Shoulder pain is a prevalent complaint that affects millions of individuals worldwide. In fact, it’s estimated that 6% to 26% of adults suffer from shoulder-related discomfort. This makes shoulder pain one of the most widespread medical afflictions in the world.
One of the factors that make this ailment so widespread is that it can stem from a range of different causes. Shoulder injuries — such as dislocation, separation, cartilage or rotator cuff tearing, and fractures to the clavicle or humerus — are among the most common causes, but they aren’t the only issues that can lead to discomfort in the shoulder and the surrounding regions. Rheumatoid arthritis, osteoarthritis, tendinitis, bone spurs, or even referred pain from the liver, heart, gallbladder, lungs, or other organs can all contribute.
As a care provider, helping your patients experience relief and regain full range of motion are your primary concerns. Unfortunately, the many possible sources of shoulder pain can also make it extremely difficult to diagnose and treat. But one cause of shoulder pain that is seeing major advances in treatment success is calcific tendonitis.
Here, we discuss calcific tendonitis, and how shockwave therapy may be able to help care providers around the globe improve the symptoms of calcific tendonitis in their patients, resulting in reduced discomfort and improved joint mobility.
What Is Calcific Tendonitis?
Calcific tendonitis is a shoulder condition characterized by the presence of calcium deposits within the tendons of the rotator cuff. These deposits, known as calcifications, can accumulate gradually over time, leading to inflammation, pain, and functional limitations. Although calcification can occur on any tendon, calcific tendinitis occurs most frequently in the shoulder.
Causes of Calcific Tendonitis
The exact cause of calcific tendonitis is not completely understood, but several likely contributing factors have been identified. Microtrauma to the tendons, repetitive overhead activities, and poor blood supply to the affected area are all believed to play roles in the development of this condition. Additionally, certain risk factors such as age, metabolic disorders, and gender (calcific tendonitis is observed more frequently in women than in men) may increase an individual’s susceptibility to calcific tendonitis.
Interestingly enough, although age-related degeneration may be a contributing factor, most cases of calcific tendonitis occur in patients between the ages of 30 and 50, with the condition seldom seen in patients who are older than 70.
Symptoms of Calcific Tendonitis
As the tendons within the rotator cuff begin to develop calcium deposits, patients may experience a range of debilitating symptoms. These include:
- Pain
Pain is the hallmark symptom of calcific tendonitis. It often manifests as a deep, aching discomfort in the affected shoulder, radiating down the arm. The pain can be intermittent or persistent and may worsen with movement or at night, making it challenging to find a comfortable sleeping position. - Limited Range of Motion
Individuals with calcific tendonitis often experience stiffness and reduced flexibility in the shoulder joint. This limitation can affect activities that involve reaching, lifting, or performing overhead movements, compromising their ability to engage in sports, perform work-related tasks, or even accomplish simple daily activities. - Tenderness and Swelling
- The affected area may become tender to the touch, and localized swelling or redness can sometimes be observed. These signs indicate the inflammatory response to the calcium deposits and the resultant tissue irritation.
- Weakness and Muscle Imbalance
As the inflammation and pain intensify, the muscles around the affected shoulder may weaken. This can lead to a noticeable imbalance in strength, making it challenging to perform tasks that require stability and control of the shoulder joint.
How Is Calcific Tendonitis Diagnosed?
Accurate diagnosis is crucial for effectively managing calcific tendonitis. Healthcare providers employ various diagnostic methods to identify and confirm the presence of this condition in individuals experiencing shoulder pain and limited range of motion. The diagnostic process typically involves a combination of clinical evaluation, imaging techniques, and medical history assessment.
Coupled with a thorough physical examination of the shoulder, imaging plays a vital role in confirming the presence of calcium deposits within the tendon. X-rays are commonly used to visualize the calcifications, providing valuable information about their size, location, and characteristics. In some cases, additional modalities such as ultrasound or MRIs may be recommended. These imaging techniques can provide a more detailed view of the calcium deposits and assess the extent of tissue involvement. Medical history assessment can likewise help determine whether the patient is likely to be suffering from calcific tendonitis.
What Treatments May Help with Calcific Tendonitis?
When it comes to managing calcific tendonitis, various treatments are available that may be able to alleviate symptoms and restore normal shoulder function. Depending on the severity of the condition and other individual patient factors, healthcare professionals may recommend one or a combination of the following treatments:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs, such as ibuprofen or naproxen, are painkillers that are commonly used to reduce pain and inflammation associated with calcific tendonitis. These medications can help alleviate discomfort and improve shoulder mobility. NSAIDs primarily provide relief to pain symptoms and do not address any of the underlying causes of the condition. Additionally, NSAID usage can lead to severe or life-threatening gastrointestinal (GI) bleeding and ulcers, and has also been linked to a higher risk of strokes, heart attacks, and heart-related deaths when used for a sustained period.
Lavage Treatment
Lavage treatment irrigates the shoulder with a saline solution to break up and flush out the calcium deposits. This procedure is typically performed using ultrasound guidance and a needle inserted directly into the affected area. Lavage is designed to remove the calcifications and reduce inflammation, thereby relieving pain and increasing shoulder mobility. However, its effectiveness is still a subject of debate, and lavage treatment is generally used as part of wider treatment plans.
Steroid Injections
Steroid injections are another common treatment option for calcific tendonitis. Corticosteroids are injected directly into the affected area to reduce inflammation and alleviate pain. These injections can provide temporary relief, but their long-term efficacy is uncertain. They are often used as a short-term measure or in cases where other conservative treatments have been ineffective.
