Calcified shoulder: Causes, Symptoms, and Treatment

A calcified shoulder is a shoulder in which calcium has been deposited. This occurs most frequently in the area of the tendon of the supraspinatus muscle, but in principle, it can also affect any other tendon of the shoulder muscles. The result is an inflammatory process in the shoulder joint, which leads to sometimes severe pain.

Epidemiology

The typical time at which a calcified shoulder becomes noticeable is between the ages of 35 and 50. However, it is difficult to say when it has developed, as in many patients, symptoms only appear several years after the onset of the disease.

On average, women are affected slightly more often than men.

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Causes of a calcified shoulder

Various reasons can be considered for a calcified shoulder. These include external influences, such as:

  • Excessive mechanical stress (for example, in certain sports or other work that places heavy demands on the shoulder in everyday life or at work)
  • Accidents or falls
  • Tears in one of the shoulder tendons
  • endogenous processes such as weak tissue perfusion or degenerative processes within the scope of aging processes

Are there psychological causes for the development of a calcified shoulder?

Psychology plays a vital role in the development of many diseases. So the shoulder movement can also be limited by the psyche, through bad posture. However, calcification caused by the psyche is unlikely. A pain symptomatology can be aggravated by psychological problems.

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How does the calcified shoulder develop?

The process that can be caused by all these different causes is ultimately the same:

The tissue of the corresponding area is not sufficiently supplied with blood. As a result, the tissue of the tendon is transformed into fibrous cartilage. Later, when this fibrocartilage dies, lime may be deposited at this site. If this “calcification” is pronounced, the tendon consequently swells and can press on surrounding structures, such as bursae or tendons of the surrounding muscles, which ultimately leads to inflammation and, in the context of this, eventually to pain. This swelling can also lead to a lack of space within the joint and, thus, to the collision of its components, which is known as impingement syndrome, which almost always goes hand in hand with a calcified shoulder.

Sometimes, however, the body resorbs the calcification by itself, the calcification deposit dissolves and disappears again unnoticed. Because of the relatively high spontaneous healing rate of this disease, it is also crucial to always weigh up the therapy options carefully. Why calcifications form in people and not in others with a comparable risk profile is not yet fully understood.

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Symptoms of a calcified shoulder

The main symptom of a calcified shoulder is (sometimes very severe) pain.

This occurs mainly during movements involving the muscle of the affected tendon. As this is usually the supraspinatus tendon, most patients with a calcified shoulder experience particular pain when the arm is moved over the head or outwards/backward, as the supraspinatus muscle plays an essential role in these movements. The pain often has a rather stinging character and can radiate into the neck or the wider arm. Also, at night when sleeping on the affected side, pain typically occurs. This pain is usually accompanied by more or less pronounced restrictions in the movement of the shoulder joint. In the worst case, paralysis of the entire arm may even develop.

Symptoms may develop slowly over a longer period, become steadily worse or even subside on their own at some point, or suddenly become severe without any recognizable acute trigger.

Pain in the upper arm

With a calcified shoulder, the pain initially occurs directly in the shoulder joint, especially when working overhead or under heavy loads, but over time pain also occurs in the upper arm. On the one hand, this can be due to calcification of the biceps, which also runs through the shoulder joint. On the other hand, compensatory overloading of the upper arm muscles can occur if the rotator cuff is increasingly restricted in its strength due to the calcification.

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Pain in the night

Affected persons suffer from pain in the shoulder, especially at night, especially when lying on the affected shoulder. The pressure on the joint causes increased pain, blood circulation is also reduced, and the symptoms may worsen.

In the case of bursitis associated with the calcified shoulder, pulsating pain can also occur at night, regardless of the lying position.

Acute phase of the calcified shoulder

The acute phase of a calcified shoulder is to be expected after the actual calcification phase. When the body begins to dissolve the calcification deposits, an immune reaction occurs in which cells enter the tissue and break down the calcification foci. This releases inflammation mediators and results in severe pain, warming, redness, swelling, and functional impairment of the shoulder. These processes can also cause inflammation of surrounding structures such as the bursae.

