Arthroscopic Treatment of Calcific Tendonitis
When would surgical treatment be considered for calcific tendonitis?
Calcific tendonitis is in the majority of cases treated nonsurgically. The symptoms from calcific tendonitis (mostly pain in the shoulder and difficulty with activities) occurs as a result of calcium becoming deposited in the substance of the rotator cuff tendon (known as “dystrophic” calcification). A combination of observation, medications, injections (barbotage), and sometimes structured exercises, is effective in 90% of patients.
Some patients that have particularly large deposits, deposits located in a particularly sensitive area (near the front of the roof bone called the acromion), or deposits that extend deeper (medially) into the rotator cuff can be more challenging to resolve nonsurgically(1). Usually barbotage is recommended, which is a procedure done in the office with local anesthesia, where a needle is used to physically break up the calcium and administer a steroid medication to the area. When this fails and the calcium persists and remains symptomatic, arthroscopic treatment is warranted.
Arthroscopic treatment for calcific tendonitis consists of utilizing a specialized surgical technique of meticulously and precisely removing all remaining calcium from the tendon under direct visualization. Oftentimes MRI is used by the surgeon to predict and understand where exactly the calcium is located within the tendon of the rotator cuff. Often this localization of the calcium deposit is confirmed using needling at the time of surgery where minor “poking” of the lesion emanates tiny flushes of white crystalline material (specifically the offending substance called hydroxyapatite). Then, a tiny incision is made in the cuff tissue overlying the calcium deposit, exposing the rest of the calcium. As it is removed with sharp instruments, one can see a “geyser” of white material being flushed from the area. Removal of the entirety of the calcium deposit is completed and any defects (tears) left in the rotator cuff are repaired.
Sometimes arthroscopic removal of the calcium deposit and repair of the tendon is coupled with a decompression of the impinging bone at the top of the shoulder (called the acromion), which can further alleviate pressure and pain from the calcium deposit.
Recovery from the procedure generally results in a trade for prompt resolution of the nagging and persistent pain from the deposit in the rotator cuff tendon with the surgical pain from the arthroscopy. Generally surgical pain subsides in several days following the procedure and patients typically discontinue pain medications within a week or so. A sling is worn for approximately six weeks and physical therapy is started early to expedite the recovery of function and to avoid stiffness. Full daily activities are restarted at six weeks when the sling is removed and complete activities are resumed between two and three months after surgery. Minor incremental improvements can continue well up to a year.
It is recommended to seek evaluation of shoulder pain, particularly pain that has worsened abruptly or caused a sharp deterioration in the ability to use the arm, including for activities like reaching, lifting, and pulling. Radiographs of the shoulder are an initial step in evaluating the problem and to help guide response to treatment. An experienced shoulder specialist, Dr. Thomas Obermeyer, can help to guide you through your options and to ensure the problem is resolved as quickly and as minimally invasively as possible.
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Have a shoulder injury and would like an orthopedic surgeon specialist diagnosis? Call or make an appointment online with Dr. Thomas Obermeyer, who specializes in shoulder conditions and sports medicine surgery serving the Elgin, Schaumburg, Hoffman Estates, Arlington Heights, Elk Grove Village, Roselle, Palatine, and Streamwood communities.
References:
- Ogon P, Suedkamp NP, Jaeger M, Izadpanah K, Koestler W, Maier D. Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulder. Arthritis Rheum. 2009 Oct;60(10):2978-84. doi: 10.1002/art.24845. PMID: 19790063.
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Dr. Thomas Obermeyer
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