Calcific Tendinitis Pain: A Guide to Understanding and Treating Calcific Tendinitis

Calcific Tendinitis Pain

Calcific tendinitis can turn everyday movements into a painful challenge, with nagging shoulder pain and stiffness that disrupt your routine. Caused by calcium deposits in the rotator cuff tendons, this condition can make simple tasks like reaching for a shelf or sleeping through the night feel daunting. In this guide, we’ll break down what calcific tendinitis is, its symptoms, and the best ways to manage it—from non-invasive treatments to surgery—so you can regain comfort and mobility.

What Is Calcific Tendinitis of the Shoulder?

Introduction

Calcific tendinitis occurs when paste-like calcium deposits build up in or around the rotator cuff tendons of the shoulder. Despite its name, these deposits aren’t hard like bone but a soft, bulky material that irritates the tendon. The cause is unknown, unrelated to diet, injury, overuse, or conditions like osteoporosis. It’s most common in women aged 40–50, though it can affect men and other age groups. The pain and restricted movement can significantly impact daily life, making it tough to lift your arm or rest comfortably.

Inside View of Calcific Tendinitis

The calcium deposits push apart the tendon fibers, causing irritation and pain. They can also protrude into the subacromial space, rubbing against the acromion (part of the shoulder blade) when you lift your arm, worsening the discomfort. When calcium escapes into the surrounding space, the body treats it as a foreign substance, triggering intense inflammation and acute pain. This mix of mechanical pressure and inflammation makes calcific tendinitis particularly debilitating.

Symptoms

Calcific tendinitis brings persistent, nagging pain and stiffness, with symptoms including:

Constant Pain: Felt in the shoulder and often down the upper arm or to the hand, worse at night and disrupting sleep. Raising the arm, like reaching overhead, intensifies the pain.
Stiffness: Limited ability to lift or rotate the arm, making tasks like dressing or carrying objects difficult.
Acute Attacks: Some experience sudden, excruciating pain lasting a few days, often during the body’s attempt to absorb the calcium, accompanied by intense inflammation.
Nerve-Like Symptoms: Tingling or numbness in the arm or fingers, which can mimic neck-related nerve issues.
Visible Bulge: In rare cases, a large deposit may create a noticeable lump under the skin.

Special Investigations

Diagnosis typically involves X-rays, which reveal calcium deposits, though multiple angles are needed to ensure bones don’t obscure them. Ultrasound is even more precise, showing deposits in three dimensions and guiding treatments like needling. These tests confirm the diagnosis and assess the deposit’s size and location.

Natural History of Calcific Tendinitis

The body can sometimes absorb the calcium naturally, often with a painful flare-up that subsides after a few days. An X-ray afterward may show the deposit gone. However, this process can take years, and there’s no predicting when it might happen. While calcific tendinitis doesn’t cause permanent shoulder damage, the pain can significantly affect quality of life, especially for those with active lifestyles.

Treatment Options

Managing calcific tendinitis focuses on relieving pain and restoring shoulder function. Here’s how:

Conservative Management

If pain is manageable, non-invasive approaches can help:

Physiotherapy: Gentle stretching and range-of-motion exercises, like pendulum swings, maintain mobility. Therapeutic ultrasound has mixed evidence—some studies suggest pain relief, while others find it no better than placebo.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen reduce pain and inflammation. Painkillers may help with nighttime discomfort.
General Exercise: Activities like walking or swimming can improve shoulder function without jarring the joint. Avoid sudden, jerky movements.

Cortisone Injections

A cortisone injection into the shoulder can offer short-term pain relief and is often a first-line treatment due to its effectiveness. It doesn’t remove the calcium but reduces inflammation, easing discomfort for daily tasks. Up to three injections, spaced weeks or months apart, are typical. If repeated injections don’t provide lasting relief, other options should be considered.

Needling Procedure

Needle aspiration and irrigation, performed under ultrasound guidance, is a minimally invasive way to flush out calcium. Using local anesthesia, a doctor inserts one or two needles into the deposit, washing it with sterile saline to break it up and encourage absorption. The paste-like calcium often escapes into the bursal space, where the body absorbs it. This outpatient procedure is painless, allows immediate return to normal activities, and has a success rate of over 70%. It’s most effective when the calcium is soft, like toothpaste, but less suitable for small, ill-defined deposits or active frozen shoulder.

Extracorporeal Shockwave Therapy

This treatment uses sound waves to fragment calcium deposits, similar to kidney stone therapy. However, it’s not widely recommended due to high recurrence rates, potential pain during the procedure, and risks like skin hematomas.

