What is Rotator Cuff Calcific Tendonitis?
Calcific tendonitis is a condition that causes the formation of a small, usually about 1-2 centimetre size, calcium deposit within the tendons of the rotator cuff. These deposits are usually found in patients at least 30-40 years old, and have a higher incidence in diabetics. The calcium deposits are not always painful, and even when painful they will often spontaneously resolve after a period of one to four weeks.
What Causes Calcific Tendonitis?
The cause of calcium deposits within the rotator cuff tendon (calcific tendonitis) is not entirely understood. Different ideas have been suggested, including blood supply and ageing of the tendon, but the evidence to support these conclusions is not clear.
One of the most compelling arguments is delayed healing.
Normally, the tendon heals via the action of collagen forming cells known as fibroblasts. After a period of weeks or months, the fibroblasts become less numerous in the region and are replaced by osteoblasts (bone forming cells). These osteoblasts stimulate the growth of bone (calcium) in the tendon.
Hence the main reason for the development of calcific tendonitis appears to be delayed healing.
How Does Calcific Tendonitis Progress?
Calcific tendonitis usually progresses predictably, and almost always resolves eventually without surgery. The typical course is:
You usually do not have any symptoms in this stage. At this point in time, the site where the calcification tend to develop undergo cellular changes that predispose the tissues to developing calcium deposits.
During this stage, the calcium is excreted from cells and then coalesces into calcium deposits. When seen, the calcium looks chalky, it is not a solid piece of bone. Once the calcification has formed, a so-called resting phase begins, this is not a painful period and may last a varied length of time. After the resting phase, a resorptive phase begins--this is the most painful phase of calcific tendonitis. During this resorptive phase, the calcium deposit looks something like toothpaste.
This is usually a painless stage as the calcium deposit disappears and is replaced by more normal appearing rotator cuff tendon.
Patients usually seek treatment during the painful resorptive phase of the calcific stage, but some patients have the deposits found incidentally as part of their evaluation impingement syndrome, usually on X-ray.
What is Rotator Cuff Impingement Syndrome?
Impingement (impact on bone into rotator cuff tendon or bursa) should not occur during normal shoulder function.
When it does happen, the rotator cuff tendon becomes inflamed and swollen, a condition called rotator cuff tendonitis.
Likewise if the bursa becomes inflamed, shoulder bursitis will develop. These conditions can co-exist or be present independently.
While a traumatic injury can occur eg fall, it is repeated movement of your arm into the impingement zone overhead that most frequently causes the rotator cuff to contact the outer end of the shoulder blade (acromion).
When this repeatedly occurs, the swollen rotator cuff is trapped and pinched under the acromion.
Rotator Cuff Calcific Tendonitis Treatment
Rotator cuff calcific tendonitis is a common complaint that we see at PhysioWorks and it is unfortunately an injury that often recurs if you return to sport or work too quickly – especially if a thorough rehabilitation program is not completed.
Your rotator cuff is an important group of control and stability muscles that maintain “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This prevents injuries such as bursitis, impingement, subluxations and dislocations.
We also know that your rotator cuff provides subtle glides and slides of the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapular) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.
Did you know that your arm only has one bony joint articulation where your collarbone (clavicle) attaches to the acromion (tip of shoulder blade)?
The rest of your attachments are muscular, which highlights the importance of retraining and strengthening of your shoulder muscles.
Calcific Tendonitis Treatment
Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence – these are:
- Early Injury Protection: Pain Relief & Anti-inflammatory Tips
- Regain Full Range of Motion
- Restore Scapular Control
- Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
- Restore Rotator Cuff Strength
- Restore High Speed, Power, Proprioception & Agility
- Return to Sport or Work
Calcific Tendonitis Treatment Results
There is no specific time frame for when to progress from each stage to the next. Your injury rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment.
You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.