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Therapy of a calcified shoulder

For the treatment of a calcified shoulder, there are many different possibilities, which should be discussed together by the patient and the doctor. Depending on the stage of the disease and the individual level of suffering, different treatment plans should be used.

As a rule, conservative therapy is started, i.e., an attempt is made to avoid surgery for the time being. In the following, you will get an overview of possible therapy methods.

  • Physiotherapy
  • Muscle strengthening exercises
  • conservative therapy with cortisone
  • Cryotherapy
  • Heat Therapy
  • Radiotherapy
  • Shockwave therapy
  • Needling
  • X-ray depth irradiation
  • Osteopathy
  • Homeopathy
  • Acupuncture
  • Therapy with home remedies
  • Operation

Wearing a shoulder brace can also help to relieve the shoulder. These simple methods are already showing excellent results with many patients. Otherwise, painkillers or anesthetics can be used, which can either be administered in tablet form or injected directly into the corresponding tissue.

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Helpful muscle exercises

A calcified shoulder is manifested in pain that is highly dependent on movement. Due to the calcium deposits in the tendons, the movement of the joint is painfully restricted. Exercises can, therefore, sometimes be difficult to perform, as they can lead to pain in the joint. Gentle stretching exercises are recommended, which stretch the tendons and muscles slowly and gently and provide more flexibility in the joint. Careful mobilization can also have a pain-relieving and movement-enhancing effect. The movements should be relaxed and painless, and if pain occurs, consideration should be given, and the exercise should be interrupted. Large sweeping movements are suitable for mobilization. However, it is possible to start with a small range of motion and then slowly increase the movement. Strengthening the rotator cuff can also help to reduce the symptoms of the calcified shoulder. In order not to put additional strain on the tissue, static holding exercises are recommended to improve strength; this is called isometric strength training.

Physiotherapy

Physiotherapy plays a significant role in the conservative therapy of the calcified shoulder. Depending on the stage of the disease, intensive exercises and techniques are used to improve or maintain shoulder mobility and to counteract muscle loss. This also stimulates the blood circulation, which can accelerate the decomposition of the lime crystals. However, the crystals cannot be eliminated directly by physiotherapy.

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Cortisone syringe

Cortisone is an anti-inflammatory and painkilling drug that is frequently used for joint pain. This is also the case with the calcified shoulder when severe pain cannot be treated or cannot be sufficiently treated by drug therapy. Cortisone can be injected directly into the joint. However, it should be remembered that cortisone can have a damaging effect on ligaments and cartilage and should, therefore, only be used in precise doses when indicated.

Radiotherapy

Radiation therapy can be very useful when pain first occurs. However, it is only promising in the early phase of the disease. Radiation therapy is given in low doses and is considered to have few side effects.

Radiation therapy involves throwing rays into the tissue, which serves to break down the calcium deposits. The lime fragments that are created during this process can be removed more easily. Also, a new inflammatory reaction occurs, which leads to increased blood circulation. Immune cells reach the shoulder more often, and the breakdown of existing lime deposits is improved. However, radiotherapy increases the risk of secondary tumors, even if only very slightly, and should, therefore, be discussed with young patients in particular. Radiation therapy is an IGeL service, which means that it must be paid for by the patient himself.

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Shock wave therapy

Probably best known is extracorporeal shock wave therapy (ESWT). This has only been used for about ten years but has an excellent success rate.

Shock waves are short, high-energy waves that discharge their energy only when they hit solid tissue. In this particular case, therefore, the skin and muscles are simply penetrated, while the calcification is then hit by all the energy. The shock waves are focused on the painful area with the help of a cushion filled with water, penetrate to the calcification and break the lime down into tiny particles which can then be absorbed by the body. Besides, shock wave therapy stimulates the blood circulation in the tissue, which additionally ensures that the body’s healing process is promoted. Usually, this therapy can be carried out on an outpatient basis, so the patient does not need to be admitted to the hospital and can go home directly after the session. Pain during this treatment is minimal, and side effects such as bruising or swelling are very rare if appropriately used.

