller calcium deposits can be treated well. In this procedure, which was originally used to break up kidney stones, sound pressure waves are generated which are bundled (focused) in the depth of the tissue. The calcium deposits are gradually pulverised and broken into smaller pieces by the permanent, rhythmic sound pressure. These smaller pieces are much easier for the body to break down. In most cases, the calcium dissolves completely after 4-6 weeks. Depending on the findings, several sessions may be necessary. Another positive effect of shock wave therapy is pain relief, which also has a positive effect on the course of the disease.
- If the conservative therapy does not bring any improvement in the symptoms or if the calcium deposits cannot be dissolved with the help of shock wave therapy, an arthroscopic calcium removal by means of arthroscopy may be considered. In this procedure, a camera and another instrument are inserted into the joint cavity through small incisions in the joint capsule of the shoulder in order to manually remove the calcium from the tendon.
What are the chances of a therapy that removes the calcium deposit? What are the risks?
Extracorporeal shock wave therapy is a very low-risk procedure for treating calcified shoulder. The calcium deposits are often dissolved with the help of this method and the shoulder can be moved without pain after a few weeks.
If the symptoms of tendinosis calcarea cannot be sufficiently alleviated by conservative therapy measures, a minor surgical intervention can in most cases permanently alleviate the symptoms or even restore complete freedom from symptoms. The calcium causing the symptoms is removed and can no longer trigger painful inflammatory reactions.
Despite all the precautions and experience of the surgeon, complications can occur during the operation. Injuries to the tendon to be operated on or other structures, haemorrhages and infections of the joint can be possible complications of the operation.
However, the probability of this happening is rather low due to the minimally invasive surgical technique (i.e. performed with the least possible injury).
Can I prepare myself for an operation? Are there any specific things I need to keep in mind after the operation?
Arthroscopic calcium depot removal is usually a minor procedure that can be performed on an outpatient basis. This means that you can be collected from the hospital by an accompanying person on the day of the operation. Before the operation, the surgeon will have an informative talk with you about the procedure and the possible risks. Likewise, the anaesthetist (anaesthetist) will have a conversation with you about the execution and types of anaesthesia, as well as its side effects.
On the day of the operation it is important to remain sober. This means not having any food or drink except a glass of water to prevent complications during the anaesthetic.
Immediately after the operation, the shoulder should first be cooled and res ted. It is also advisable to take painkillers (e.g. ibuprofen or diclofenac) against the pain that occurs after such an operation. These also reduce the inflammatory reaction and swelling after a joint endoscopy (arthroscopy).
It is important that you then carry out a slowly increasing physiotherapy adapted to the pain. This should begin after the operation and, if possible, be arranged before the date of the operation. Ideally, physiotherapeutic treatment is also carried out before the operation, as well as the practised shoulder exercises at home. In this way, a reserve of strength can be built up in the shoulder joint, which makes the post-operative treatment easier.
Schedule after the operation
- After about a week, you can resume normal everyday activities (cooking, shopping, etc.) with the affected side.
- When you can return to work depends on your job description. It usually takes about two to three weeks before you can return to work.
- Sporting activities should only be resumed after consultation with your post-operative doctor or when you are fully able to bear weight and are pain-free.
The post-operative examinations and the removal of the stitches from the 7th to 10th day after the operation can be carried out in our practice. Appointments for this will be made with you in advance.
If you develop a fever or notice redness on the surgical wound in the first two weeks after the operation, please call our practice immediately.
To clarify specific questions about calcified shoulder and the various therapy options, you can consult with Dr. Braune and his team.