Therapy
It is not possible to make a blanket judgement about the individual course of the disease. While some patients “sit out” the disease in the course of the body’s own self-healing process, surgical treatment may become necessary for other patients, especially those who suffer from severe pain, whose calcification is larger than 1 cm and indicates a hard consistency. Since this disease is attributed a high spontaneous healing tendency, surgery is usually very rare.
During the operation, the calcium deposits are removed and the acromion (subacromial space) for the shoulder tendons is widened. In the context of an acute inflammation of the bursa (bursitis subacromialis) and thus in the event of severe pain, the arm can be relieved for a short time with a shoulder orthosis (a type of bandage). The administration of analgesics (= painkillers) and NSAIDs (= non-steroidal anti-rheumatic drugs), which have a strong anti-inflammatory effect, relieve the pain.
Cooling the shoulder (cryotherapy) also relieves pain and also slows down the inflammatory processes. Rapid pain relief can be achieved by injecting a light anaesthetic, if necessary with additional cortisone. The mixture is injected from the side or from the back under the acromion (subacromial infiltration).
The local anaesthetic provides an immediate pain-relieving effect, while the cortisone, as the most powerful anti-inflammatory drug of all, ensures pain relief even after the anaesthetic has been broken down.Since cortisone causes the blood sugar level to rise sharply, sugar patients (diabetes mellitus) must adjust their insulin requirements and check their blood sugar levels more frequently. As soon as the pain subsides, physiotherapy should be started. The aim of physiotherapy is to relieve the shoulder tendons under the acromion and to maintain shoulder joint mobility.
The shoulder joint is the joint of the body that tends to become partially stiff if movement is restricted due to pain or otherwise immobilized for a long period of time due to capsule shrinkage. In ESWT (Extracorporeal Shockwave Therapy), the calcifications in the tendon are specifically exposed to shock waves, which should lead to the disintegration of the foci. Shock waves are very high-energy pressure waves that can break up the calcifications.
What remains are fine particles of calcification, which can be more easily broken down and transported away from the body. This requires several sessions. Possible side effects of this treatment are local swelling of the treated tissue, as well as bleeding and reddening of the skin.
Some patients also experience ESWT as painful, but this varies from patient to patient. Injuries to the surrounding bones, nerves, tendons and vessels may also occur. ESWT does not achieve the desired effect in every patient.
In some cases, the symptoms may even worsen, but overall very good results have been achieved with ESWT in the treatment of tendinosis calcarea. Good to very good results (patient satisfaction) can be achieved to 60-90%. The calcified shoulder (tendinosis calcarea) is one of the classic areas of application for shock wave therapy.
The mode of action can be explained biologically rather than mechanically. The calcium deposit in the shoulder is not destroyed, but a biological tissue reaction is induced, which results in the dissolution of the calcium deposit and a local decrease in inflammation. The success of the therapy should be measured not so much by whether the calcium deposit has completely disappeared in the X-ray control, but rather by the reduction in the patient’s pain.
Many people have calcium deposits in their shoulder vision without these becoming symptomatic (painful). In this respect, a calcified shoulder is sometimes a random diagnosis without therapeutic relevance. However, shock wave therapy (ESWT) is a promising treatment option for painful calcified shoulder (tendinosis calcarea), which should be seriously considered before surgical intervention.
The shock wave should take effect within the first 3 months after treatment. Much later, a therapeutic success (pain reliefDissolution of the calcium depot) is no longer expected. The therapy should be performed with a high-energy shock wave.
Surgical treatment may be necessary for patients who suffer from persistent severe pain, whose calcium deposits are larger than 1 cm and have a hard consistency. However, since the tendinosis calcarea is associated with a high spontaneous healing tendency, the indication for surgery is rather reserved. If conservative methods have failed, surgical removal of the calcified shoulder should be performed.