How often ESWT must be repeated depends very much on the severity of the disease. For many, however, it takes three appointments. If, after three months, there is still no success, it is usually advisable to discontinue treatment and still carry out an operation.

The success rates for shock wave therapy are around 40-70%.

However, shock wave therapy is an IGeL service. In other words, it is a service that is not covered by health insurance and must be paid for by the patient.

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Home remedies

In addition to drug therapy and immobilization, home remedies are often used to alleviate the symptoms associated with a calcified shoulder. Apple vinegar, heat applications using a hot-water bottle or grain pillow, or even massages are popular. Other household remedies are bitter-salt baths, ginger, and turmeric. These substances are said to have a muscle-relaxing or anti-inflammatory effect and are meant to help with the calcification of the shoulder.

Is a treatment with apple vinegar useful?

Therapy with apple vinegar is in no way a substitute for conventional medical diagnosis and treatment. However, it can be used as an accompanying treatment. Apple cider vinegar contains some valuable electrolytes and the so-called pectin (from the skin of the apple), which is said to have a medicinal effect. Apple vinegar is best taken slightly diluted with water in the morning and evening. It is noted that existing lime deposits should be reduced, and the appearance of new ones prevented. Everyone should decide for themselves whether therapy with apple vinegar will help. There are usually no side effects.

Should a calcified shoulder be cooled or warmed?

You should test individually whether warmth or cold is right for you. As a rule, heat is perceived as pleasant. It increases the blood flow and relaxes the muscles. However, in acute stages of inflammation, e.g., bursitis, heat is contraindicated. In this case, the joint should be cooled. In most cases, however, the patient feels what is right for him or her.

Surgery

Surgery is almost always the last resort in the treatment of a calcified shoulder when everything else could not result in any or only an insufficient reduction of the symptoms. Only in exceptional cases, for example, when the pain is very sudden and very severe, is surgery directly recommended. Usually, the surgical procedure for a calcified shoulder is minimally invasive, i.e., through a tiny skin incision through which an arthroscope is inserted. This includes a small camera, with the help of which the surgeon can detect calcific deposits as well as any further damage to tendons or other joint components or the onset of arthrosis. During this operation, not only the disease-causing calcification but also surrounding tissue can be removed if it is inflamed. This is often one of the bursa of the shoulder (bursa subacromialis).

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Diagnosis of a calcified shoulder

The possibilities for diagnosing a calcified shoulder vary depending on how advanced the disease is at the time of the doctor’s visit. Often the diagnosis is even a chance diagnosis, which is made in the course of another examination, as it sometimes has a very long pain-free interval.

On the one hand, the exact anamnesis of the patient is important, i.e., the exact inquiry of the pain:

  • when
  • how often
  • to what extent
  • where
  • since when
  • in which way they occur above all.

It can help the doctor if the patient brings a pain diary to his appointment in which he has noted down exactly these points over several days. During the physical examination, the orthopaedist carries out various tests to check the range of motion of the shoulder joint and to show whether and to what extent a movement restriction has already developed.

In addition to the detailed questioning, imaging procedures are the most important pillar of the diagnosis of a calcified shoulder. Both ultrasound and X-rays allow any existing calcium deposits to be very clearly identified and precisely localized.

A magnetic resonance tomography of the shoulder (MRT) can also depict the calcifications but is not primarily performed due to the greater complexity and costs involved. It must always be kept in mind that the size and number of calcifications do not always necessarily correlate with the extent of the patient’s complaints. Furthermore, calcification is not so easily detected in MRI of the shoulder.

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Ultrasound

A calcified shoulder can be well visualized in ultrasound. Also, the sonographic examination is a fast, uncomplicated, and side-effect free method. The calcification appears as an echo, i.e., in the image bright structure, which may also cast typical shadows in the image. The deposit is usually found in the middle of the tendon.

