Calcific tendinitis

Disease name confirmation

• Disease name: Calcific tendinitis — This is the medically accepted term. The provided information (calcium deposits in the shoulder tendons → acute pain, calcific findings on X-ray, etc.) is consistent with standard findings.

1) Disease description (causes and symptoms)

• Causes and pathophysiology
  • This is a condition in which calcium (primarily hydroxyapatite) is deposited in a tendon, mainly a rotator cuff tendon, causing inflammation.
  • The exact cause is unknown, but factors such as low oxygen levels in the tendon, repeated compression and friction, and degenerative changes are known to be associated.
  • The calcification progresses through stages such as formation → resting → resorption (which may be accompanied by acute inflammation and severe pain).
• Main symptoms
  • Sudden, severe shoulder pain (which may radiate to the arm), tenderness, night pain, and limited shoulder movement (especially when raising or abducting the arm).
  • Localized tenderness is pronounced on palpation, and in severe cases, the person may be unable to sleep.
• Diagnostic findings
  • Diagnosis is straightforward when a calcific lesion in the tendon area is observed on a plain X-ray.
  • Ultrasound (US) is useful for identifying the location and size of the calcification and for ultrasound-guided procedures.
  • MRI is mainly used for differential diagnosis (rotator cuff tear, arthritis, etc.) or for evaluating complications.

2) Treatment methods

• Conservative treatment (first-line)
  • Rest, activity restriction (avoiding movements that cause pain), ice packs or heat therapy (ice during the acute phase), gradual range-of-motion (ROM) exercises, and physical therapy.
  • Medication: NSAIDs (nonsteroidal anti-inflammatory drugs) to control pain and inflammation. In some cases, short-term oral steroid use.
  • Corrective exercises and stretching to restore strength and mobility around the shoulder.
• Injection treatment
  • Ultrasound-guided steroid injection (mainly into the subacromial bursa or the painful area): effective for relieving acute pain, but does not remove the calcification.
• Procedural treatment
  • Ultrasound-guided barbotage (needle lavage): the calcification is dissolved and aspirated with a needle to relieve pain. It is relatively safe and can be repeated.
  • Extracorporeal shock wave therapy (ESWT): used to relieve symptoms and promote resorption of the calcification; effectiveness varies depending on individual cases and studies.
  • Arthroscopic calcification removal: considered when there is no response to conservative or minimally invasive procedures, or when persistent pain and functional impairment are severe.
• Precautions (related to treatment)
  • Steroid injections may help relieve pain, but repeated administration should be used cautiously because of the risk of tendon weakening.
  • Patients taking anticoagulants or with suspected infection should inform the medical staff before the procedure.
• Prognosis
  • The prognosis is generally favorable, and many cases improve or resolve with conservative treatment. In some cases, symptoms improve as the calcification is naturally resorbed. A small number of patients may require treatment for chronic pain and limited movement or surgical treatment.
• Complications
  • Persistent pain and limited movement (joint stiffness/frozen shoulder), rotator cuff damage/tear, infection or bleeding related to treatment (injections/procedures), and, rarely, recurrence.

3) Checklist before an outpatient visit (including items to bring · example questions)

• Items to bring
  • A list of currently used medications (including anticoagulants) and information about allergies (especially medication and latex allergies).
  • Previous shoulder imaging (if possible, X-ray, ultrasound, and MRI — CD or report).
  • Pain diary: when the pain occurs and its characteristics (e.g., night pain, radiating pain), movements that trigger it, pain intensity (1–10), and whether it interferes with daily life or sleep.
  • History of previous shoulder injuries or surgery, and chronic diseases (such as diabetes).
• Items useful to record in advance for the outpatient visit (including example questions)
  • When did the pain begin? (Sudden/gradual)
  • With which movements does the pain worsen?
  • Fever, redness, or systemic symptoms (whether infection is suspected)
  • Previous treatment for similar symptoms and its effectiveness

4) Examples of general questions to ask the doctor

• What are the expected effects and possible side effects of this medication (or injection)?
• What is the prognosis in my case? How long does recovery usually take?
• Which movements should I avoid, or which activities are recommended, in daily life (exercise, work, and driving)?
• What lifestyle habits or rehabilitation exercises do you recommend to prevent recurrence?

5) Examples of condition-specific questions

• Among ultrasound-guided barbotage, shock wave therapy (ESWT), and arthroscopic removal, which treatment is most suitable for my condition, and what are the advantages and disadvantages and expected recovery period for each treatment?
• Is this calcification likely to be naturally resorbed? (If it is resorbed, what changes in pain should be expected, and how long does it usually take?)

Additional information

• When to seek emergency care or visit a hospital immediately: when the pain suddenly becomes much worse and is accompanied by arm paralysis, severe sensory loss, fever, or symptoms of a wound, redness, or pus.
• Preventive recommendations: avoid shoulder overuse and repeated impact, perform regular stretching and rotator cuff strengthening, and prevent worsening through early medical evaluation when initial shoulder pain occurs.

If needed, please provide your symptoms (pain characteristics, duration, previous imaging results, etc.), and we will organize more specific questions for consultation and recommendations for tests/treatment.