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Calcific Tendinitis of the Shoulder – Reactive Calcification

Calcific tendinosis is the abnormal deposition of calcium in the tendons of the rotator cuff muscles. The rotator cuff muscles are a group of muscles that surround and stabilize the shoulder joint. When tendon cells die, scar tissue is normally formed. However, sometimes the body responds by depositing calcium which irritates the tendon and surrounding tissues causing pain. These calcium deposits are visible on X-rays and are occasionally present without pain.

Calcific tendinosis normally affects people in the age group of 30-50 years. Though an exact cause is not established, it has been attributed to aging, severe wear and tear, increased pressure on the tendon, and inadequate oxygen supply.

Symptoms include intense pain on the outside of the shoulder which may affect sleep, stiffness, difficulty with overhead activities and lumps in the shoulder tendons.

Calcific tendinosis normally passes through 3 stages. In the initial stage calcium deposits are not visibly formed and there is no pain. This is followed by a painful calcific stage and finally a stage where the calcium is replaced by normal tendon tissue.

To diagnose calcific tendinosis your doctor will review your symptoms and medical history and perform a physical examination. The calcium deposits are usually visible on X-rays. Ultrasound imaging can provide a clear view of the deposits when X-ray images are unclear.

Calcific tendinosis usually heals on its own but may have a prolonged course. Treatment depends on the severity of symptoms, the phase of the disease and the size of the deposits. Your doctor may prescribe analgesics and anti-inflammatory medications to control pain and inflammation. Severe symptoms may be controlled by steroid injections. Shockwave therapy may be recommended to break the calcium deposits so that they are absorbed by the body. The deposits may be removed by a lavage procedure where the tendon is repeatedly flushed with saline until the deposits loosen and are aspirated out with a needle. The deposits may also be removed with instruments during a minimally invasive arthroscopic procedure.