Calcific tendonitis of the shoulder (shoulder joint) is a disease in which calcium salts are deposited in the tendons and muscles of the rotator cuff. In this case, reactive inflammation of the tissues around calcium deposits occurs, which is accompanied by intense pain and limited range of motion in the shoulder joint. Calcific tendonitis of the shoulder is a fairly common disease. It most often occurs in people over 40 years of age. Most often, calcium deposits are found in the supraspinatus tendon. Deposits of calcium salts sometimes reach significant sizes and become a serious hindrance in human life.
Causes of calcification in the tendon.
The reasons for the appearance of foci of calcification in tendons are poorly understood. There are separate works indicating the causes or pathogenesis of the development of this disease. It follows from them that the causes of calcific tendonitis of the shoulder are microtraumas of the tendons, disturbances in the blood supply to them, which leads to metabolic disorders, small foci of necrosis, fibrosis and subsequent deposition of calcium salts in places of fibrosis. In parallel, tendon degeneration and fiber disintegration occur with disruption of the morphological structure of tendon tissue.
Side effects in the treatment of diseases of the elbow joint
The procedure is well tolerated; mild side effects sometimes manifest themselves in the form of pain and slight swelling at the procedure site and disappear by the 2nd day after the procedure. Based on the experience of our clinic, we can say that pain and stiffness in the joint are relieved in most cases by the 4th - 7th procedure. Tissue regeneration, as a consequence of the effects of radial wave application, provides a longer delayed positive effect after completion of the course of treatment.
Symptoms of calcification in the shoulder.
- Pain when making movements in the shoulder. Especially when moving the shoulder, associated with the work of the affected tendon or muscle. If we talk about the supraspinatus muscle of the shoulder, then this is pain precisely when raising the arm up.
- The pain can be at rest and localized in the outer part of the shoulder with irradiation to the forearm.
- Restricted mobility in the shoulder joint.
- One of the most common complaints is shoulder pain at night. Aching pain that can significantly disturb the patient’s sleep.
- Symptoms can develop gradually, and most often appear in the resorption stage of the disease.
Diagnostics
The diagnosis of shoulder tendonitis is made by an orthopedist based on typical clinical symptoms. If in doubt, an MRI of the shoulder joint is indicated (thickening of the tendon sheaths and joint capsule is determined). In case of traumatic injuries, areas of ruptures are visible.
To exclude arthrosis, fracture, dislocation, an x-ray of the shoulder joint is performed. With tendovaginitis, as a rule, the x-ray picture is normal.
With calcific tenosynovitis, the images show areas of calcification.
Calcific tendinitis of the shoulder. Modern treatment.
Until recently, the only treatment for calcific tendonitis of the shoulder was surgical removal of calcium deposits. The surgeon removed the calcification using a scalpel. After the operation, fibrosis often reappeared and after some time calcifications reappeared in the same place. Painkillers and anti-inflammatory drugs brought temporary relief. Injections of steroid hormones relieved pain in some patients for several weeks, but intensified degenerative processes in the tendon and did not contribute to the resorption of calcium crystals in the tendon. Shock wave therapy makes it possible to cope with such a complex task as the treatment of calcific tendinitis without surgery and with comparable effectiveness. Recently, many researchers and specialists in the field of orthopedics have paid great attention to extracorporeal shock wave therapy in the treatment of calcifications in tendons. In an article by the American Academy of Orthopedic Surgeons, extracorporeal shock wave therapy ranks alongside surgical treatment methods for the effectiveness of treating calcific tendinitis of the shoulder. J Am Acad Orthop Surg. 2014 Nov;22(11):707-17. doi: 10.5435/JAAOS-22-11-707. Calcific tendinitis of the rotator cuff: management options. Suzuki K, Potts A, Anakwenze O, Singh A. Abstract. Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical debridement . These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial. Copyright 2014 by the American Academy of Orthopedic Surgeons. PMID: 25344596 DOI: 10.5435/JAAOS-22-11-707
Other studies give priority to shock wave therapy in the treatment of calcific tendinitis of the shoulder due to the high effectiveness and non-invasiveness of this method. J Orthop Traumatol. 2008 Dec;9(4):179-85. doi:10.1007/s10195-008-0024-4. Epub 2008 Aug 8. Arthroscopy surgery versus shock wave therapy for chronic calcifying tendinitis of the shoulder. Rebuzzi E1, Coletti N, Schiavetti S, Giusto F. Operative Unit of Orthopedics, Oderzo Hospital, Treviso, Italy. [email protected] Abstract BACKGROUND: There are several treatment modalities for calcifying tendinitis of the shoulder. If the pain becomes chronic after several months of conservative treatment, open or arthroscopic removal is usually recommended. Recently, extracorporeal shock wave therapy has shown encouraging results in treating calcific deposits. CONCLUSIONS: We conclude that shock wave therapy is equivalent to arthroscopy, and so shock wave therapy should be preferred because of its noninvasiveness. PMID: 19384483
Specialists at the Avatage Medical Center also prefer the use of extracorporeal shock wave therapy in the treatment of calcific tendonitis of the shoulder, based on their own successful experience in the treatment of this disease, as well as on the work of our foreign colleagues.
