Causes | Tendinosis calcarea of the shoulder

Causes

The exact causes of tendinosis calcarea have not been conclusively clarified. It is assumed that degenerative changes in the tendons, i.e. wear and tear during the aging process, cause the blood circulation in the tendons to deteriorate and the pressure on the tendons to increase. This eventually leads to reactive deposits of calcium crystals in the tissue, which cause pain when moving.In the example of the shoulder joint, the crystals lead to a relative thickening of the tendon, so that it is trapped between the shoulder joint and the acromion when the arm is raised.

This causes the typical complaints. In the course of the disease, the immune system also reacts to the stored crystals by certain immune cells, the macrophages, trying to break down the crystals. Ultimately, this leads to scarring of the tissue and, under certain circumstances, to continued thickening of the tendons.

History

Often the tendinosis calcarea is diagnosed rather by chance, as it is usually quite painless. Many patients may have a “calcified shoulder” without it ever causing any discomfort. The course of the disease and the development of the tendinosis calcarea calcified shoulder can be divided into individual phases.

Due to the phase-like course of the disease, acute pain usually occurs in phases. Staying in a disease phase varies from patient to patient and cannot be predicted. Phases of inflammatory shoulder pain change to phases of almost complete freedom from pain.

There are four phases of tendinitis calcarea:

• Phase: Phase of cell transformation: Within the first phase a cell transformation takes place. During this process the tendon tissue is converted into fibrous cartilage. The patient usually suffers no or very slight pain.

  This phase cannot yet be diagnosed by an x-ray because calcification has not yet occurred.

• Phase: Phase of calcification: In the course of the second phase, the cartilage tissue partially dies off, lime deposits. This phase can be diagnosed by means of ultrasound, but also by X-ray examinations. If the shoulder tendon is very much raised by the calcium deposit, a shoulder roof tightness can result when the arm is raised.

  This in turn leads to irritation of the tendons that slide under the acromion, in particular the supraspinatus tendon, and of the bursa (bursa subacromialis). The painful clinical picture of an impingement syndrome can thus develop.

• Phase: Phase of resorption: In this phase, the limescale stove dissolves spontaneously. Frequently, lime particles are carried over into adjacent bursae, which can cause massive inflammation.

  The third phase is therefore often characterized by strongest pain, which is due to the strong bursitis. Due to the pain, patients have great difficulty in moving their arm. Within a few weeks, however, the calcifications finally subside.

• Phase: Phase of repair: In the last phase, the calcification has receded to such an extent that new scar tissue can fill the remaining tendon injury.

  Under certain circumstances, this can result in a thickened tendon, which can continue to cause problems. In the best case, however, the tendon can also regain its original shape and thickness. Not every tendinosis calcarea disease goes through this cycle completely. The tendinosis calcarea can remain at any stage of the disease and may not even reach the next stage.