pathology: tendinosis calcarea – calcified shoulder

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Tendinosis calcarea / calcified shoulder

Definition

Degenerative changes are found in the shoulder girdle area, e.g. in the tendons, muscles or the bones involved. The tendons in the shoulder area are frequently affected, 80% of them in the supraspinatus, and there are calcium deposits. The peak age is 30-50 years, W > M. The calcified shoulder is divided into 4 phases:

  1. Transformation of tendon tissue to fibrocartilage, usually asymptomatic or mild symptoms
  2. Calcification: partial necrosis in the tendon tissue, calcification. Now recognizable in sonography, later also in X-ray. If the calcification wears off significantly, a subacromial impingement may develop
  3. Resorption: Dissolution of the calcium deposit in a violent inflammatory reaction, severe shoulder pain. If calcium gets into a bursa, bursitis develops.
  4. Repair: Recurrences possible. The sequence of the 4 stages does not have to be completed; the disease can remain in one stage.

Cause

  1. Reduced blood flow to the „rotator cuff“

Predisposing

  1. More frequent overhead work
  2. Volleyball, swimming, sports with repetitive overhead postures

Diagnosis

  1. Sono
  2. X-ray
  3. MRI to rule out DD

Symptoms

  1. Often gradual development of pain
  2. Sometimes sudden onset of pain with overhead and rotational movements of the arm
  3. Pain when lying on the affected side
  4. Exercise-induced pain
  5. with larger calcium deposits: permanent pain
  6. Pain due to overhead work
  7. Sudden shoulder pain without a recognizable trigger
  8. Apparent immobility of the shoulder (pseudoparalysis)
  9. Phase 1: asymptomatic or moderate shoulder pain
  10. Phase 2: possibly pain from subacromial impingement
  11. Phase 3: up to severe shoulder pain

Complications

  1. Prolonged resting posture or resting position can lead to periarthropathia humeroscapularis (frozen shoulder/painfulfrozen shoulder) due to tissue adhesions, e.g. due to reduced synovial fluid production
  2. Tendon ruptures due to damage to the tendons caused by the mechanical effect of the calcium. If therapy is started too late, there is a risk of iterated ruptures as a lot of tendon material is damaged
  3. Neck pain due to relieving posture and consecutive tension

Therapy

  1. Shock wave therapy
  2. OP if necessary
  3. Relief through orthosis
  4. Exercise training only after the symptoms have subsided
  5. Anti-inflammatory/analgesics
  6. Lidocaine injection
  7. Cryotherapy