Calcifying tendinitis of the shoulder
CONSULT TREATMENT PROTOCOL

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ANATOMICAL AREAS



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GLOSSARY OF DISEASES

NameTissueType of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome
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MORE INFORMATION

Calcifying tendinitis of the shoulder is an acute or chronic painful disorder that is characterized by calcifications in rotator cuff tendons.

The main clinical symptom is shoulder pain, often aggravated by lying on the shoulder or elevation of the arm above shoulder level. The patient may be awoken from sleep by the pain. Other complaints may be weakness, stiffness, snapping or catching of the shoulder. Diagnosis is based on the clinical features of the disease and on imagery. The calcifications occur most commonly in the supraspinatus tendon (51%–90%) and least commonly in the subscapularis tendon (3%).

The etiology is largely unknown. It has been hypothesized that the condition may be related to hypovascularity-induced fibrosis and necrosis within the tendon with subsequent degeneration. The characteristics of an existing, symptomless calcific deposit may be changed by minor traumatic episodes, leading to acute symptoms. The condition may also be related to mechanical irritation by deposits when the arm is abducted and deposits impinge on the acromion.

The disease usually presents in four stages:
(i) precalcific stage (usually without symptoms), involving fibrocartilaginous metaplasia within the tendon;
(ii) formative phase (with or without pain), with calcific deposits formed in the fibrocartilaginous matrix;
(iii) resorptive phase (massive pain), with deposits disappearing by cell-mediated resorption (inflammatory response); and
(iv) final stage (with or without pain), involving healing and rotator cuff repair. Notably this cycle can be blocked at any one stage in chronic calcifying tendinitis.

The incidence is approximately 3% in the healthy population, and approximately 7% in those with shoulder pain. The predominant age is 30 to 50 years. Women are two times more affected than men.

The initial treatment should be conservative including rest, physiotherapy, and nonsteroidal anti-inflammatory drugs. In later stages, radial shock wave therapy (RSWT) should be considered (not in the resorptive phase), or subacromial infiltration with corticosteroids. Surgery should be considered for recalcitrant cases of calcifying tendinitis of the shoulder.

 

CLINICAL EVIDENCE

Kvalvaag et al., Am J Sports Med 2017;45:2547-2554.

Effectiveness of Radial Extracorporeal Shock Wave Therapy (rESWT) When Combined With Supervised Exercises in Patients With Subacromial Shoulder Pain: A Double-Masked, Randomized, Sham-Controlled Trial.

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TREATMENT PROTOCOL

Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2 to 4 bar
Air pressure Power+ 1.5 to 3 bar
Impulses 2000 on the painful spot
Frequency 8Hz to 12Hz
Applicator 15mm
Skin pressure Heavy

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