By Steve Mora MD
Orange County Shoulder Specialist
Calcific tendinitis of the shoulder is a condition which usually presents with abrupt onset pain, stiffness and inflammation. It is a condition which involves the rotator cuff tendon. The pain is usually located over the outer and posterior aspect of the shoulder. In many cases patients can hardly move their shoulder. Over the ensuing few weeks the pain improves and tends to be associated mostly with lifting.
The x-rays will show a calcific nodule. Often times an MRI only shows “tendinitis” along with the calcific nodule.
Most cases of calcific tendinitis responds to non-surgical treatment which entails one or 3 steroid injections, gentle stretching, physical therapy and just waiting. Sometimes a short course of oral steroids is also necessary to cool down the inflammation. Some physicians who have experience with ultrasound, might be able to break up the calcification by using a needle. It might take 3-6 months for this condition to improve on its own.
In some cases patients don’t improve; the pain is persistent and associated with lifting as well as with sleeping or night time pain.
If patients don’t respond to non-surgical treatment and they are having debilitating pain and the have waited a reasonable amount of time, I might recommend surgical treatment.
The surgical treatment will include arthroscopy (small incisions and a camera) which is done under general anesthesia and in an outpatient surgery center. The surgery includes a complete evaluation of the shoulder. The calcified area is cleaned up. Most people think that the nodule is a firm solid pebble-like structure. It’s actually more like calcium paste that is intricately embedded within the fibers of the rotator cuff tendon. The calcification erodes, damages and weakens the tendon.
Prior to surgery patients are told that if the erosion is extensive the tendon will have to be reattached to the bone. The reattachment is called a rotator cuff repair.
I recorded a live surgery from start to finish. The video below shows the removal, or debridement, of the calcification and the resulting erosion in the supraspinatus tendon which I then repaired. This is a typical rotator cuff surgery.
To summarize, if you have calcific tendinitis please know that you are not necessary destined to have surgery. It’s also important to know that often times the calcified nodule does not always compromise the tendon or cause pain. Therefore if your surgeon shows you an x-ray with the calcification don’t be alarmed you may not need to have surgery.
Be patient and be optimistic. The pain may subside with time. If you continue to have pain after six months and you feel that it is negatively affecting your life then you might want to go through the surgery below. Also know that the surgical treatment requires that you use an arm sling for approximately six weeks. Wearing an arm sling for six weeks is not compatible with certain jobs therefore patients might need to be on disability. It takes about three months just to feel good. Strength returns after about six months. You can usually do heavy lifting and working out hard after nine months. I’m sure that some doctors will say you can do things sooner however you also need to know that if your repair fails your shoulder may never be well. For this reason it’s better to be conservative, go slow, and don’t push yourself too hard with lifting.
TAKE HOME MESSAGE
And the last piece of advice I have for anyone going through the surgery is to make sure that you maximize your stretching and have full range of motion before you do strengthening.
Here’s the full surgical video.
About Dr Mora:
Dr. Mora is a board-certified orthopedic surgeon at Restore Orthopedics and Spine Center in Orange County.
He specializes in:
-Sports Trauma -Arthroscopy of the knee, shoulder, hip and elbow.
-Arthritis of the Knee
-Mixed Martial Arts Injuries
-First Responder Injuries
-Regenerative Medicine:Lipogems, Bone Marrow Stem Cells, Plasma therapy.
For a consultation please call Restore Orthopedics and Spine Center in the City of Orange 714-598-1745
Dr. Mora’s family heritage is Peruvian. He speaks fluent Spanish.
Restore Orthopedics and Spine Center
112o W. La Veta Ave, Third Floor
Orange, CA 92868
Office: (714) 598-1745
Fax: (714) 941-9539