Tendon calcifications

Shoulder pain can result from calcifications in the rotator cuff. These calcifications cause a constant, nagging pain over many years. The pain may suddenly become extreme if the calcifications break loose.

Why tendon calcifications form is not known. Hereditary factors may play a role, as may variations in the blood circulation to the rotator cuff (muscles around the shoulder). Overload does not seem to be a major factor. We see calcifications equally in people who do not perform strenuous jobs or participate in sports. The calcifications are often present in both shoulders and are asymptomatic.

It is best to treat these inflammation flare-ups with strong painkillers, rest (wearing the arm in a sling or brace) and, if possible, a cortisone injection. The injection will not dissolve the calcium, but rather suppresses the severe inflammatory response. Pain is usually brought under control two days after the injection. Applying cold therapy to the inflamed shoulder also helps to alleviate the pain. Applying heat causes the opposite effect.

If the calcification does not dissolve spontaneously, we can try to speed up the process by firing (ultrasonic) shock waves at the calcifications. This procedure, known as ESWT (Extracorporeal Shock Wave Therapy), is akin to the kidney stone pulverisation. Under local anaesthetic, and after confirming the site with ultrasound, a probe is place on the skin above the calcification and shock waves are aimed at the calcification. This treatment can be temporarily painful (a bruising feeling). Large calcifications and calcifications that are associated with a cuff tear are usually not treated successfully with ESWT.

If these basic measures fail, or if patient would like the calcifications dissolved more quickly, surgery can help. The largest parts of the calcification foci are removed, after which the opening created in the tendon is closed back up.

Small remnants of the calcifications may remain stuck in the tendon, but they usually do not cause any discomfort. Once removed, calcifications do not usually recur.

Latest publication date: 02/08/2024