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Calcific shoulder (tendinosis calcarea)

What is meant by a calcified shoulder?

Sudden, stabbing shoulder pain that intensifies when the arm is raised may be the first indication of what is known as calcified shoulder. If left untreated, this condition can cause significant problems for sufferers, depriving them of sleep even when at rest. The mobility of the shoulder becomes limited and the pain intensifies with inflammation that further damages the battered shoulder joint.

The causes of calcified shoulder are still largely unclear, but are probably caused by reduced blood flow to the tendons. The diagnosis is made by means of catchy examinations of the symptoms, ultrasound, X-ray and / or magnetic resonance imaging (MRI). Treatment is usually a multistage approach that addresses symptoms and alleviates concomitant conditions, followed by appropriate measures to restore shoulder mobility. With good therapy, calcified shoulder can be treated specifically – in most cases even without surgery.

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Table of Contents:

Calcareous shoulder symptoms
What is a calcified shoulder?

Supraspinatus tendon
Infraspinatus tendon
Subscapularis tendon

Causes of calcified shoulder often unclear

Precalcification stage
Calcification stage
Postcalcification stage

What diagnostics and therapies are used for calcified shoulder?

Modern Therapies for the Treatment of Calcified Shoulder at the Orthopaedic Center Munich East (OZMO)
Related links

Calcareous shoulder symptoms

The disease develops in phases, the pain develops insidiously. When rotating or lifting the arms, the first discomfort is often noticed in the form of shooting pain. When the calcium deposits become larger, the pain is also present for longer and longer.

The following symptoms are typical:

Pain when lying on the affected side
Pain during stress
shoulder pain shooting in for no reason
Pain when lifting the arms to the side

At the beginning of the disease, the tendon tissue transforms into fibrocartilage. Almost no pain is noticeable here yet. The next phase is the death of cartilage tissue and calcium deposits. These deposits can cause the shoulder tendon to be thrown up. Then, when the arms are lifted, there is tightness in the acromion.

This phenomenon is known as impingement. There is irritation of the tendons and bursa. The calcium is eventually broken down again by the body, leading to an inflammatory reaction. If calcific foci extend to the acromion, bursitis may also follow.

What is a calcified shoulder?

Calcified shoulder is the name given to a syndrome in which the tendons in the area known as the rotator cuff are stressed by calcium deposits. The natural and congenital norm variations of the shoulder structure form a low (shoulder) roof. Below this lie various tendon cords, for example the supraspinatus tendon, the infraspinatus tendon and the subcapularis tendon. The tendons connect the muscles to the bones to allow specific movement.

Supraspinatus tendon

This tendon and the associated muscle (spuraspinatus muscle) allow the shoulder to splay the arm. This tendon is most commonly affected when calcific shoulder is present.

Infraspinatus tendon

Together with the muscle and the infraspinatus tendon (Musculus infraspinatus), external rotation of the arm is made possible. This is another common area where mobility is affected in calcific shoulder.

Subscapularis tendon

The internal rotation of the arms is made possible by the subscapularis tendon and the associated muscle (Musculus subscapularis). This tendon-muscle combination is rarely limited by calcific shoulder.

Since the space under the acromion is limited, there is a constriction here in which a bursa protects the tendons from pressure from above. If calcium deposits settle in this area, the tendon is pressed against the acromion. The lime deposits constrict the already limited space. Friction and irritation occur, which limits the natural flexibility of the rotator cuff.

In the acute phase, the symptoms of calcific shoulder are usually caused by an inflamed bursa that presses the tendons against the acromion during movement. This combination provides pain that is exacerbated when the tendons are pinched between the acromion and the bursa (impingement).

Causes of calcified shoulder often unclear

The first appearance of symptoms of calcific shoulder mostly occurs in patients between 30 and 50 years of age. For a long time, a link to osteoarthritis was seen. In contrast to osteoarthritis, calcific shoulder is not a wear and tear disease, but an independent clinical picture. Often, calcific shoulder is preceded by rotator cuff injury or disease (rotator cuff defect), which requires immobilization of the shoulder area. Sometimes the symptom picture also develops during bursitis or entrapment/impingement, both of which are considered typical concomitant diseases of calcific shoulder.