Physical Therapy
Physical therapy plays a crucial role in the comprehensive management of calcific tendonitis. A skilled physical therapist can design a tailored exercise program that includes stretching, strengthening, and range-of-motion exercises. Physical therapy helps improve shoulder mobility, correct muscle imbalances, and promote healing. Additionally, therapists may incorporate heat or ice therapy to further alleviate pain and reduce inflammation. On the other hand, physical therapy carries with it an extensive time commitment, and may not fit into some patient’s schedules.
Surgery
In cases where conservative treatments fail to provide relief or for severe and chronic calcific tendonitis, surgical intervention may be considered. Surgery aims to remove the calcium deposits, repair damaged tissue, and restore normal shoulder function. The specific surgical technique employed will depend on the individual patient’s condition and the surgeon’s preference.
Therapeutic Ultrasound
Therapeutic ultrasound is a non-invasive treatment that utilizes high-frequency sound waves to heat the soft tissues deep in the affected area to improve blood flow, reduce pain, and enhance the absorption of medications. Although the evidence supporting the efficacy of therapeutic ultrasound for calcific tendonitis is somewhat limited, it is sometimes used as an adjunct to other treatments.
Extracorporeal Shockwave Therapy (ESWT)
ESWT is a promising treatment option that has gained popularity among medical providers. Shockwave therapy for calcific tendonitis involves the application of high-energy shockwaves to the affected tendons, breaking down calcium deposits and promoting healing on a cellular level. Instead of heating the calcified tendons, ESWT delivers high-energy shockwaves from a shockwave therapy device, creating a pressurized wave of energy that directly stimulates tissue. ESWT has been shown to reduce pain, improve tendon function, and enhance the resorption of calcifications. This non-invasive procedure is typically performed on an outpatient basis.
Does SoftWave Therapy Help Calcific Tendonitis?
SoftWave therapy, an innovation in shockwave therapy, shows promising results in the treatment of calcific tendonitis. This treatment modality utilizes low-energy acoustic waves to stimulate healing and alleviate the symptoms associated with tendon calcification. Unlike focused or radial shockwave devices, SoftWave shockwave treatment is low enough intensity that it does not cause any microtrauma at the site. Instead, the unfocused shockwaves modulate various signaling molecules (such as TLR3) to encourage the body’s natural healing response — essentially prioritizing healing to the area even though no trauma or microtrauma has occurred.
The acoustic pulses penetrate the affected tendon, triggering a cascade of biological responses. This includes increased blood flow, the release of growth factors, and the activation of cells involved in tissue repair. By promoting these natural healing processes, SoftWave therapy aids in the breakdown and resorption of calcium deposits within the tendon, leading to improved shoulder function and pain reduction.
It is important to note that SoftWave therapy is not a one-size-fits-all solution; the specific protocols and treatment plans for SoftWave therapy may vary depending on the severity of the condition and other factors. Working closely with patients to determine their specific circumstances and needs is an essential part of an effective SoftWave therapy plan.
How Often Do Patients Need Shockwave Therapy for Calcific Tendonitis?
The frequency and duration of shockwave therapy sessions for calcific tendonitis can vary depending on the individual patient and the severity of their condition.
While every patient’s treatment plan may differ, it is generally observed that most individuals require between three and six sessions of shockwave therapy before experiencing significant pain relief and improvements in their symptoms. These shockwave therapy sessions are typically spaced approximately one week apart. The intervals between sessions allow the body to respond to the treatment, promoting healing and resorption of the calcium deposits within the affected tendon. The one-week interval also provides an opportunity to assess the patient’s response to the therapy and adjust the treatment plan as needed.
With an average treatment duration of three to six weeks, shockwave therapy offers a relatively condensed and time-efficient approach to managing calcific tendonitis. The duration of treatment can be influenced by various factors, including the size and location of the calcium deposits, the patient’s overall health and healing capacity, and the individual response to the therapy.
How Long Does it Take to Recover from Calcific Tendinitis?
Recovery from calcific tendonitis can be a lengthy process, typically lasting anywhere from 12 to 18 months. The condition itself involves the formation and resorption of calcium deposits within the affected tendon, which takes time for the body to naturally resolve.
The duration of recovery can vary depending on several factors. The severity of the condition plays a significant role, as more extensive calcium deposits and tissue damage may require a longer healing timeline. Additionally, individual patient factors such as overall health, age, and healing capacity can influence recovery speed. That said, SoftWave shockwave therapy is known to speed up the recovery process while also providing symptom relief during the healing period.
SoftWave Therapy Solutions for Your Calcific Tendonitis Patients
Calcific tendonitis poses significant challenges for individuals experiencing shoulder pain and limited mobility. Unfortunately, while there are many treatment options available ranging from physical therapy and steroid injections to invasive surgeries, many have only limited effectiveness in providing long-term relief. SoftWave shockwave therapy may be the answer, addressing the underlying causes of calcific tendonitis, accelerating the healing process, and alleviating symptoms associated with this condition — all in a non-invasive, outpatient setting. By incorporating shockwave therapy into a comprehensive treatment plan, healthcare professionals can significantly improve patient outcomes and help individuals regain optimal shoulder function.
Don’t force your patients to shoulder this burden on their own; give them the treatment they need to regain their optimal shoulder health, quickly, easily, and with minimal discomfort. Learn more about SoftWave therapy, and if you’re ready to take the next steps, become a SoftWave provider.