Shoulder calcification

Calcification

Calcified tendinitis of the shoulder includes calcifications in the inflamed tendons of the rotator cuffs.

Their existence is quite frequent – between 2.5 and 7.5% of X-rayed shoulders, and they are sometimes found by chance.

Sometimes this calcification does not exhibit symptoms, patients do not complain of pain. On the contrary, when calcification is disintegrating, crystals of calcium migrate in the subacromial space and this migration causes a very rapid inflammation, at the origin of acute painful crises.

Patients are no longer able to move their shoulders because of the very intense pain.

These calcifications are deposits of calcium hydroxyapatite, which may, among other things, be present at other inflamed tendons (tendon in the foot, elbow and hip).

Illness is frequently bilateral and calcifications are often encountered in diabetic patients subjected to dialysis.

Between crises, these calsifications are well supported and patients can normally use their shoulders.

Pain occurs only after the tendon calcium migrates in the subacromial space with chemical irritation of subacromial bursitis at the base of the very painful inflammation.

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X-rays made during check-ups easily show these calcifications.

Sometimes, further tests are needed, to rule out a tear associated to the rotator cuffs or to better locate this calcification in the tendon.

An ultrasound may be required for the same reasons.

Conservative treatment

In the chronic phase, non-steroidal anti-inflammatory treatment will allow pain alleviation.

We sometimes suggest infiltration of the subacromial space that allows a significant attenuation of these pains. Only rarely, there will be more than 2-3 shoulder infiltrations per year. Side effects are limited because the anti-inflammatory product remains in the joint, largely in the subacromial space. Diabetic patients should be warned that this type of infiltration could significantly increase the blood sugar concentration in the following days.

Surgical treatment

A treatment essentially performed arthroscopically, with the trituration and aspiration of calcium deposit.

Calcification is aspired under arthroscopic control; all inflamed tissue (subacromial bursitis) and the existing calcium are removed.

Surgical ablation by arthroscopy allows a final healing of 80-90% of patients.

24 hours of hospitalization are sufficient.

Intervention is performed under general anaesthesia; the patient leaves the hospital the same day with the arm supported by a sling.

The patient will have two scars about 1 cm each at the shoulder.

Kinesiotherapy is recommended after a week; first, with a passive mobilization, then assisted, active.

Active mobilization of the shoulder may be authorized from the third postoperative week. From this moment, supportive cling may be abandoned.

Usually work is resumed four weeks after surgery, with a complete functional recovery of the operated shoulder 6 to 8 weeks after surgery.

 

Possible complications after intervention

Most often, the consequences are simple.

We must remember, however, certain complications such as transient postoperative stiffness, infection, algo-dystrophy.

Physical therapy

The use of ultrasound performed by the physical therapist can be a solution for removing pain related to this calcification.

In addition, shock waves may relieve pain in the acute phase when calcification is very low.

Therapeutic indications must therefore be studied based on several parameters (patient’s physical condition, size of calcification, related injury…), but arthroscopy with calcification ablation is most often the best solution.

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