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Calcific Supraspinatus Tendinitis

What is calcific supraspinatus tendinitis?

Calcific supraspinatus tendinitis is a condition that causes pain and inflammation in the supraspinatus tendon, one of the four tendons in the rotator cuff. The rotator cuff is a group of muscles and tendons that help to stabilize the shoulder joint and allow it to move through a wide range of motion.

Calcific supraspinatus tendinitis is caused by calcium deposits that form in the supraspinatus tendon. These calcium deposits can causes localised irritation within the tendon, leading to inflammation and pain.

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Who is affected by calcific supraspinatus tendinitis?

Calcific supraspinatus tendinitis can affect people of all ages, but it is most common in adults between the ages of 30 and 60. It is also more common in women than in men.

People who are at increased risk of developing calcific supraspinatus tendinitis include those who:

  • Participate in activities that require repetitive overhead movements, such as tennis, baseball, and swimming

  • Have a history of shoulder injuries

  • Have diabetes

  • Are overweight or obese

What are the main symptoms of calcific supraspinatus tendinitis?

 

The main symptom of calcific supraspinatus tendinitis is severe pain, often in the front/side of the shoulder. The pain classically comes on very rapidly within hours to days and often without any obvious trigger or injury.  The severity of the discomfort causes the patient to restrict their movements, which become exquisitely painful.  As a result this condition can mimic a frozen shoulder with severe restriction of range of movement but the onset of calcific tendinitis tends to be far more rapid and also tends to settle very quickly, unlike with frozen shoulder.

The pain may be worse with activity, especially activities that involve overhead lifting or reaching. Other symptoms of calcific supraspinatus tendinitis may include:

Tenderness in the front of the shoulder

Weakness in the shoulder

A popping or clicking sound when moving the shoulder

Reduced range of motion in the shoulder

How is calcific supraspinatus tendinitis diagnosed?

The diagnosis of calcific supraspinatus tendinitis is usually made based on the patient's medical history and physical examination as above. The doctor will examine the shoulder for severe pain, localised tenderness, and range of motion limitations. Imaging tests, such as X-rays, ultrasound or MRI scans, may be ordered to confirm the diagnosis and rule out other causes of shoulder pain. The area of maximal tenderness can first be identified on examination and then scrutinised with ultrasound, looking for a focal region of calcification, often seen with increased localised blood flow on doppler/ultrasound assessment.

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How is calcific supraspinatus tendinitis treated?

 

Treatment for calcific supraspinatus tendinitis depends on the severity of the condition. Non-surgical treatments are often effective. Non-surgical treatments may include:

  • Rest:

    Avoiding activities that aggravate the pain.
  • Ice:

    Applying ice to the shoulder for 10-15 minutes at a time, can help to reduce inflammation and pain.
  • Over-the-counter pain relievers:

    Over-the-counter pain relievers, such as ibuprofen, paracetamol, naproxen or codeine can help to relieve pain.
  • Physiotherapy:

    Physiotherapy can help to improve range of motion and strengthen the muscles around the shoulder.
  • Corticosteroid injections:

    Corticosteroid injections can be used to reduce inflammation and pain in the supraspinatus tendon.

At The Joint Injection Clinic, these injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor. The experienced medical doctor will then place you in a seated or lying position. The front of the shoulder is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions. Local anaesthetic can be injected from the skin to the sub-acromial bursa under ultrasound guidance. After giving the local anaesthetic a few minutes to take effect, the sun-acromial bursa injection is performed with a small dose of steroid and local anaesthetic.

The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given. The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever. If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed. The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours). This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

Other injection options include a barbotage procedure, whereby a larger bore needle is used to fenestrate (make small holes in) the calcification within the tendon. This can be used in conjunction with saline which is injected into the area of calcification. This can help to dissolve and disrupt the calcium and reduce the mechanical impingement symptoms within the shoulder.

If non-surgical treatments are not effective, surgery may be an option. Surgery for calcific supraspinatus tendinitis may involve:

  • Arthroscopic lavage:

    This minimally invasive surgery involves using a camera and small instruments to flush out the calcium deposits from the supraspinatus tendon.

The best treatment option for you will depend on the severity of your calcific supraspinatus tendinitis, your overall health, and your activity level.