Calcific Tendonitis

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What is Calcific Tendonitis?

Calcific tendonitis is a condition that causes the formation of a small, usually about 1-2 centimeter size, calcium deposit within the tendons of the rotator cuff. These deposits are usually found in patients at least 30-40 years old, and have a higher incidence in diabetics. The calcium deposits are not always painful, and even when painful they will often spontaneously resolve after a period of 1-4 weeks.

What is the causes of Calcific Tendontis?

The cause of calcium deposits within the rotator cuff tendon is not entirely understood. Different ideas have been suggested, including blood supply and aging of the tendon, but the evidence to support these conclusions is not clear.

How does Calcific Tendonitis Progress?

Calcific tendonitis usually progresses predictably, and almost always resolves eventually without surgery. The typical course is:

  • Precalcification Stage
    Patients usually do not have any symptoms in this stage. At this point in time, the site where the calcifications tend to develop undergo cellular changes that predispose the tissues to developing calcium deposits.
  • Calcific Stage
    During this stage, the calcium is excreted from cells and then coalesces into calcium deposits. When seen, the calcium looks chalky, it is not a solid piece of bone. Once the calcification has formed, a so-called resting phase begins, this is not a painful period and may last a varied length of time. After the resting phase, a resorptive phase begins–this is the most painful phase of calcific tendonitis. During this resorptive phase, the calcium deposit looks something like toothpaste.
  • Postcalcific Stage
    This is usually a painless stage as the calcium deposit disappears and is replaced by more normal appearing rotator cuff tendon.

What are the treatment options available for Calcific Tendonitis?

Patients usually seek treatment during the painful resorptive phase of the calcific stage, but some patients have the deposits found incidentally as part of their evaluation impingement syndrome.

Nonoperative treatment is nearly always the first line of treatment for calcific tendonitis. The treatment protocol is similar to the treatment for impingement syndrome of the shoulder. This includes:

  • Physical Therapy/Exercises
    Exercises and stretching can help prevent a stiff shoulder. One of the most difficult problems associated with calcific tendonitis is the development of a frozen shoulder because of pain. Exercises can help prevent this problem from occurring.
  • Anti-Inflammatory Medications
    Anti-inflammatory medications can help treat the pain associated with the calcific tendonitis. No studies have shown a significant change in the time course of symptoms with these medications, but patients certainly have lessened symptoms.

When is surgery necessary?

Surgery is recommended in the following situations:

  • When symptoms continue to progress despite treatment
  • When constant pain interferes with routine activities (dressing, combing hair)
  • When symptoms do not respond to conservative care

Available treatment options include needling and aspiration of the calcium deposit and excision of the calcium deposit.

Needling is a procedure that is done under sedation or general anesthesia. Our surgeon will direct a large needle into the calcium deposit and attempt to aspirate, or suck out, as much of the calcium deposit as possible. Injections of saline, novocaine, is then performed into the calcium deposit. Patients can resume activity shortly after the procedure.

Excision of the deposit is a larger procedure, but may be necessary, especially is cases of chronic calcific tendonitis. Either through a small incision or through the use of shoulder arthroscopy, the calcium deposit is identified and removed. Physical therapy is usually necessary after this procedure to help regain strength and motion in the affected shoulder.

Are other treatments available for Calcific Tendonitis?

Over the last decade, several reports have shown successful treatment of chronic calcific tendonitis with the use of shockwave therapy. Shockwave therapy is thought to work by inducing so-called ‘microtrauma’ and stimulates blood flow to the affected area. Most reports on this method of treatment of calcific tendonitis show guarded success–perhaps 50-70% of patients improving after one or two high-energy shockwave treatments.

This treatment of calcific tendonitis can be painful, and usually requires anesthesia in order for it to be tolerated by the patient. The good news is that there is a very low complication rate from shockwave therapy. Most patients will develop a hematoma (bruising) from the treatment, but otherwise there are very few complications.

Get professional Opinion and Treatment about your Calcific Tendonitis. Effective and fast relief treatment by Experienced Shoulder Specialist. Call us +65 97731458 to schedule for an appointment.

Biceps Tendon Rupture

Get professional Opinion and Treatment about your Biceps Tendon Rupture. Non Invasive treatment by Experienced Orthopaedic Specialist Surgeon. Call us +65 97731458 to schedule for an appointment.

What is a biceps tendon rupture?

