Calcific tendinitis of the rotator cuff is a pathological condition characterized by the deposition of calcium salts in the tendon tissue, leading to an increase in local volume and pressure. This causes irritation, inflammation of the tissues and bursa, reduces the subacromial space, and leads to impingement and shoulder pain.
The exact cause of calcifications is not fully understood.
Symptoms of calcific tendinitis of the rotator cuff
The most characteristic symptom is sudden or progressive shoulder pain, often without any preceding injury. Gradually worsening symptoms lead to a limited range of motion. The pain can be diffuse, involving the entire surface of the shoulder, or it may radiate down the arm to the elbow and increase with sudden or overhead movements.
This condition most commonly affects patients between the ages of 30 and 60, with a higher prevalence in women. It can resolve spontaneously, but it is a chronic process.
A well-conducted medical history and clinical examination, along with basic imaging such as X-rays, are usually sufficient for diagnosis. On X-ray, small calcifications are typically seen in the area around the greater tuberosity of the humerus.
If there is a sudden exacerbation of symptoms and significant impairment of joint function, which may indicate tendon damage, an ultrasound or magnetic resonance imaging (MRI) may be recommended.
Treatment of calcific tendinitis of the rotator cuff
The primary treatment for calcific tendinitis of the rotator cuff consists of conservative management, which includes pharmacological treatment with pain and anti-inflammatory medications, as well as rehabilitation. Physiotherapy aims to improve mobility, strengthen the tendons, and increase the subacromial space to reduce compression.
The next step is the local administration of anti-inflammatory steroid medications or an outpatient procedure called needling and lavage, which involves puncturing and rinsing the calcifications with a saline solution. This type of treatment is performed under ultrasound guidance.
If there is no improvement with conservative treatment, arthroscopic surgical treatment may be indicated. This procedure is done under general anesthesia, and it involves making several small incisions in the skin. The procedure involves making a localized incision in the tendon to remove the calcification. Typically, this does not require additional suturing, as the tendon will heal on its own. In cases of massive calcifications and extensive tendon incision, local suturing may be required, resulting in a longer healing process and immobilization with a brace for approximately 4 weeks. Rehabilitation is recommended after the procedure, and it takes about 3 months to return to daily functioning and around 6 months to achieve full athletic ability.
In MIRAI, the shoulder area is covered by:
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