Calcific tendonitis of the shoulder joint is a particularly debilitating condition that affects the quality of life for men and women between the ages of 30 and 50 and has mostly no correlation with physical activities. Calcific tendonitis is caused by calcium deposits building up in a person’s tendons– the most common area for the development of calcific tendonitis is the rotator cuff of the shoulder, and predominantly the supraspinatus tendon.
According to medical bibliography, the precise pathogenetic mechanism of calcific tendonitis remains unclear, despite the presence of inflammatory cells consistently observed around the area of calcification. In 2016, a study published by the Journal of Bone and Joint Surgery linked calcific tendonitis of the rotator cuff with the increase of blood vessels and pain receptors in patients. As a result, in comparison to conditions such as frozen shoulder, patients experience more pain during sleep, and more extreme pain in general.

Symptoms may vary: from mild discomfort to excruciating pain, as well as alternating increased and decreased stiffness of the joint to total loss of movement. Clinical examination by the orthopedist as well as radiography, can determine the existence of calcific tendonitis of the rotator cuff, whereas shoulder ultrasound is used to assess in detail the extent of calcification and the current state of the tendon and soft tissue.

Primary treatment for calcific tendonitis includes rest, application of ice, medication and physiotherapy. In most cases, after one or two months, a progressive decrease of the patient’s pain is observed. Corticosteroid and/or biologic agents are injected into the injured shoulder in order to promptly treat particularly debilitating cases of calcific tendonitis.
However, in cases of unsuccessful conventional therapy or frequent relapses, surgical techniques are deemed necessary. The least invasive surgical technique is performed with the use of ultrasound and a percutaneous needle, in order to aspirate the calcium deposit from the affected area. This surgical method reduces the duration of therapy to one week. Another surgical option to treat calcific tendonitis is extracorporeal shock wave therapy which ‘‘breaks up’’ the calcium deposit and has a similar function to shock wave lithotripsy in urology.
After two or three months of conventional therapy, if there is no significant improvement of the patient’s condition, the most reliable surgical option is arthroscopic removal of the calcium deposit. It is estimated that the arthroscopic technique is a suitable option for 10% of patients, those suffering from chronic calcific tendonitis that causes shoulder impingement syndrome. The arthroscopic technique is excluded in acute cases, and the objective is to ‘‘clean up’’ the affected tendon and treat potential coinciding pathology in the totality of the shoulder joint. Acromioplasty (surgical decompression of the acromion), and in some cases, reconstruction of the affected tendon are common procedures. Postoperative rehabilitation is usually rapid and carries no risk of a relapse.

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