A biceps tendon rupture is an injury that occurs to the biceps tendon causing the attachment to separate from the bone. A normal biceps tendon is connected strongly to the bone. When the biceps tendon ruptures, this tendon is detached. Following a biceps tendon rupture, the muscle cannot pull on the bone, and certain movements may be weakened and painful.

There are two types of biceps tendon ruptures:

  • Proximal Biceps Tendon Ruptures
    A proximal biceps tendon rupture is an injury to the biceps tendon at the shoulder joint. This injury type is the most common type of biceps tendon injury. It is most common in patients over 60 years of age, and often causes minimal symptoms.
  • Distal Biceps Tendon Ruptures
    The distal biceps tendon is injured around the elbow joint. This is usually an injury that occurs with heavy lifting or sports in middle-aged men. Most patients with a distal biceps rupture will have surgery to repair the torn tendon.
  • Rupture of the proximal head of the biceps tendon involves one of two heads of the biceps tendon. This condition usually occurs in older individuals and is caused by degenerative changes within the biceps tendon leading to failure of the structure. Most patients have preceding shoulder pain consistent with impingement syndrome or a rotator cuff tear. The proximal biceps tendon rupture may then occur during a trivial activity, and some patients may experience some pain relief once the damaged tendon ruptures.The proximal biceps tendon can rupture in a younger patient with activities such as weight-lifting or throwing sports, but this is quite unusual.

What are the causes of Biceps Tendon Rupture?

Biceps ruptures generally occur in people who are between 40 and 60 years old. People in this age group who’ve had shoulder problems for a long time are at most risk. Often the biceps ruptures after a long history of shoulder pain from tendonitis (inflammation of the tendon) or problems with shoulder impingement. Shoulder impingement is a condition where the soft tissues between the ball of the upper arm and the top of the shoulder blade (acromion) get squeezed with arm motion.

Years of shoulder wear and tear begin to fray the biceps tendon. Eventually, the long head of the biceps weakens and becomes prone to tears or ruptures. Examination of the tissues within most torn or ruptured biceps tendons commonly shows signs of degeneration. Degeneration in a tendon causes a loss of the normal arrangement of the collagen fibers that join together to form the tendon. Some of the individual strands of the tendon become jumbled due to the degeneration, other fibers break, and the tendon loses strength.

A rupture of the biceps tendon can happen from a seemingly minor injury. When it happens for no apparent reason, the rupture is called nontraumatic.

Aging adults with rotator cuff tears also commonly have a biceps tendon rupture. When the rotator cuff is torn, the ball of the humerus is free to move too far up and forward in the shoulder socket and can impact the biceps tendon. The damage may begin to weaken the biceps tendon and cause it to eventually rupture.

What are the symptoms of a proximal biceps tendon rupture?
Usually patients will have sudden pain associated with an audible snap in the area of their shoulder. The pain is usually not significant, and, as mentioned previously, some patients may experience pain relief after the rupture. After the ruptured tendon retracts, patients may notice a bulge in their arm at the biceps muscle. This is the retracted muscle bunched up in the arm, and is sometime referred to as a “Popeye Muscle,” because the muscle is more pronounced than normal.

What is the treatment for a proximal biceps tendon rupture?
Patients usually do not notice any loss of arm or shoulder function following a proximal biceps tendon rupture. A slight bulge in the arm, and some twitching of the retracted muscle are usually the most significant symptoms. Surgical repair of the proximal biceps tendon is usually only considered in the case of a younger patient who is more active.

The reason there is little functional loss following a proximal biceps tendon rupture is that there are actually two tendinous attachments of the biceps at the shoulder joint (that is why the muscle is named “bi-ceps,” meaning two heads). When the rupture occurs at the distal biceps tendon at the elbow, where there is only one attachment, surgical repair is much more commonly needed.

If pain persists following a proximal biceps tendon rupture, other causes of shoulder pain should be considered. These include impingement syndrome (rotator cuff bursitis), rotator cuff tears, or fractures around the shoulder.

Rupture of the distal biceps tendon at the elbow joint is much less common and accounts for less than 5% of biceps tendon ruptures. This injury is also usually found in middle-aged patients, although not always. There is usually some degree of tendinosus, or degenerative changes within the tendon, that predisposes the patient to rupture of the tendon.