How does shock wave therapy treat calcifications?
By applying a shock wave to an area of tissue with calcification, we trigger a number of processes in the tendon. These processes lead to natural lysis and removal of calcification from the body. What are these processes? – Multiple increases in blood circulation at the site of exposure, and at the same time an increase in metabolic processes. – Activation of fibroclasts and macrophages, which eliminate (“eat”, dissolve) pathological calcium deposits. – Stimulation of connective tissue growth factors, which help restore the natural structure of the tendon, stimulates fibroblasts that synthesize collagen and other components of the tendon. – Powerful activation of lymph circulation at the site of exposure – calcification breakdown products are naturally removed. As a result, after some time, calcium deposits are resorbed and replaced by healthy tendon tissue. Inflammation goes away, pain disappears, and the full range of movement in the joint is restored. The man is healthy.
Results of treatment of calcifications in the shoulder using a method developed at the Avatage MC using shock wave therapy.
Example 1: Calcific tendinitis of the shoulder. Patient G., 56 years old. The duration of the disease is more than 1.5 years. R-graphy data before and after the course of treatment at the Avatage MC. The complete removal of calcification is visible in the second image.
Calcific tendonitis of the shoulder, before and after shock wave therapy treatment
Example 2. Calcification in the shoulder. Patient K., 53 years old. Calcific tendinitis of the shoulder. After 1 course of treatment, I completely got rid of shoulder pain and restored full range of motion in the shoulder joint.
Example 3. Calcific tendonitis of the shoulder, calcification in the supraspinatus muscle ligament. 7 UVT procedures were performed.
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Example 4. Calcific tendonitis of the shoulder, the patient underwent 8 shock wave therapy procedures. After the course of treatment, the patient ceased to be bothered by pain, and the range of motion in the shoulder joint was completely restored.
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Calcific tendonitis of the shoulder treatment in Zaporozhye, phone 061 222 87 00.
How is the procedure for treating elbow joint diseases using the UVT method?
The procedure itself is performed in combination using focused and radial applicators. Radial shock wave is most often used at the beginning of the procedure. The radial wave is used not only when working in the joint area, but also with adjacent regions, since the pathological process often affects adjacent tissues. The radial applicator targets tissue at shallow depths and results in many beneficial long-term “tissue” effects (reduced inflammation, capillary sprouting, stem cell influx, etc.). These effects do not appear immediately, but after a fairly long period of time - from 3 weeks, and develop over several months, leading to deep tissue regeneration. The main effect of the shock wave is aimed at relieving pain and swelling, suppressing inflammation, accelerating tissue metabolism, and loosening the tissues of the affected areas.
After the radial wave, a focused wave is used, which penetrates deep into the tissue, reaching the area of pain, and causing loosening, analgesic and anti-inflammatory effects. At the same time, the doctor carefully directs the focal spot area of the device to the affected areas; when working with pain syndrome, it is important to get to the places of greatest pain, from which the procedure may cause some discomfort, which does not harm health in any way and should be perceived as a benefit. Thus, the effect of a focused wave is usually immediate and increases with each procedure, while the effect of a radial wave is delayed, noticeable from the 3rd week onwards.