Surgical Removal

When pain severely impacts quality of life and other treatments fail, arthroscopic surgery (keyhole surgery) is an option. Performed under general anesthesia, a small incision is made in the tendon to remove the calcium, with an X-ray during surgery ensuring complete removal. If the calcium leaves a large defect, the tendon may be sutured closed. Recovery can take 3–6 months for full pain relief, as the “sick” tendon heals slowly, and small calcium flakes may linger, absorbing over time. About 30% of patients develop temporary frozen shoulder post-surgery, especially middle-aged women or those with diabetes, but this usually resolves within months.

Post-Operative Care

Immediate Movement: Full motion is encouraged right after surgery, guided by pain limits. A physiotherapist will provide exercises like gentle stretches.
Sling Use: A sling may be worn for a few days for comfort but isn’t required.
Return to Activities: Most resume work or light activities within days, depending on discomfort. Tendon repairs may delay recovery slightly.

Tips for Physical and Technical Exercises

To prevent or recover from calcific tendinitis, combine strength, mobility, and smart movement habits:

Physical Exercises

Shoulder Mobility: Perform pendulum swings (1–2 minutes daily) to keep the shoulder loose without aggravating inflammation.
Rotator Cuff Strength: Use light resistance bands for external rotations (10 reps per side, 2 sets) to support the tendons.
Core Stability: Do planks (30–60 seconds, 3 sets) to reduce shoulder strain during daily activities.

Technical Tips

Posture Awareness: Maintain relaxed shoulders during tasks like typing or lifting to avoid unnecessary strain.
Ergonomic Adjustments: Adjust workspaces or chairs to prevent hunching, which can stress the shoulder.
Gradual Activity Increase: Ease into new physical tasks to avoid overloading the shoulder.

Duration of Exercises

Warm-Up: 5–10 minutes of arm circles and shoulder rolls before physical activity.
Strength Training: 15–20 minutes, 2–3 times weekly, targeting shoulders and core.
Cool-Down: 5–10 minutes of static stretches, like cross-body shoulder pulls, after activity.
Mobility Work: 5 minutes daily of gentle shoulder stretches to maintain flexibility.

Injury Prevention for the Modern Lifestyle

Stay ahead of calcific tendinitis with these proactive strategies:

Early Intervention: If shoulder pain or stiffness begins, consult a physio or doctor early to prevent worsening.
Recovery Focus: Use a foam roller on your upper back and shoulders daily to release tension. Aim for 7–8 hours of sleep for tissue repair.
Hydration and Nutrition: Drink plenty of water and eat protein-rich meals to support tendon health and prevent fatigue-related posture issues.
Cross-Training: Incorporate yoga or swimming to improve shoulder flexibility and reduce repetitive stress.
Monitor Activity Levels: Use a fitness tracker to avoid overexertion, which can strain shoulders and trigger inflammation.

FAQ: Common Questions About Calcific Tendinitis

Q: What causes calcific tendinitis?
A: The cause is unknown, possibly linked to reduced oxygen or blood flow to the tendon. It’s not related to diet, injury, or osteoporosis.

Q: Can I stay active with calcific tendinitis?
A: Yes, if pain is mild, stick to low-intensity activities. Avoid aggressive movements like heavy lifting or rapid arm motions.

Q: How effective is a cortisone injection?
A: It reduces pain in many cases but doesn’t remove the calcium. Up to three injections are typical, spaced weeks apart.

Q: Is needling painful, and how well does it work?
A: Done under local anesthesia, it’s usually painless and has a 70%+ success rate, especially for soft, toothpaste-like deposits.

Q: How long is recovery after surgery?
A: Full pain relief can take 3–6 months, though light activities can resume within days, depending on comfort.

Q: Can calcific tendinitis lead to frozen shoulder?
A: Yes, about 30% of surgical patients develop temporary frozen shoulder, especially middle-aged women or those with diabetes, but it resolves with time.

Calcific tendinitis can make simple movements feel like a struggle, but it doesn’t have to define your daily life. From cortisone injections and needling to arthroscopic surgery, there are effective ways to tackle the pain and stiffness. Combine these treatments with targeted exercises, proper posture, and a recovery-focused mindset to keep your shoulders strong. With patience and the right approach, you’ll be back to moving freely and enjoying life without shoulder pain holding you back.

Calcific Tendinitis Pain: A Guide to Understanding and Treating Calcific Tendinitis

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