Introduction
Tendinitis calcarea in general is a disease in which calcareous deposits occur in tendons and tendon attachments. It is assumed that 2 to 3 % of all people are affected. The most common age of onset is between the third and fifth decade of life.
A group of muscles in the shoulder region (the so-called rotator cuff) is most frequently affected by tendinitis calcarea, colloquially known as a calcified shoulder. The patellar tendon and Achilles tendon are also often affected. In tendons of the hip joint, however, such calcifications occur rather rarely.
Symptoms
Although it is rare, the disease can also cause severe discomfort in the hip joint. The main symptoms are pain that increases over days to weeks, usually felt as stabbing pain when the hip joint is moved and loaded. Pain can also be provoked specifically by applying pressure to the affected tendon. Further symptoms can include swelling, redness and restricted movement due to the pain. All these symptoms are signs of an inflammatory reaction.
Cause
The clinical picture of tendinitis calcarea is caused by degenerative, i.e. wear-related, changes in the respective tendon. The exact process is not yet fully understood. What is certain, however, is that various processes at the tendon result in a remodelling of the tendon tissue and the accumulation of calcium crystals.
As a result, inflammatory processes take place, which trigger the swelling, redness and pain typical of inflammation. In the case of the hip, various tendons can be affected by this process. Up to now, calcification has been observed in the musculus gluteus maximus, musculus adductor brevis and the musculus iliopsoas.
Therapy
Like other joints affected by tendinitis calcarea, the treatment of the affected hip joint is usually conservative, i.e. non-surgical. The main focus here is on the use of so-called non-steroidal anti-inflammatory drugs (NSAIDs). These painkillers, which also include the well-known over-the-counter drugs Aspirin (ASS), Diclofenac and Ibuprofen, have both analgesic and anti-inflammatory effects.
It is also important to protect the shoulder or hip to prevent further irritation of the tendon tissue. Heavy strain should therefore be avoided in any case. In most cases, this alone can cause the disease to heal itself.
White blood cells begin to break down the calcium deposits and the tendon tissue can recover. In addition, physiotherapeutic exercises and cold therapy are available as further measures to promote healing and alleviate pain. In addition to the injection of local anesthetics, which is also useful for severe pain, some doctors also recommend the injection of steroids, although it is controversial how helpful this therapeutic step actually is.
It is also possible to use the so-called extracorporeal shock wave therapy (ESWT), in which the calcium crystals are shattered by low-energy waves. However, this procedure is expensive and is usually not covered by health insurance companies. It should also be mentioned that only about half of all patients benefit from this treatment method.
About 95% of all tendinitis calcareae heal on their own within a few weeks under this conservative therapy. For the remaining 5%, which are mostly affected by large calcium deposits, surgical intervention may be necessary for final recovery. In general, this is performed if after about six months no success could be achieved by conservative measures.