What happens in the tendon
In the area of the tendon with impaired blood supply, the cells are rearranged, and calcium hydroxyapatite crystals are deposited in the tissue. A dense focus is formed - calcification. The resting stage can last for months and years with almost no complaints. Then the body begins to resolve the deposit: vessels grow into the lesion, calcium softens and breaks into the subacromial bursa. It is this phase that gives the most severe pain. After it, the tendon is gradually restored.
- Formation stage - usually no complaints
- Rest stage - aching pain during exercise
- Resorption stage - severe pain and limitation of movements
- Recovery stage - pain subsides, mobility returns
- The supraspinatus tendon is most often affected
Causes and risk factors
The exact reason is unknown. This is not “salt deposition” from the diet and is not a consequence of excess calcium in food: the level of calcium in the blood in such patients is usually normal. Local disruption of blood flow in the tendon, microtrauma from repetitive overhead movements, and metabolic characteristics are believed to play a role. Middle-aged people get sick more often, women - somewhat more often than men.
- Age from 35 to 55 years
- Working with raised arms, repetitive movements
- Diabetes mellitus
- Thyroid diseases
- Low mobility of the shoulder girdle
- Hereditary predisposition
Symptoms
Complaints depend on the stage. Outside of exacerbation, a dull pain bothers you when you raise your arm, when you try to get an object from a shelf or fasten clothes at the back. In the acute phase, the pain increases over several hours, becomes burning, radiates to the outer surface of the shoulder, intensifies at night and when lying on the painful side. The person keeps his arm close to his body and avoids any movement. Without treatment, permanent shoulder stiffness may develop.
- Pain when raising the arm above shoulder level
- Acute exacerbation without injury
- Night pain, inability to lie on that side
- Limitation of arm abduction and rotation
- Clicking and catching sensation in the shoulder
- Arm weakness due to pain
Diagnostics
The main method is conventional radiography of the shoulder joint: calcification is clearly visible as a dense round formation above the head of the humerus. Ultrasound clarifies the size and density of the deposit, the condition of the rotator cuff and the presence of fluid in the subacromial bursa, and also allows puncture to be performed under control. MRI is used when it is necessary to exclude a tendon rupture or other joint pathology. Additionally, your doctor may check your blood glucose and thyroid function.
- Examination with rotator cuff tests
- X-ray of the shoulder joint in two projections
- Ultrasound of the shoulder with assessment of tendons and bursa
- MRI of the shoulder joint if in doubt
- Blood glucose and TSH according to indications
Treatment and recovery
In the acute phase, the goal is to relieve pain and prevent the shoulder from freezing. The doctor prescribes non-steroidal anti-inflammatory drugs, rest for several days and cold, and if the pain is very severe, he may inject a glucocorticoid into the subacromial bursa. Shock wave therapy works well: it accelerates the destruction of calcification. For large, dense deposits, acupuncture with ultrasound-guided rinsing is used. Surgery is rarely needed if the pain persists for months. From the first days, gentle exercises on range of motion are included, then strengthening of the cuff muscles. Treatment is prescribed by a doctor.
- Short course anti-inflammatory drugs
- Relative rest, but not complete stillness
- Shock wave therapy
- Acupuncture and washing of calcification under ultrasound
- Glucocorticoid injection into the bursa for severe pain
- Physical therapy and capsule stretching exercises