Calcific tendinitis is another shoulder girdle disease that can potentially cause shoulder pain, and the etiology of which is unknown, although, similarly to frozen shoulder, a slightly higher incidence of the disease has been observed in diabetics as well as in women. The onset of this disorder is not thought to correlate with previous shoulder trauma.
Development of calcific tendinitis and course of the disease
What is the dynamics of the disease? Calcifying tendinitis is a condition characterized by two stages of development:
- The chronic phase of calcific tendonitis, also called the formative phase, is characterized by the deposition of calcium hydroxyapatite minerals in the shoulder tendon apparatus, most often in the immediate vicinity of the bone tendon grip.
- The acute phase of calcific tendinitis, also called the resorptive phase, is characterized by resorption of deposited calcifications and healing of the tendon, with the shoulder becoming extremely painful and tender.
Clinical picture and symptoms of calcific tendinitis
The presentation of patients with calcific tendinitis largely depends on the stage of the disease in which the patient is. Patients in the formative phase usually feel mild discomfort when moving in the shoulder and sensitivity to pressure in the projection of the grip of the deltoid muscle on the humerus, but without major functional problems, so they rarely report to the doctor at this stage of the disease.
In the acute, resorptive phase of calcifying tendinitis, the symptomatology of the disease greatly worsens. Namely, in parallel with the resorption of calcifications from the tendon, vascular tissue swells in its vicinity, which ultimately leads to an increase in pressure within the tendon sheath of the rotator cuff muscles, most commonly the muscle supraspinatus. Furthermore, due to the increase in pressure inside the tendon sheath, the entire tendon grows in its volume and gets stuck in the coracoacromial arch, which further intensifies the feeling of pain in the shoulder. The pain in the shoulder is so severe that the patient usually keeps his hand completely next to the body and does not suffer the slightest movement from that position.
In the acute phase of calcific tendinitis, the pain is so strong that the patient holds his hand to his body and does not allow any movement.
Diagnosis of calcific tendinitis
X-ray findings with a typical clinical picture represent the gold standard in the diagnosis of calcific tendinitis. On X-rays taken from the front while the shoulder is in internal and external rotation, calcifications are clearly visible, and their appearance varies with the stage of the disease. In the formative phase the calcifications are clearly visible and easy to localize, while in the resorptive phase the calcifications are inhomogeneous, cloudy and vaguely limited in relation to the surrounding tissue. For calcific tendinitis, it is specific that the calcifications are located inside the tendon sheath and are not in any contact with the bone, unlike calcifications in various inflammatory – degenerative diseases of the shoulder, which are located outside the tendon sheath.
A typical X-ray finding of calcifications in the shoulder tendon apparatus
Treatment of calcific tendinitis
The treatment of calcific tendinitis largely depends on the stage of the disease the patient is in. In the formative phase, physical therapy is extremely useful, as it preserves the range of motion and the corresponding trophism of the shoulder girdle muscles, while the use of corticosteroids in the form of “blockade” in this phase is not useful. The opposite story is true in the resorptive phase of the disease, in which patients are very reluctant to physical therapy due to the great pain they suffer, however, in this phase of the disease it is very useful to apply “blockade”, as it affects the pain itself and the amount of inflammation. the cells that cause that pain. The use of cryotherapy is also extremely useful.
Targeted physical therapy is an excellent way to improve shoulder mobility in the formative phase of the disease, but is avoided in the acute phase due to the severe pain the patient suffers