Calcific Tendonitis

Calcific tendonitis is a condition that causes the formation of a small, usually about 1-2 centimeter size, calcium deposit within the tendons of the rotator cuff. These calcium deposits are usually found in patients at least 30-40 years old, and are more common in diabetics. The calcium deposits are not always painful, and even when painful they will often spontaneously resolve after a period of 1-4 weeks.

Cause of Calcific Tendonitis

The cause of calcium deposits within the rotator cuff tendon is not entirely understood. Different ideas have been suggested, including blood supply and aging of the tendon, but the evidence to support these conclusions is not clear.

Calcific tendonitis usually progresses predictably, and almost always resolves eventually without surgery. The typical course is:

• Precalcification Stage
  Patients usually do not have any symptoms in this stage. At this point in time, the site where the calcifications tend to develop undergo cellular changes that predispose the tissues to developing calcium deposits.
• Calcific Stage
  During this stage, the calcium is excreted from cells and then coalesces 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.
• Postcalcific Stage
  This is usually a painless stage as the calcium deposit disappears and is replaced by more normal appearing rotator cuff tendon.

Patients usually seek treatment during the painful resorptive phase of the calcific stage, but some patients have the deposits found as part of their evaluation for impingement syndrome.

Treatment of Calcium Deposits

Treatment of calcific tendonitis usually begins with some simple steps including rest, ice application, medications, and therapy. In some situations, if symptoms persist, surgical intervention is considered. However, the standard treatment of a calcium deposit does not require surgery.

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