During surgery, the calcific deposits are removed and the subacromial space is widened. As a rule, the procedure is minimally invasive, i.e. arthroscopic. Arthroscopy describes the observation (reflection) of a joint by inserting a rod camera through very small incisions (0.5-1 cm).
Special instruments can also be used to treat damaged joint structures during such a reflection (arthroscopy). After endoscopy of the glenohumeral joint, which can be used to diagnose possible additional damage (shoulder arthrosis, rotator cuff tear), the acromion space is usually widened by sparingly removing bone from the acromion subsurface (subacromial decompression). The acromioclavicular bursa is also removed.
As soon as the calcification has been localized, it can be removed. The calcification can also be removed by means of a normal, open (not minimally invasive) operation. The operation is then performed through a small skin incision of about 3 cm.
After surgery, the shoulder should be spared for a period of about 3 weeks. Post-operative follow-up care is usually carried out in conjunction with anti-inflammatory and painkilling medication.Physiotherapeutic exercise treatments are designed to maintain shoulder joint mobility. Physiotherapy represents an important therapeutic pillar of the calcified shoulder.
A tendinosis calcarea carries the risk of developing chronic pain, as well as the development of a stiff shoulder, this should be averted with the help of physiotherapy. It is important to keep the shoulder in motion with the right exercises, as otherwise permanent bad posture can occur due to adopted relieving postures. Physiotherapy is not only used as part of the conservative therapy of tendinosis calcarea, but also after surgical removal of calcification.
Often physiotherapy is combined with a so-called cryotherapy (cold therapy). Physiotherapy enlarges the space in the shoulder joint so that less pressure is exerted on the tendons of the shoulder joint and the pain is relieved. Exercises should not only be performed together with the treating physiotherapist, but also independently at home.
This allows the healing process to progress more quickly. It is best to let the treating physiotherapist show you the exercises, so that you know exactly what you should pay attention to. Exercises that are recommended for a calcified shoulder are stretching exercises.
Stretching exercises ensure that tendons and muscles become more elastic and blood circulation is increased. A simple but good exercise for the shoulder is the pendulum movement in the shoulder joint. The arm dangles loosely back and forth on the body.
In another exercise, the arm can be stretched out horizontally and the forearm can be angled 90 degrees upwards. The forearm is carefully pressed against a wall with the body weight until at some point a feeling of tension is felt. For another exercise, stand in a door frame: The upper arms rest against the body and the forearms are angled forward in 90 degrees and now both are pressing against the respective door frame.
In a last recommended exercise, put your hand behind your head as if you wanted to tie an apron or something similar around your neck. With the other hand a pull is made on the upward stretched and angled elbow towards the top outside. During these exercises you should only feel a slight feeling of tension, if pain occurs, the exercise should be finished.
In the long term, exercises can help with tendinosis calcarea. Planned and targeted exercises should always be performed to avoid incorrect loading or overloading of the shoulder. Training or supervision by a physiotherapist is very useful.
In this way, malpositioning and incorrect training can be avoided and further damage to the affected area prevented. In addition, it is very important to spare the affected area in case of sudden and acute severe pain. Kinesio-Taping is a comparatively newer treatment method.
It can be used for various clinical pictures, including tendinosis calcarea. Kinesio-Taping involves sticking elastic strips onto the skin in certain directions. This treatment can correct incorrect posture, relieve pain and support certain supporting movements.
Many patients respond positively to this treatment method. Kinesio-Tapen should not be used as the sole therapy, but only as a support. As with many other diseases, homeopathy can also be used for the calcified shoulder.
Here, remedies such as Solanum malacoxylon, Vermiculite, Lyopodium, Calcium phosphoricum and apple vinegar are used. The preparations are said to have effects that are supposed to be effective against calcification. Apple vinegar, for example, can be used both externally in the form of a soaked compress and internally for drinking in the form of a water-apple vinegar mixture (about two spoons of apple vinegar). Apple cider vinegar should be able to dissolve the lime. However, the effect of these preparations has not been scientifically proven.
