What is Rotator Cuff Calcific Tendinopathy?
Calcific tendinopathy is a condition that causes the formation of a small, usually about 1-2 centimetre size, calcium deposit within the tendons of the rotator cuff. These deposits are typically found in patients at least 30-40 years old and have a higher incidence in people with diabetes. The calcium deposits are not always painful, and even when painful, they will often spontaneously resolve after a period of one to four weeks.
What Causes Calcific Tendinopathy?
The cause of calcium deposits within the rotator cuff tendon (calcific tendonitis) is not entirely understood. Different ideas have been suggested, including blood supply and ageing of the tendon, but the evidence to support these conclusions is not clear.
Delayed healing is one of the most compelling arguments.
Usually, the tendon heals via the action of collagen forming cells known as fibroblasts. After weeks or months, the fibroblasts became less numerous in the region and replaced by osteoblasts (bone-forming cells). These osteoblasts stimulate the growth of bone (calcium) in the tendon.
Hence the main reason for the development of calcific tendonitis appears to be delayed healing.
How Does Calcific Tendinopathy Progress?
Calcific tendonitis usually progresses predictably, and almost always resolves eventually without surgery. The typical course is:
You usually do not have any symptoms at this stage. At this point, the site where the calcification tends to undergo cellular changes that predispose the tissues to develop calcium deposits.
During this stage, the calcium is excreted from cells and then blends into calcium deposits. When seen, the calcium looks chalky. It is not a solid piece of bone. Once the calcification has formed, a so-called resting phase begins, this is not a painful period and may last a varied length of time. After the resting phase, a resorptive phase begins–this is the most painful phase of calcific tendonitis. During this resorptive phase, the calcium deposit looks something like toothpaste.
This phase is usually a painless stage as the calcium deposit disappears and is replaces more normal appearing rotator cuff tendon.
Patients usually seek treatment during the painful resorptive phase of the calcific stage. Still, some patients have the deposits found incidentally as part of their evaluation of impingement syndrome, usually on X-ray.
What is Rotator Cuff Impingement Syndrome?
Impingement (impact on bone into rotator cuff tendon or bursa) should not occur during normal shoulder function.
When it does happen, the rotator cuff tendon becomes inflamed and swollen. A condition called rotator cuff tendonitis.
Likewise, if the bursa becomes inflamed, shoulder bursitis will develop. These conditions can co-exist or be present independently.
While a traumatic injury can occur, e.g. fall, it is repeated movement of your arm into the impingement zone overhead that most frequently causes the rotator cuff to contact the outer end of the shoulder blade (acromion).
When this repeatedly occurs, the swollen rotator cuff is trapped and pinched under the acromion.
Rotator Cuff Calcific Tendinopathy Treatment
Rotator cuff calcific tendinopathy is a common complaint that we see at PhysioWorks, and it is, unfortunately, an injury that often recurs if you return to sport or work too quickly – especially if an incomplete rehabilitation program.
Your rotator cuff is an essential group of control and stability muscles that maintain “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This centralisation prevents injuries such as bursitis, impingement, subluxations and dislocations.
We also know that your rotator cuff provides subtle glides and slides of the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.
Did you know that your arm only has one bony joint articulation where your collarbone (clavicle) attaches to the acromion (tip of the shoulder blade)?
The rest of your attachments are muscular, which highlights the importance of retraining and strengthening of your shoulder muscles.
Calcific Tendinopathy Treatment
Researchers have concluded that there are mostly seven stages that need to be covered to rehabilitate these injuries and prevent recurrence effectively – these are:
- Early Injury Protection: Pain Relief & Anti-inflammatory Tips
- Regain Full Range of Motion
- Restore Scapular Control
- Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
- Restore Rotator Cuff Strength
- Restore High Speed, Power, Proprioception & Agility
- Return to Sport or Work
Calcific Tendinopathy Treatment Results
There is no specific time frame for when to progress from each stage to the next. Many factors will determine your injury rehabilitation status during your physiotherapist’s clinical assessment.
You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
It is also crucial to carefully monitor each progression as attempting to progress too soon to the next level can lead to re-injury and frustration.
For more specific advice about your bursitis or rotator cuff injury, please contact your PhysioWorks physiotherapist.
Common Shoulder Pain & Injury Conditions
- Rotator Cuff Syndrome
- Shoulder Tendinopathy
- Rotator Cuff Calcific Tendinopathy
- Rotator Cuff Tear
- Bicep Tendinopathy
- Shoulder Impingement
- Swimmer's Shoulder
- Shoulder Dislocation (Instability)
- Subacromial Decompression
- Shoulder Arthroscopy
- Rotator Cuff Repair
- SLAP Repair
- Biceps Tenodesis
- Biceps Tenotomy
- Total Shoulder Replacement
Researchers have discovered that managing your shoulder injury with physiotherapy is usually successful. Typically, you have two options: non-operative or a surgical approach. Your condition will dictate which option is best for you at this time. Non-operative care is conservative rehabilitation.
If shoulder surgery is required, then your physiotherapist may undertake:
- Pre-operative rehabilitation - to either try a non-operative treatment approach or to condition and prepare your body for a surgical procedure.
- Post-operative physiotherapy - to safely and methodically regain your normal range of movement, strength, speed and function.
PhysioWorks physiotherapists have a special interest and an excellent working relationship with leading shoulder surgeons. Our physiotherapy team provide you with both conservative and post-operative shoulder rehabilitation options. We aim for you attaining the best possible outcome for your shoulder injury.