The significance of a distal biceps tendon rupture is that without surgical repair, patients who experience complete rupture of the distal biceps tendon will notice loss of strength at the elbow. The strength will affect both the ability to bend the elbow against resistance, and the ability to turn the forearm to the palm-up position against resistance (for example, turning a doorknob or screwdriver).

What are the symptoms of distal biceps tendon rupture?
Distal biceps tendon rupture is characterized by sudden pain over the front of the elbow after a forceful effort against a flexed elbow. Usually the patient will hear a snap and have pain where the tendon rupture occurs. Swelling and bruising around the elbow are also common symptoms of distal biceps tendon rupture.

What is the treatment of distal biceps tendon rupture?
Most patients will experience benefit if the biceps tendon is repaired surgically. If the tear is incomplete, or if the patient is very low-demand (not active), then surgery may not be needed. However, most patients who want more normal use of their arm will benefit from surgery to repair the ruptured tendon to the bone.

Get professional Opinion and Treatment about your Biceps Tendon Rupture. Non Invasive treatment by Experienced Orthopaedic Specialist Surgeon. Call us +65 97731458 to schedule for an appointment.

Shoulder pain

Dr Ambrose Yung Knee, Sports and Orthopaedic Centre Knee, Sports and Orthopaedic Clinic

Stop your Shoulder Pain today. Effective Treatment, Non Surgery. Discuss with our Shoulder Specialist for the Diagnosis, Treatment and Prognosis of your Shoulder Pain. Call us +65 97731458 to schedule for an appointment.

Shoulder pain are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. The injuries to the shoulder can, and do, cause a lot of pain. Usually the pain is related to a particular function or task but often times the pain becomes more prevalent throughout the day.

What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm from scratching your back to throwing the perfect pitch.

Mobility has its price, however. It may lead to increasing problems with instability or impingement of the soft tissue or bony structures in your shoulder, resulting in pain. You may feel pain only when you move your shoulder, or all of the time. The pain may be temporary or it may continue and require medical diagnosis and treatment.

This article explains some of the common causes of shoulder pain, as well as some general treatment options. Our doctor can give you more detailed information about your shoulder pain.

Some common Shoulder Pain conditions include:

  • BURSITIS / ROTATOR CUFF TENDONITIS – Rotator cuff tendonitis is an inflammation (irritation and swelling) of the tendons of the shoulder.
  • ROTATOR CUFF TEAR – The rotator cuff is made up of four muscles that help move and stabilize the shoulder joint. Damage to any one of the four muscles or their ligaments that attach the muscle to bone can occur because of acute injury, chronic overuse, or gradual aging.
  • FROZEN SHOULDER – is a condition that causes restriction of motion in the shoulder joint. The cause of a frozen shoulder is not well understood, but it often occurs for no known reason.
  • CALCIFIC TENDONITIS – Calcific tendonitis is a condition that causes the formation of a small, usually about 1-2 centimeter size, calcium deposit within the tendons of the rotator cuff.
  • SHOULDER INSTABILITY / DISLOCATION – Shoulder instability is a problem that occurs when the structures that surround the glenohumeral (shoulder) joint do not work to maintain the ball within its socket.
  • LABRAL TEAR – The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable.
  • SLAP LESION – A SLAP tear is an injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable.
  • ARTHRITIS – Osteoarthritis is the most common type of shoulder arthritis. Also called wear-and-tear arthritis or degenerative joint disease, osteoarthritis is characterized by progressive wearing away of the cartilage of the joint.
  • BICEPS TENDON RUPTURE – A biceps tendon rupture is an injury that occurs to the biceps tendon causing the attachment to separate from the bone. A normal biceps tendon is connected strongly to the bone.

When do you need to call us about your shoulder pain?
If you are unsure of the cause of your shoulder pain, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of these conditions must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:

  • Inability to carry objects or use the arm
  • Injury that causes deformity of the joint
  • Shoulder pain that occurs at night or while resting
  • Shoulder pain that persists beyond a few days
  • Inability to raise the arm
  • Swelling or significant bruising around the joint or arm
  • Signs of an infection, including fever, redness, warmth
  • Any other unusual symptom

What are the best treatments for shoulder pain?
The treatment of shoulder pain depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment.

Stop your Shoulder Pain today. Effective Treatment, Non Surgery. Discuss with our Shoulder Specialist for the Diagnosis, Treatment and Prognosis of your Shoulder Pain. Call us +65 97731458 to schedule for an appointment.