MRI

In the MRT, a calcified shoulder can be seen using the thickened tendons and the calcified deposits in the tissue. However, due to better availability, a radiological examination is often performed. A sonographic examination (ultrasound) is also a good complement to X-ray and MRI. With sonography, the patient is not exposed to any radiation, which is an advantage over X-rays. Furthermore, an ultrasound machine is available in every medical facility, and the examination can be performed quickly and easily, which is a clear advantage over MRI.

Prophylaxis

Since it is not known exactly why a calcified shoulder develops, it is also difficult to prevent it. Since it is assumed that it often occurs in connection with mechanical overloading of the shoulder joint (especially during overhead activities), this type of stress should be kept as low as possible. Otherwise, unfortunately, not much can be done to protect against this disease.

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Does the diet affect a calcified shoulder?

The calcified shoulder (tendinosis calcarea) is indeed a calcification of the tissue. However, these are probably not directly caused by increased calcium consumption. Nutrition does not seem to have any influence on the development of the disease.

Nevertheless, inflammation-related symptoms can be alleviated by a healthy, balanced diet. In shoulder arthrosis, for example, it is suspected that a healthy diet low in meat (especially pork) improves the inflammatory state. Large amounts of eggs, butter, alcohol, and coffee should also be avoided. Certain vegetables and fruits as well as some herbs (aniseed, fennel, turmeric…), can have an anti-inflammatory effect. These recommendations are considered helpful in the case of shoulder arthrosis. Still, as inflammatory conditions also occur in the joint during tendinosis calcarea, symptoms may also be improved by a conscious diet.

Prognosis

The prognosis of a calcified shoulder can be classified as relatively good.

In many patients, the calcific deposits dissolve on their own without any treatment. For those in whom this does not happen, the disease can then usually be brought under control by one of the various treatment options or a combination of these. If a calcified shoulder has remained untreated for a long time, there is a risk that the tendon and thus the affected muscle will remain weakened permanently, which can sometimes lead to arthrosis in the further course of the disease. For this reason, one should not wait too long with therapy, even if spontaneous healing is not unlikely.

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Can a calcified shoulder dissolve on its own?

The calcified shoulder dissolves on its own in many cases. First, the lime crystals are absorbed by the body, and then the tissue is regenerated. In rare cases, a calcified shoulder remains so long that it has to be treated surgically.

Duration of a calcified shoulder

The course of the calcified shoulder varies individually, and the disease is divided into four stages.

A painless initial stage, during which there are changes in the joint, the phase of calcification, in which movement-dependent pain occurs, the phase of resorption, in which the pain is often most severe. This is followed by the phase of repair, in which the calcium deposits have already disappeared, and the body tries to restore the tissue.

Not all patients go through all phases. However, the calcified shoulder usually heals on its own after a few weeks or months. After an operation, you can expect to be spared for about 3-4 weeks.

Rehabilitation after surgery

Following an operation, the shoulder joint should be immobilized for about three weeks. Afterward, a longer period of physiotherapy is necessary to restore full mobility and freedom from pain.

How long are you on sick leave after surgery?

The length of time one is on sick leave after an operation for a calcified shoulder depends significantly on the individual stresses to which the patient is exposed. The surgery is often performed arthroscopically, but there is also a so-called needle lavage (Needling), in which lime crystals are first crushed and then sucked out. Depending on the course of the operation and the individual healing process, a rest period of about three weeks may be indicated. Patients who are exposed to heavy strain on the shoulder in their job may have to reckon with a somewhat longer period of absence.

Summary

The calcified shoulder is not a rare disease whose causes are not yet fully understood. The calcification, which is particularly common in the shoulder, is deposited on the tendon of the supraspinatus muscle, causing the tendon to swell and thus lead to a lack of space in the joint. Different structures can be irritated, to which they react with inflammation or scarring, resulting in pain and a restriction of the joint’s mobility. In many cases, the lime recedes without help from outside. If it does not, physiotherapy, extracorporeal shock wave therapy, or, if necessary, surgery can usually be used to remove all the calcium and thus cure the disease completely, as the risk of relapse is considered very low.

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