Calcific tendinopathy is a condition marked by the accumulation of calcium hydroxyapatite crystals in a tendon, mostly in the shoulder rotator cuff tendons. This condition often leads to significant pain, swelling, and restricted movement, making routine activities difficult.
Symptoms
Sharp, confined pain: This is commonly experienced in the shoulder, particularly when you reach above the head or lift the arm. Based on the impaired tendon, the pain could also radiate to the nearby joints.
Pain during rest: Sometimes, pain continues despite the joint being at rest, especially at night. Most people report more pain during sleep, more so when they lie on the affected side.
Restricted range of motion: Calcium deposits build up can limit tendon mobility and cause the affected joint to stiffen. For the shoulder, doing things like dressing or reaching can become challenging.
Tenderness above the tendon: The affected part may be sensitive to the touch, with noticeable swelling caused by inflammation.
Weakness in the affected limb: Extreme cases may involve reduced strength or muscle weakness in the affected arm or leg. This makes it challenging to carry out day-to-day tasks.
Causes and Risk Factors
Although the exact origin of calcific tendinopathy remains unclear, a combination of mechanical, biochemical and genetic factors are thought to be involved. There are a number of theories, though no one explanation clarifies every situation.
Among the possible contributing factors and causes are:
Degenerative changes: With time, tendons experience wear and tear, especially in high-stress areas like the rotator cuff of the shoulder. This can reduce blood flow and prompt abnormal recovery processes, leading to calcium deposit formation. Age is a major factor because degenerative changes are more likely in those above 40 years.
Tissue hypoxia (low oxygen levels): It is widely believed that localized cell death may result from tendons receiving less oxygen, especially those associated with repetitive motions. The body may respond with an abnormal repair process, which leads to calcium build-up.
Overuse and repeated stress: The tendons may develop tiny tears and get inflamed because of continuous stress, especially from overuse or repeated motions (like heavy lifting or sports such as swimming and tennis). As part of the recovery process, this might occasionally cause calcification.
Genetic predisposition: Some people may be genetically predisposed to calcific tendinopathy, suggesting that there might be an inherited component. Anomalies in calcium metabolism may be more common in some people, which may lead to abnormal calcium accumulation in tendons.
Endocrine and metabolic factors: The risk of developing calcific tendinopathy may be elevated by certain metabolic illnesses, like diabetes or thyroid issues. Although the precise association is still unknown, studies have revealed a higher frequency of calcium deposits in tendons for people with these disorders.
Trauma or injury: Acute injury or trauma to a tendon may lead to inflammation and abnormal calcification during tissue repair, particularly in already degenerated tendons.
Gender and hormonal factors: Females, especially between 30 and 60 years old, are more likely to develop calcific tendinopathy compared to males. This is possibly due to hormonal influences, though the exact link remains uncertain.
Not all people with these risk factors will develop calcific tendinopathy; some may experience the condition without any identifiable cause.
Diagnosis
Our clinicians at The Joint Pain Clinic diagnose calcific tendinopathy with a combination of clinical assessment and imaging techniques.
Common diagnostic methods include:
Physical examination: A healthcare provider evaluates the affected joint by assessing its range of motion, strength, and areas of tenderness.
Ultrasound: This imaging technique offers real-time picturing of the tendon and any calcific deposits. It is especially valuable for guiding interventions such as cortisone injections.
Management and Treatment
Our treatment approaches for calcific tendinopathy vary from conservative to more invasive methods. Common approaches include:
Rest and activity adjustment: Limiting activities that exacerbate symptoms helps alleviate pain and reduce inflammation.
Physical therapy: Targeted strengthening and stretching workouts enhance shoulder joint mobility and minimize discomfort.
Ultrasound-guided cortisone injections: Corticosteroids are precisely delivered to the affected area using ultrasound guidance, effectively reducing pain and inflammation.
