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The Invisible Enemy of the Shoulder: What Is Calcific Tendonitis and How Does It Affect Your Life?
Calcific tendonitis is a common condition that involves the deposition of calcium phosphate within the tendon and can cause pain in the affected area. Although deposits of this disease can occur in many areas of the body, they are most common in the rotator cuff tendons of the shoulder. Research shows that about 80 percent of people with calcification experience some degree of symptoms, which often manifest as chronic pain with certain shoulder movements or severe pain that worsens at night.
Calcific tendonitis most commonly affects adults between the ages of 30 and 50, and is twice as common in women as men.
The medical community usually relies on physical examination and X-ray images to diagnose this condition. Although most cases of calcification improve spontaneously over time, in some cases, patients may need nonsteroidal anti-inflammatory drugs, rest, and physical therapy to relieve pain and promote recovery.
Symptoms of calcific tendonitis
The symptoms of calcific tendinitis vary depending on the stage of the disease. In the developmental stages, most patients will have no obvious symptoms, while some may experience intermittent shoulder pain, especially when the shoulder is lifted forward. However, when the condition enters the resorption phase, patients experience severe acute pain, which is particularly noticeable at night. Additionally, patients may rotate their shoulders inward to relieve pain and experience discomfort while lying in bed.
People with calcific tendinitis may also experience heat, redness, and swelling in the affected shoulder, along with limited range of motion.
Cause
The pathophysiology of calcific tendinitis involves myxoid degeneration, a lesion of connective tissue accompanied by chondroid transformation of fibroblasts. This transformation allows fibroblasts, like chondrocytes, to deposit calcium in soft tissue.
Specifically, calcium deposits typically occur most commonly above the acromion of the shoulder, as in the rotator cuff tissue of the shoulder. The development of calcific tendonitis can be divided into three stages. The first is the "precalcific stage", in which tendon cells begin to transform into cells capable of triggering calcium deposition. Next is the "calcification stage", which is divided into a formation stage and an absorption stage. During the resorption phase, the body begins to break down the calcium deposits, and finally in the "postcalcification phase," the calcium deposits are replaced by new tissue and the tendon is completely healed.
Diagnostic methods
When diagnosing calcific tendonitis, doctors usually perform a physical examination supplemented by X-rays. Looking at the images, during the formation stage, X-rays will show uniform density of calcium deposits; during the more painful absorption stage, the appearance of the deposits will become blurry and the edges will not be clear.
Ultrasonography is also commonly used to detect and evaluate calcium deposits, providing clear images for diagnosis.
Treatment Plan
The first line of treatment for calcific tendonitis is often nonsteroidal anti-inflammatory drugs to relieve pain, and patients are advised to rest the affected joint. For patients experiencing severe pain, doctors may recommend direct injections of steroids to relieve pain, but this may affect the absorption of calcium deposits. And for patients who don't improve with medication and rest, a small amount of ultrasound-guided technology can be used to eliminate calcium deposits.
In addition, extracorporeal shock wave therapy is also one of the common treatment methods. This therapy uses shock waves to destroy deposits and promote healing. Although there are no standard specifications for the energy level, length of time and treatment interval of treatment, most Research reports all show positive results.
Surgery
Surgery is generally considered when conservative treatment fails to improve symptoms for 6 months. Surgery is mostly arthroscopic and involves removal of calcifications and possibly acromioplasty. There is still controversy as to whether complete removal of calcium deposits is necessary, as partial removal may achieve similar pain relief.
Despite the complexity and challenges of the surgery, the success rate is as high as 90%. About 10% of patients will need another surgery.
Prognosis
Nearly all people with calcific tendinitis recover fully with time or treatment. Treatment can relieve pain, but long-term follow-up studies show that most patients improve with or without treatment.
Epidemiology
Calcific tendonitis usually occurs in adults between the ages of 30 and 50, and is less common in people over the age of 70. The condition is twice as common in women as men, and certain endocrine, autoimmune, and metabolic diseases may increase the chance.
So, behind this seemingly tiny calcium deposit, are there greater health risks lurking?
