Calcific Tendinopathy

 

Introduction

Calcific tendinopathy is a musculoskeletal condition characterised by the build-up of calcium deposits within the tendons of a joint, most often affecting the shoulder, particularly the rotator cuff tendons. These calcium deposits can cause discomfort, restrict movement, and interfere with daily activities.

At Joint Injections, our clinicians understand that shoulder pain can significantly affect work, hobbies, and quality of life. One of the treatment options we offer is ultrasound-guided cortisone injections, designed to target inflammation and help restore mobility. This blog provides a comprehensive overview of calcific tendinopathy, from anatomy and pathology to diagnosis and management, written in an informative and non-claiming manner.

Anatomy Overview

To understand calcific tendinopathy, it’s important to first consider the anatomy of the affected area.

• Tendons — Strong, fibrous connective tissues that attach muscle to bone, enabling joint movement.
• Rotator cuff — A group of four muscles and their tendons that stabilise the shoulder joint: supraspinatus, infraspinatus, teres minor, and subscapularis.
• Bursa — Small fluid-filled sacs that reduce friction between moving structures in the joint.
• Blood supply — The rotator cuff tendons have areas with relatively limited blood flow, making them more susceptible to degenerative changes.

In calcific tendinopathy, calcium deposits form within the tendon structure, most often within the supraspinatus tendon.

Pathology of Calcific Tendinopathy

Calcific tendinopathy is not merely a result of wear and tear. It involves a process of calcium crystal deposition within the tendon. The exact cause is not fully understood, but several theories have been proposed:

1. Degenerative Theory — Calcium forms as a result of tendon degeneration.
2. Reactive Theory — Calcium deposition occurs due to a reactive process where tendon cells change into cartilage-like cells, which then calcify.
3. Genetic and Metabolic Factors — Certain individuals may be more prone due to inherited or metabolic conditions.

The condition often progresses through three phases:

• Formative phase — Calcium deposits begin to develop.
• Resting phase — Deposits remain in place with minimal change.
• Resorptive phase — The body reabsorbs the deposits, often causing more intense symptoms due to inflammation.

Common Symptoms

Symptoms vary depending on the phase of the condition but may include:

• Gradual onset of shoulder pain, often worse at night
• Pain during lifting or overhead movements
• Reduced range of motion
• Localised tenderness over the affected tendon
• Occasional episodes of sharp, acute pain

Causes and Risk Factors

While the precise cause remains unclear, certain factors increase the likelihood of calcific tendinopathy:

• Age (most common in individuals aged 30–60)
• Female gender (slightly higher incidence)
• Repetitive overhead activities (e.g., sports, painting, lifting)
• Metabolic disorders (e.g., diabetes, thyroid conditions)
• Reduced blood supply to tendons
• Previous tendon injury

Diagnosis

A clinician can diagnose calcific tendinopathy through a combination of:

1. Medical history and symptom review — Understanding the pattern, duration, and triggers of symptoms.
2. Physical examination — Assessing range of motion, strength, and tenderness.
3. Imaging –

• Ultrasound — Helps visualise the exact location and size of deposits.

Management Approaches

The management of calcific tendinopathy is tailored to the individual’s symptoms, functional needs, and the stage of the condition. Options can include:

Activity Modification

Reducing activities that aggravate the shoulder, especially repetitive overhead movements.

Ultrasound-Guided Cortisone Injections

At Joint Injections, our clinicians provide ultrasound-guided cortisone injections for targeted delivery to the affected area. Ultrasound ensures accurate placement of the needle, allowing the anti-inflammatory medication to be delivered precisely to the site of irritation. Cortisone can help reduce inflammation around the tendon, which may assist in improving mobility and comfort.

Mechanism of Action — Cortisone Injections

Cortisone is a synthetic corticosteroid that mimics the effects of natural hormones produced by the adrenal glands. Its main function in this context is to reduce inflammation.

When injected into the area around the tendon:

1. It suppresses inflammatory chemicals.
2. It reduces swelling in surrounding tissues.
3. It can alleviate irritation in the bursa and tendon sheath.
4. It may allow improved range of motion by decreasing pain-related guarding.

Ultrasound guidance ensures precision, minimising the risk of the medication being delivered into the wrong area and enhancing procedural accuracy.

Prevention and Shoulder Health

Although calcific tendinopathy cannot always be prevented, maintaining good shoulder health can help reduce the risk:

• Warm up before activity and cool down afterwards.
• Avoid repetitive overhead strain where possible.
• Strengthen the rotator cuff and surrounding muscles.
• Maintain good posture, especially during desk work.
• Address shoulder discomfort early with a clinician’s advice.

Why Choose Joint Injections for Ultrasound-Guided Cortisone Injections?

• Specialist clinicians with extensive musculoskeletal experience.
• Ultrasound-guided precision for accurate medication delivery.
• Personalised care based on individual assessment.
• Convenient appointments with a streamlined process.
• Focus on patient comfort throughout the procedure.

Final Thoughts

Calcific tendinopathy is a common but potentially disruptive shoulder condition. With accurate diagnosis, tailored management, and targeted interventions such as ultrasound-guided cortisone injections, it is possible to address inflammation and work towards restoring function.

At Joint Injections, we provide thorough assessments and precise treatments designed with your comfort and mobility in mind.