Calcific tendinitis
Encyclopedia
Calcific tendinitis a form of tendinitis, is a disorder characterized by deposits of hydroxyapatite
(a crystalline calcium phosphate) in any tendon
of the body, but most commonly in the tendons of the rotator cuff
(shoulder), causing pain and inflammation
.
The condition is related to and may cause frozen shoulder
.
The etiology is unknown.
The calcific deposits are visible on X-ray
as discrete lumps or cloudy areas. The deposits look cloudy on X-ray if they are in the process of re-absorption, and this is also when they cause the most pain. The deposits are crystalline when in their resting phase and like toothpaste in the re-absorptive phase. However, poor correlation exists between the appearance of a calcific deposit on plain x-rays and its consistency on needling.
restriction have been documented. Dietary restriction applies to all milk
products, nut
s that have a high calcium content, calcium-fortified products and high calcium vegetables and snacks. Food nutritional labels
are helpful in determining foods to restrict. If no improvement is noted after three months, other treatment modalities should be tried.
It is assumed the body scavenges the pathological calcium deposits when dietary calcium is restricted. Studies are required in this area.
s and non-steroidal anti-inflammatory drugs (NSAID) are useful to a limited extent.
Hydroxylapatite
Hydroxylapatite, also called hydroxyapatite , is a naturally occurring mineral form of calcium apatite with the formula Ca53, but is usually written Ca1062 to denote that the crystal unit cell comprises two entities. Hydroxylapatite is the hydroxyl endmember of the complex apatite group...
(a crystalline calcium phosphate) in any tendon
Tendon
A tendon is a tough band of fibrous connective tissue that usually connects muscle to bone and is capable of withstanding tension. Tendons are similar to ligaments and fasciae as they are all made of collagen except that ligaments join one bone to another bone, and fasciae connect muscles to other...
of the body, but most commonly in the tendons of the rotator cuff
Rotator cuff
In anatomy, the rotator cuff is the group of muscles and their tendons that act to stabilize the shoulder. The four muscles of the rotator cuff, along with the teres major muscle, the coracobrachialis muscle and the deltoid, make up the seven scapulohumeral muscles of the human body.-Function:The...
(shoulder), causing pain and inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
.
The condition is related to and may cause frozen shoulder
Frozen shoulder
Frozen shoulder, medically referred to as adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.Adhesive capsulitis is a painful and...
.
The etiology is unknown.
Presentation and diagnosis
Pain is often aggravated by elevation of the arm above shoulder level or by lying on the shoulder. Pain may awaken the patient from sleep. Other complaints may be stiffness, snapping, catching, or weakness of the shoulder.The calcific deposits are visible on X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
as discrete lumps or cloudy areas. The deposits look cloudy on X-ray if they are in the process of re-absorption, and this is also when they cause the most pain. The deposits are crystalline when in their resting phase and like toothpaste in the re-absorptive phase. However, poor correlation exists between the appearance of a calcific deposit on plain x-rays and its consistency on needling.
Dietary calcium restriction
A controversial topic, this conservative treatment can be very effective for some patients, and reports of pain cessation with strict dietary calciumCalcium
Calcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...
restriction have been documented. Dietary restriction applies to all milk
Milk
Milk is a white liquid produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals before they are able to digest other types of food. Early-lactation milk contains colostrum, which carries the mother's antibodies to the baby and can reduce the risk of many...
products, nut
Nut (fruit)
A nut is a hard-shelled fruit of some plants having an indehiscent seed. While a wide variety of dried seeds and fruits are called nuts in English, only a certain number of them are considered by biologists to be true nuts...
s that have a high calcium content, calcium-fortified products and high calcium vegetables and snacks. Food nutritional labels
Nutritional facts
]The nutrition facts label is a label required on most packaged food in many countries....
are helpful in determining foods to restrict. If no improvement is noted after three months, other treatment modalities should be tried.
It is assumed the body scavenges the pathological calcium deposits when dietary calcium is restricted. Studies are required in this area.
Magnesium supplementation
Low magnesium levels can result in calcium deposition in soft tissues. Therefore magnesium supplementation may prevent the formation of calcifications.Extracorporeal shock wave therapy (ECSW)
ECSW uses sound waves focused onto the deposit. It works by an unknown mechanism in this disorder. In some German studies, 30-70% of patients obtained pain relief, and, in 20-77% of cases, the calcific deposit disappeared or disintegrated.Medications
AnalgesicAnalgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
s and non-steroidal anti-inflammatory drugs (NSAID) are useful to a limited extent.