Who does it affect?
Anyone, but more prevalent in women.
Why does it happen?
Calcific tendonitis is when there is a build-up of calcium pyrophosphate in the rotator cuff (calcific deposit). When the calcium builds up in the tendon, it can cause a build up of pressure in the tendon, as well causing a chemical irritation, leading to pain. The pain can be severe and is one of the worst pains in the shoulder.
In addition to the chemical irritation and pressure, the calcific deposit reduces the space between the rotator cuff and the acromion, impacting on the normal function of the rotator cuff. This can lead to subacromial impingement between the acromion and the calcium deposit in the rotator cuff when lifting the arm overhead.
Calcific tendonitis is an extremely painful condition in which the shoulder, exacerbated when lifting the arm overhead.
The condition is well known and easily identifiable and may be confirmed using x-ray or ultrasound.
Physiotherapy may be used to minimise the irritation, strengthen the shoulder and attempt to restore a wider range of movement.
Therapeutic steroid injections may be used to reduce inflammation and provide pain relief. These are only performed once or twice and may be done via ultrasound guidance.
Pain-killers and anti-inflammatory drugs will also be offered. Often the pain is not averted and you will be offered surgery at this point.
Surgery is carried out as a day case procedure usually under general anaesthetic and takes about 30 minutes. An arthroscopic subacromial decompression (ASD) is carried out and the calcium deposit removed.
The surgery is performed arthroscopically (key-hole surgery) and aims to increase the size of the subacromial area and reduce the affect of the impingement by increasing the amount of space between the acromion and the rotator cuff tendons. It involves cutting the ligament and shaving away the bone spur on the acromion bone, allowing the muscle to heal. In turn this allows for easier movement and less pain and inflammation. The calcium deposit is also removed at the same time.
You can go home soon after the operation. You will return from theatre wearing a sling. This is for comfort only and should be removed as soon as possible (usually within the first day). Some people find it helpful to continue to wear the sling at night for a little longer if the shoulder feels tender.
The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The bulky dressing will be removed after 1 day. The wound is cleaned and redressed with a simple dressing. Keep the wound dry until 12 days after your surgery.
You should notice an improvement in symptoms within a few weeks but the final result may take up to 12 months.
Return to normal routine
The aim is really to try to return to your normal, day to day activities as soon as you feel capable of doing so.
Most patients do not need physiotherapy afterwards as long as the arm and shoulder are moved and used as soon after surgery as possible. Occasionally, I will refer you to the physiotherapist following surgery.
I would expect you to have approximately 80% recovery by three months after the operation. You may feel some discomfort in the shoulder for up to 12 months after the operation.
Return to driving:
You are advised to avoid driving for at least 7 days. You will be given further advice about this at the time of your operation.
Return to work:
Everyone has different work environments. You will be given advice on your own particular situation. In general, my advice would be to return to your work as soon as you feel that you are able to do your job without too much discomfort.
Overall over 95% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any upper limb surgery from a minor procedure to a complex reconstruction).
- Failure to completely resolve the symptoms.