Language
Country/Area
No result found
Never Feeling Severe Pain: What Are the Secrets of the Different Stages of Calcific Tendinitis?
Calcific tendonitis is a common condition in which calcium and phosphorus are deposited in the tendon, often causing pain in the affected area. This deposit can appear in several places on the body, but the most common place is in the rotator cuffs of the shoulders. For about 80 percent of people with calcific tendonitis, they experience symptoms, usually chronic pain with certain shoulder movements or worsening pain, especially at night.
Calcific tendonitis is usually diagnosed with a physical examination and X-rays, and often resolves on its own.
Among adults, those aged 30 to 50 are most commonly affected, and it is twice as common in women as in men. This condition, not associated with exercise, was first described by Ernest Codman in 1934 as calcification in the rotator cuff. In 1952, Henry Plenk named this condition "calcific tendinitis."
Symptoms and signs
Up to 20% of people with calcific tendinitis will not experience any symptoms, as this may be an integral part of the tendinopathy. For those who have symptoms, symptoms vary depending on the stage of the disease. During the initial "formative phase," during which calcium deposits are forming, patients have few symptoms and occasionally experience intermittent shoulder pain, especially when the front shoulder is lifted.
During the "absorptive phase," as calcium deposits break down, many patients experience severe acute pain that worsens at night.
These patients often rotate the shoulder medially to relieve pain and have difficulty lying on the affected shoulder. Some people may experience heat, redness, and swelling, as well as limited range of motion.
Cause
The pathophysiological change of calcific tendonitis is mucinous degeneration, part of which is related to chondroid degeneration of fibroblasts. This means that fibroblasts begin to work like chondrocytes, depositing calcium in soft tissue, just like in bone. Calcification in tendons is a common component of tendinopathy.
Most of these deposits occur in multiple parts of the rotary cuff, the most common of which is the suprascapularis tendon (63%), followed by the subscapularis tendon (7%), subscapular bursa (7%), subscapularis tendon (3%) and subskeletal tendon (20%). Calcific tendonitis can generally be broken down into three stages: first, the precalcific stage, when certain factors cause tendon cells to transform into cells that can deposit calcium; second, the calcific stage, when calcium deposits form and the body begins to break them down. ; and finally, the postcalcification phase, where calcium deposits are replaced by new tissue and the tendon is completely healed.
Diagnosis
Physical examination and X-rays are the most common ways to diagnose calcific tendonitis. During the formation stage, X-rays usually show calcium deposits with uniform density and clear boundaries. In the more painful absorption stage, the deposition appears fuzzy and unclear. At this time, under arthroscopic examination, the deposits in the formation phase appear crystalline and chalky, while the deposits in the resorption phase appear smooth and resemble toothpaste. Additionally, ultrasound can be used to locate and evaluate calcium deposits.
During the formation phase, deposits are seen as hyperechoic and arcuate; during the absorption phase, they are less echogenic and patchy.
Treatment
The first line of treatment for calcific tendonitis is usually nonsteroidal anti-inflammatory drugs to relieve pain and rest for the affected joint, and sometimes includes physical therapy to avoid joint stiffness. For those patients with severe pain, steroid injections directly into the affected area are often found to be effective in relieving pain but may interfere with the reabsorption of calcium deposits. For those patients who do not see improvement with drugs and rest, the techniques of "ultrasound-guided acupuncture", "stirring" and "ultrasound-guided injection" can be used to solve the problem.
Another common treatment is extracorporeal shock wave therapy, in which pulses of sound waves are used to break up deposits and promote healing. Although the energy levels, duration, and time intervals of treatments are not standardized, most studies show good results using low to moderate energy waves (less than 0.28 mJ/mm₂).
Surgery
Surgery is recommended only if conservative, non-surgical treatments fail to reduce symptoms for six months. Surgery is usually an arthroscopic procedure involving removal of calcifications, or sometimes an acromioplasty of the shoulder. Additionally, controversy remains as to whether complete removal of deposits is required or whether partial removal results in the same pain relief. Whether it is open shoulder surgery or arthroscopic surgery, both are difficult operations, but the success rate is as high as 90%, and about 10% require re-operation.
If the deposit is large, patients often require rotational sleeve repair to repair the defect left in the tendon after removal of the deposit or to reattach the tendon to the bone, especially if the deposit is located at the myotendinous junction. .
Prognosis
Nearly all people with calcific tendinitis recover completely with time or treatment. Although treatment can help reduce pain, long-term follow-up studies show that patients' distress eventually improves with or without treatment.
Epidemiology
Calcific tendonitis usually occurs in adults between the ages of 30 and 50, and is quite rare in people over the age of 70. The incidence is twice as high in women as in men. Factors that increase the risk of calcific tendonitis include hormonal abnormalities (such as diabetes and hypothyroidism), autoimmune diseases (such as rheumatoid arthritis), and certain metabolic diseases.
History
Calcification in the rotation sleeve was first described in Ernest Codman's 1934 book "The Shoulder." In 1952, Henry Plenk used the term "calcific tendonitis" in his research on X-ray treatment of this type of calcification.
As our understanding of calcific tendonitis deepens, we can’t help but wonder, what kind of health secrets may be hidden behind it?
