CALCIUM IN THE SHOULDER
It is quite common for calcium to be found within the shoulder. The calcium is deposited within the rotator cuff which is part of the muscle that lifts up your arm. The calcium takes two forms – a chalk-like form which is hard and a toothpaste form which is almost liquid in nature. It is diagnosed on an x-ray where the calcium appears as white spots within the rotator cuff.
There are two types of conditions where calcium is seen.
In this condition, calcium is laid down in areas where the rotator cuff is damaged. This quite commonly occurs in older people. This appears as tiny flecks of calcium seen on x-ray or ultrasound. With this sort of calcification the most important thing is the underlying rotator cuff problem and the calcium in itself is not a problem. It is therefore ignored and the other condition treated as appropriate.
TRUE CALCIFIC TENDINOPATHY:
In this condition, which occurs in younger patients, calcium is deposited within normal rotator cuff tissue. We don’t know why this occurs. Interestingly enough the calcium is often resorbed with the tendon becoming completely normal again. However, this can take a very long time – even up to 20-30 years!
When the calcium is deposited in the tendon, 3 outcomes usually occur:-
Firstly, it may not cause any problem. Often calcium is found in patients who have an x-ray for other reasons – such as a chest x-ray. If this is the case no treatment is needed.
Secondly, symptoms may occur when the body tries to reabsorb the calcium. This can promote a very severe inflammation within the shoulder and lead to marked pain. People often are in so much distress they need to go to hospital – some people even think they are having a heart attack! This severe inflammation lasts approximately one week and often settles down completely or nearly completely. An injection in the shoulder can often help with the pain.
Thirdly, patients may have ongoing chronic pain in the shoulder. This is related to the fact that the shoulder is very tight and there may not be enough room for the calcium within that joint. Patients experience chronic pain, particularly with use of the arm and are often woken at night. Their symptoms can settle down somewhat but then reappear again.
Treatment for true calcific tendinopathy varies on the symptoms. Often no treatment is required and eventually the calcium is resorbed. However, if patients have recurrent severe acute attacks or ongoing chronic pain, they may choose to have surgery to relieve their symptoms. A subacromial decompression is first performed. This involves removing inflamed tissue and some bone to make more room for the tendon. The calcium is then removed. If there is a large amount of calcium embedded in the tendon a small amount of calcium may be left behind. The remaining calcium then resorbs very quickly without any problem.
Although surgery for calcific tendinopathy is very effective the recovery is often quite prolonged and can sometimes take as long as one year before patients completely recover. Complications such as frozen shoulder (where the shoulder becomes very stiff after surgery) are quite common but luckily enough are usually mild and almost always resolve completely.