The rotator cuff is the term used to describe the 4 muscles surrounding the shoulder that help raise and lower the arm. The muscles lie under the roof of the shoulder, known as the acromion and need to glide freely in this space. The subacromial bursa, a fluid filled sac, is also found in this space to assist the smooth movement of the rotator cuff.
Calcific tendinitis describes the accumulation of calcium (chalk like substance) in the rotator cuff tendons. It is an incredibly painful condition of the shoulder.
What are the causes?
It is not entirely clear what causes the calcium to accumulate in the tendon but is probably a response to an injury to the rotator cuff. It is usually seen in middle aged patients. The pain occurs due to an increased pressure within the tendon and inflammation caused by the calcium itself.
What are the symptoms?
Patients can present with exquisite pain in the shoulder, commonly thought to be due to infection. This can settle over a few weeks to become a dull ache with symptoms similar to subacromial impingement. Pain can be worse at night and when trying to lift the affected arm away from the body.
How is it diagnosed?
X-rays can usually demonstrate the calcium sitting in the rotator cuff. An ultrasound can also be helpful, particularly if the calcium deposits are small.
How is it treated?
The calcium deposits can absorb on their own but this may take many years. When the pain is very intense simple painkillers, including anti-inflammatories, and ice can help. Occasionally, an injection into the subacromial space will be needed to settle the severe symptoms. Physiotherapy can help keep the shoulder moving and strengthen the rotator cuff muscles.
If symptoms persist the calcium deposits can be removed by needling the affected area under ultrasound guidance. The majority, however, will require keyhole surgery known as arthroscopic subacromial decompression and excision of calcific deposits.