Tendinosis calcarea is the medical term for tendon calcification. It is most commonly seen in the shoulder.
What is tendinosis calcarea?
Tendinosis calcarea is said to occur when calcification of different tendons is present. It occurs due to the deposition of calcium crystals. In principle, tendinosis calcarea can occur in any tendon of the body, but in most cases it is seen in the shoulder tendons such as the supraspinatus tendon of the supraspinatus muscle. Physicians then speak of a calcified shoulder. Occasionally, however, tendinosis calcarea also develops in the patellar tendon of the knee or in the Achilles tendon. Occasionally, the rotator cuff is also affected by tendinosis calcarea. In most cases, tendinosis calcarea occurs between the ages of 40 and 50. Women suffer from tendinosis calcarea slightly more often than men. It is estimated that tendinosis calcarea affects two to three out of every one hundred people.
Causes
The way in which tendinosis calcarea develops is not yet known. Degenerative tendon changes are suspected. Thus, the pressure on the affected tendons is increased by wear and tear, for which the natural aging process and weaker blood circulation are responsible. As a result, more calcium crystals are deposited in the tissue, causing painful discomfort when performing movements. At the shoulder joint, the crystals cause the tendon to thicken, which results in it being pinched between the acromion and the shoulder joint when the affected arm is raised, which in turn causes pain. As tendinosis calcarea progresses, the body’s defense system sends out macrophages. These are special immune cells designed to break down the crystals. This causes the tissue to scar and the thickening of the tendon to continue.
Symptoms, complaints, and signs
The symptoms of tendinosis calcarea depend on which tendon it occurs on. If the calcification shows up on the shoulder, there is pain when the arm is lifted. The same applies when the affected person lies on his or her side. In some cases, it is even no longer possible to move the arm at all, which is called pseudoparalysis. The longer tendinosis calcarea persists, the more the symptoms worsen. Thus, in the further course of the disease, there is a risk of the tendon calcification passing into the shoulder joint. This results in inflammation of the bursae, which is accompanied by pronounced pain. In addition, there is redness and an overheated joint. Pain-free movements can usually only be performed when the arm is splayed outward or inward. Secondary complaints may also occur as a result of tendinosis calcarea, such as neck tension or headaches. Thus, pain-avoiding awkward movements often result in tense neck muscles. Sometimes the discomfort in the neck is so intense that the tendinosis calcarea is no longer registered. In some people, however, tendinosis calcarea does not cause any discomfort at all, so its diagnosis is purely incidental.
Diagnosis and course of the disease
If tendinosis calcarea is suspected, the patient should consult an orthopedist who specializes in complaints of this type. Detection of tendon calcification is usually possible with just sonography (ultrasound examination). Thus, the calcification focus causes a sound extinction, which can be determined during the examination. In addition, sonography can determine the precise position of the calcium deposit. This makes it easier for the physician to track down the calcific focus, which has a positive effect on the planning of a surgical intervention. In tendinosis calcarea, the thickening is always in the center of the tendon. Another diagnostic method is an X-ray examination. Tendinosis calcarea is usually clearly visible on X-ray images. In order to determine the exact location of the calcification, however, images from several angles are required. The course of tendinosis calcarea varies from individual to individual. Thus, there is a possibility that the pain will intensify rapidly.
Complications
Equally, however, they can also be minor for a longer period of time.It is not uncommon for painful inflammation to occur due to calcium deposits, but the calcium is broken down as a result. In some patients, the tendon calcification regresses on its own due to the body’s self-healing process, while in others surgery is required. Tendinosis calcarea can cause different complications depending on which tendon it occurs on. If the calcification occurs on the shoulder, there is pain when the arm is moved. In severe cases, the arm can no longer be moved at all. This pseudoparalysis worsens as the disease progresses and may eventually lead to complete tendon calcification in the shoulder joint. A possible consequence of this is bursitis, which is always associated with severe pain and the risk of further infections. In addition, redness and overheating occur in the affected joint. In individual cases, those affected suffer from headaches and tension in the shoulder and neck area. The treatment of tendinosis calcarea also involves risks. Occasionally, side effects and interactions occur after taking pain-relieving medications. Patients who already suffer from a disease of the cardiovascular system or the immune system are particularly susceptible to acute complaints and late complications. Typical complications include gastrointestinal complaints, headaches, muscle and limb pain, skin irritation and muscle weakness. In the long term, damage can occur to the heart, kidneys and liver. In the context of a surgical procedure, the usual complications are conceivable: Bleeding, nerve injury, infection, and wound healing problems.
