Tendinitis calcarea is characterized by deposits of crystalline calcium phosphate in the tendon. Why tendons calcify is not yet fully understood. Symptoms range from the complete absence of any symptoms to hyperacute pain with severely restricted mobility due to the pain, which may cause stiffness of the shoulder. X-rays often reveal a calcareous deposit.
Large calcareous deposit in the
left shoulder area.
Treatment aims to eliminate pain by dissolving the calcareous deposit or alleviating the concomitant inflammatory responses, to preserve the mobility of the shoulder, and to prevent muscular atrophy caused by rest.
- Conservative therapy
- Electrotherapy: Treatment with diadynamic currents has proven successful, with a good pain-relieving effect.
- Ultrasound: Some patients find that this mechanotherapy using high-frequency micro-vibration massage alleviates pain. However, there are as yet no published clinical studies.
- Subacromial infiltration: In combination with a cortisone preparation, infiltration with a local anaesthetic results in freedom from pain for a period of time, but does not cause the calcareous deposit to dissolve.
- Extracorporeal shock wave therapy (ESWT): This kind of therapy has shown its effectiveness in a number of prospective studies over the last decade. The success rate of this albeit costly treatment is about 65%, thus significantly lower than that of surgical studies.
- Needling: Needling is the puncture and flushing out of the soft, paste-like calcareous deposit.
- Surgical therapy
If conservative treatment options have failed, the calcareous deposit should be completely removed surgically. Possible surgical treatment options are:- Arthroscopic-endoscopic removal: Endoscopic removal may be successful If the calcareous deposit is clearly visible at the side of the bursa.
- However, deeper deposits are frequently not visible, thus necessitating an open removal via "mini-open access".
Aftercare
Generally, the arm is immobilized in a Gilchrist bandage for the first day after surgery; at the same time, physiotherapeutic exercises are introduced early in order to prevent stiffening. Because the inflammation in the soft tissue continues initially, pain can persist for a few weeks, thus necessitating physical measures.