Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I've just been diagnosed with calcifying tendinitis. What is it? How long will it last? Will it go away on its own?

Answer:

Calcific tendinitis is a degenerative condition affecting the four tendons surrounding the shoulder called the rotator cuff. These include the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. All four muscles can be affected, but usually it's just one of the four. And the tendons are listed here in declining order of frequency (i.e., supraspinatus is affected most often and subscapularis least often). Calcium crystals called calcium pyrophosphate are deposited in the tendons. No one knows where these crystals come from exactly. But once the tendons start to degenerate, the crystals are released into the soft tissues as the tendon fibrils break down. Research shows that the calcium crystals help the tendon degenerate. The tendons harden and symptoms of impingement can develop. With impingement, there is shoulder pain when the arm is raised overhead or to the side above shoulder level. The stiff tendon doesn't move and glide as it should and it gets pinched between the bony structures of the shoulder. Sometimes the person with this problem can move the arm through the pain all the way overhead. But other people have limited motion that leads to decreased function. The natural history of calcific tendinitis (i.e., what happens over time) varies from person to person and doesn't follow a set pattern. Some people get better with time and without doing anything. Resolution of this condition can take anywhere from weeks to months. Others get worse and require treatment with antiinflammatories, physical therapy, and/or steroid injections. If no improvement occurs after several months of conservative (nonoperative) care, then surgery might be considered. The surgeon removes as much of the calcium deposits as possible without disrupting the tendons, muscles, or other soft tissues. Some patients consider a treatment step between the nonoperative and surgical approach and that is extracorporeal shockwave therapy (ESWT). ESWT is the use of sound waves to create enough energy to disintegrate the calcium deposits. It has been used with good results for other problems like gallstones and kidney stones. Once the calcium crystals have been broken up, it appears that the body absorbs them because X-rays show they disappear. The physician who diagnosed the problem will be able to guide you through the best treatment approach for you. If the pain is not disabling, you might try a wait-and-see approach. Let nature takes its own course and see if you experience a spontaneous recovery. If not, then it might be necessary to try some conservative care and progress from there. Adnan Saithna, BMedSci(Hons), MBChB, MRCSEd, et al. Is Extracorporeal Shockwave Therapy for Calcifying Tendinitis of the Rotator Cuff Associated with a Significant Improvement in the Constant-Murley Score? A Systematic Review. In Current Orthopaedic Practice. September/October 2009. Vol. 20. No. 5. Pp. 566-571.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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