When should you see a doctor?
Medical treatment should always be sought for tendinosis calcarea. It may also not heal on its own, so the affected person is always dependent on treatment by a doctor. If tendinosis calcarea is not treated, further complications will occur and the symptoms will worsen. For this reason, a doctor should be contacted at the first symptoms of the disease. The doctor should be consulted if the affected person suffers from severe pain in the arm. These occur without any particular reason and do not disappear on their own. They can also occur in the form of pain at rest and have a very negative impact on the quality of life of the affected person. Redness in the affected area also often indicates tendinosis calcarea and must be checked by a doctor. Furthermore, the disease can also be manifested by severe pain in the head or neck. If the symptoms of tendinosis calcarea occur, either an orthopedist or a general practitioner can be contacted.
Treatment and therapy
Treatment of tendinosis calcarea can be conservative or surgical. As part of conservative treatment, the patient receives pain-relieving medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). It is better to avoid sports activities or gymnastic exercises because they aggravate the pain. Orthopedists also have the option of injecting local analgesics directly into the affected area of the body.One treatment option for calcific shoulder is shock wave therapy. In this procedure, a short, intense pressure pulse is delivered, which leads to improved blood flow to the tissue. In addition, new blood vessels form and the calcium deposit dissolves. As the pressure of tension decreases, the pain subsides. If the symptoms continue unabated despite conservative treatment, surgery must be performed, but this is rare due to the high spontaneous healing rate. In this procedure, the surgeon removes the calcific deposits and dilates the subacromial space. The procedure usually takes place through minimally invasive arthroscopy. After surgery, the patient must take it easy for about three weeks.
Prevention
To prevent tendinosis calcarea, doctors recommend a diet rich in magnesium. Foods rich in magnesium include especially nuts and whole-grain products.
Aftercare
If tendinosis calcarea must be treated surgically, subsequent aftercare is exceedingly important. After the surgical procedure, the affected shoulder should be rested for about three weeks. To treat the pain, the patient receives medications that have analgesic and anti-inflammatory effects.An important part of the aftercare of a calcified shoulder is the subsequent physiotherapeutic exercises. They take place after the acute pain has subsided. After the tendon has healed, pain-adapted mobilization treatment is performed. If passive exercises are performed in the first phase of therapy, active exercises are performed in the second phase, which are useful for achieving full range of motion of the shoulder joint. Pain-adapted therapy is understood to mean exercises that only put as much strain on the shoulder as the pain allows. The pain threshold must not be exceeded. Postoperative follow-up treatment also includes a third phase. In this phase, the stability, strength and muscle coordination of the affected shoulder can be completely restored. Normally, the pain after calcified shoulder surgery has noticeably subsided after 24 to 48 hours. Therefore, further follow-up treatment, which is performed on an outpatient basis, can usually be carried out without difficulty. However, the patient’s general state of health and any previous illnesses are also important. In about 90 percent of patients, long-term satisfaction can be achieved through follow-up care.
Here’s what you can do yourself
Patients with tendinosis calcarea primarily suffer from recurrent pain that increases in frequency and severity as the disease progresses. However, sufferers must be aware that tendinosis calcarea cannot be treated by self-help measures alone. Even relief of the symptoms by self-help measures is usually only temporary. This is because, in the absence of medical intervention and therapy, tendinosis calcarea progresses progressively, causing the pain to intensify. In general, physiotherapeutic measures are considered a good way to reduce some of the discomfort caused by tendinosis calcarea and to promote musculature and mobility. However, if these conservative therapy methods do not show the desired success, patients usually have to undergo surgery. Here, too, those affected have the opportunity to positively influence the outcome of the surgical intervention by actively participating. Before and especially after the operation, patients should refrain from sports. After surgery, patients with tendinosis calcarea also strictly adhere to the physician’s instructions regarding physical rest. With targeted scar care, patients can help to ensure that the surgical scars heal as well as possible and that no infections develop. Patients do not engage in sports again until they have received medical permission.