The specific cause of calcified shoulder is considered uncertain and not yet sufficiently researched due to its differentiation from osteoarthritis. Various theories link calcified shoulder to reduced blood flow to tendons or rely on a connection with metabolic and tissue disorders that occur in addition to a genetic predisposition. Elevated blood lipid levels are also being considered in conjunction with the development of calcific shoulder as a cause and observed as a possible influence. This is said to cause calcium deposits in the shoulder joint, which, if undetected and untreated, can lead to calcified shoulder. It is quite possible that a calcified shoulder remains undetected, since symptoms do not always occur. If an injury then occurs and, based on this, the shoulder is immobilized during the healing process, the calcium deposits can increase and trigger calcific shoulder.

The course of the disease is divided into three phases that follow one another:

Precalcification stage
Calcification stage
Postcalcification stage

Precalcification stage

In the precalcification stage, increased calcification in the tissue stimulates the formation of more cartilage tissue in the shoulder joint.

Calcification stage

In the calcification stage, calcium substances are deposited in the tissue. They form small calcium deposits.

Postcalcification stage

In the postcalcification stage, liquefaction of the calcium deposits begins spontaneously or is triggered by treatment. The now viscous, paste-like mass dissolves, but takes on an increased volume in the process. This volume increases pressure on the tissues in the shoulder joint, which can cause irritation and painful inflammation.

In some cases, spontaneous healing occurs, in which the body breaks down the calcium deposit on its own. If this is not the case, adept treatment is indispensable.

What diagnostics and therapies are used for calcified shoulder?

On the basis of the medical history and the physical examination, it is usually already possible to guess what is behind the complaints. Sonography and X-rays usually provide good evidence of the calcium deposits, which must be suitably removed in the resulting therapy. The therapy then proceeds in 2 phases.

In the first phase, conservative treatment of calcific shoulder usually begins. In this case, one should try to reduce the inflammation as much as possible by means of medication and injections. These include above all painkillers with anti-inflammatory properties (anti-inflammatory drugs), which also include non-steroidal anti-inflammatory drugs. In some cases, injections with cortisone support the healing of the inflammation. Very severe pain can also be relieved with local anesthetics in exceptional cases. Immobilization of the shoulder joint with relief of the shoulder by an arm sling may also be necessary in the acute phase of calcific shoulder.

Once the inflammation and associated pain situation is improved, the second phase can be to treat the cause. This is usually followed by a so-called shock wave therapy, which causes the calcium deposit to dissolve. Here it is important to ensure that the calcium deposit is sustainably “treated away”, otherwise the inflammation will return after a certain time. The high-energy pressure waves are intended to dissolve the calcium deposits and remove them from the body. In addition, targeted physiotherapy is an optimal promotion for the complete healing process of the calcific shoulder.

Modern Therapies for the Treatment of Calcified Shoulder at the Orthopaedic Center Munich East (OZMO)

What most patients do not know is that radial shock waves are still used in many practices today. The required devices are found in many practices, but their performance is nowhere near that of devices that deliver focused shock waves. Because of this, the calcium cannot be completely eliminated, causing the calcium deposits to build up again and the pain to return quickly.

At the Orthopaedic Center Munich East (OZMO), we therefore rely on a combination of focused and radial shock waves. The focused shock waves are delivered specifically to the calcium deposit, while the radial shock waves loosen and detonate the affected tendons fascia and muscles. The combination can significantly increase the success of the therapy.

Shock wave therapy is performed 3-5 times a week. More than 90% of those affected become symptom-free within a few months with conservative measures, which means that surgery for calcified shoulder can be avoided. Only if there is no improvement during this time, the calcium is removed by a so-called keyhole surgery in an outpatient procedure.

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