Shoulder pain is a common complaint affecting up to a third of the general population. One cause of shoulder pain is shoulder calcification, a very frustrating condition causing high levels of pain that can last for months. So, what should you do if you have shoulder calcification?

What is shoulder calcification? 

Shoulder calcification, also known as calcific tendonitis shoulder, occurs when calcium deposits form in a rotator cuff tendon. The rotator cuff tendons connect your upper arm to your shoulder. Usually, deposits of calcium in these tendons lead to severe shoulder pain and restriction in movement.

Why do calcium deposits form in the shoulder? 

We don’t know why some people develop calcium deposits. Firstly, some conditions that increase calcium build-up include hormonal problems such as thyroid abnormalities and metabolic conditions such as diabetes. Secondly, calcium deposits are more common in women between the ages of 40 and 60. Also, people who use their arms such as labourers and athletes are more at risk. Finally, a fall on the shoulder can also precipitate a deposit.

Generally, there are three stages to the formation of calcification. Usually, the last stage known as ‘resorptive’ is the most painful.

How do you identify shoulder calcification? 

Usually, calcium deposits in the shoulder cause severe shoulder pain and stiffness. Often, pain is so severe that sleeping is difficult. In addition, lifting the arm in different directions is limited.

X-ray of the shoulder shows larger hard deposits. However, ultrasound can pick up smaller deposits that can be missed on X-ray. Also, ultrasound can stage the calcification (ie resorptive stage) to know whether it’s a likely cause of pain. It is important to understand that the presence of calcium on an X-ray does not necessarily mean the calcium is causing pain.

Calcific tendonitis vs frozen shoulder 

Sometimes, it can be difficult to differentiate between these two common shoulder problems – calcific tendonitis vs frozen shoulder. However, generally, calcific tendonitis of shoulder comes on suddenly (although not always). Also, movement restriction is only limited to one plane whereas all movements are restricted in frozen shoulder. Nevertheless, it can still be a challenge to differentiate between these common shoulder conditions in the early stages. Sometimes, an MRI is needed to help with the diagnosis.

X-ray showing shoulder calcification

Treatment of shoulder calcification

Most calcium deposits improve with treatment. In fact, at least 75% of patients will respond to simple treatments. 

Simple treatments:

Treatment of shoulder calcification mirrors other shoulder conditions. Generally, a combination of treatments is more effective than just one.

  • Physiotherapy treatment for shoulder calcification: As shoulder calcification causes loss of mobility, exercises can improve range of motion. Also, exercise reduces the risk of developing another shoulder condition called frozen shoulder.

Other treatments for shoulder calcification:

If simple treatments are unsuccessful, then other treatments can help. However, these treatments need more specialised equipment.

  • Cortisone shot for calcific tendonitis: Cortisone is a powerful anti-inflammatory and is more effective if delivered to the source of pain. Usually, for shoulder calcification, injection of cortisone in the bursa above the calcium deposits improves pain. It is important to use ultrasound to direct the cortisone shot for calcific tendonitis into the right spot. Overall, cortisone injections are helpful but you may need more than one.
  • Orthopedic barbotage: Overall, this procedure, also called shoulder lavage, is more invasive than a simple cortisone shot. After using a local anesthetic, we use a special larger needle to suck out or break down the calcium deposits. Generally, the aim is to remove or break down most of the calcification. Breaking down the calcification helps the body break it down further.  You will be sore for 1-2 weeks but should feel better after 2-4 weeks. Sometimes, you may need more than one barbotage.  Evidence suggests that shoulder lavage for calcification is more effective than other treatments such as shockwave therapy. Moreover, most people find benefits in this procedure. This video shows the orthopedic barbotage using ultrasound to perfect the technique.

  • Surgery: In general, calcific tendonitis shoulder surgery is reserved for cases that fail other treatments. Most doctors agree that surgery should only be considered after 6 months.  Surgery involves removing the calcium deposits and opening the space between the shoulder tendons and bone. Overall, risks of calcific tendonitis shoulder surgery include infection, ongoing pain, and a return of calcium deposits.

Frequently asked questions about shoulder calcification

Causes of calcific tendonitis in shoulder: Is it due to your diet? 

Generally no. Diet or nutrition does not directly affect whether you get calcific tendonitis in shoulder. However, we know those people who are overweight or have diabetes are more likely to get more severe pain from calcific tendonitis.

What is shoulder lavage for calcific tendonitis? 

Shoulder lavage is similar to barbotage. However, in shoulder lavage, we try to aspirate or suck out the calcium from the tendon rather than just break it up. Generally, lavage is a more complicated procedure and should only be performed by a doctor with experience in advanced ultrasound-guided procedures.

Should you have shockwave therapy for calcific tendonitis of shoulder? 

Recent evidence suggests that shockwave therapy is as effective as injections for calcific tendonitis of shoulder. However, treatment often takes longer (1 session per week for 5 weeks). Generally, we recommend high-energy focussed shockwave.

Final word from Sportdoctorlondon about shoulder calcification

Shoulder calcification is a common cause of sudden severe shoulder pain. Overall, if simple steps are not effective, then sucking out (aspirating) the calcification is usually effective. However, you should find a doctor experienced in this advanced procedure. Many other therapists such as physiotherapists are doing injections but do not have the experience of doctors.

Other common shoulder conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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