New Hope for Shoulder Pain Caused by Calcific Tendonitis

The human body is uniquely designed to walk on two legs, and walking is our primary form of locomotion. In fact, when you walk, every joint in your body is activated, making walking an ideal form of exercise for anyone. But when you suffer from chronic low back pain, every step can be a challenge, sending pain signals along your central nervous system to your brain.

Many people subconsciously compensate for back pain by altering their gait to reduce force loads on the structures and nerves that cause the most pain. While this strategy may work in the short run, it can become a vicious cycle over time, creating gait abnormalities that cause more back pain.

Learn about gait fundamentals, the connection between low back pain and walking gait, and the benefits of 3D gait analysis.

Shoulder Rotator Cuff Mechanics

Due to the shoulder’s multiplanar range of motion, the glenohumeral joint relies on tendons, ligaments, muscles and bony structures to provide stability. Shoulder stability is achieved by dynamically balancing the forces acting at the shoulder at any given time, including muscle contractile forces, fascial tension and external forces.

Muscles of the rotator cuff are:

• The subscapularis: The largest of the four muscles, it is part of the posterior wall of the axilla (armpit). It prevents dislocation of the humerus and rotates the humerus inward. A large bursa protects it from rubbing against the neck of the scapula].
• The supraspinatus: The only muscle of the cuff that does not rotate the humerus, the supraspinatus passes above the glenohumeral joint to hold the humerus in place.
• The infraspinatus: A powerful muscle that rotates the humerus outward, its tendon is sometimes protected from the joint capsule by a bursa.
• The teres minor: A long, narrow muscle that is completely covered by the deltoid muscle, it functions as a stabilizer and a lateral (external) rotator.

The rotator cuff plays a key role in stabilizing the glenohumeral joint by compressing the head of the humerus (the ball) against the glenoid cavity (the socket). The tendons form a musculotendinous cuff around the front, back and top of the joint to keep the humerus from sliding out of place, allowing for full range of motion while at the same time providing stability.

The rotator cuff muscles also contribute to joint mobility by assisting in shoulder abduction, and medial and lateral rotation. The rotator cuff works in concert with a kinetic chain of 18 muscles that create a functional unit in the shoulder girdle complex. It works in conjunction with the deltoid muscle to balance the forces surrounding the glenohumeral joint

Rotator Cuff Tendon Calcification

Shoulder calcific tendinopathy is a painful condition caused by calcium deposits in the rotator cuff tendons. Symptoms include persistent shoulder pain and stiffness with reduced joint range of motion. The specific factors that trigger calcific tendinopathy are as yet unknown, although researchers speculate that biological and genetic factors, along with lifestyle behaviors, likely play a role.

In about 80% of cases, the supraspinatus tendon is the site of calcification, followed by the infraspinatus at15 %, and the subscapularis at 5 %. About 70% of calcific tendinopathy patients are female, leading some researchers to suspect a hormonal influence. According to one study, patients with type 2 diabetes have a 27% increased risk of developing shoulder calcific tendinopathy within eight years after being diagnosed with diabetes.

Tendon calcification takes place in three distinct stages:

1. 1. Precalcific stage: In this stage the tendon’s fibrocartilage becomes altered, possibly due to decreased oxygen tension in the tendon fibers. This stage is typically asymptomatic.
   2. Calcific stage: Calcification occurs in 3 phases – formative, resting, and resorptive.

1. • In the formative stage, patients may experience low-grade pain, especially at night.
   • In the resting phase, well-defined calcifications can be detected with ultrasound imaging.
   • In the resorptive phase, tendon vascularity increases and calcium deposits grow larger. Calcifications may migrate into adjacent tissues such as the bursae during this phase.
2. Repair stage: The tendon begins to remodel itself over time, with fibroblasts and collagen aligning along the tendon axis. This stage can take months or even years.

Diagnosis of Shoulder Calcific Tendinopathy

For decades, magnetic resonance imaging (MRI) has been the gold standard for diagnostic imaging. However, in addition to its inconvenience and expense, MRI has multiple disadvantages compared to high resolution diagnostic ultrasonography.

With ultrasound we can:

• Conduct on-site diagnosis in real time
• Visualize the body’s structures in motion
• Elicit patient feedback during the diagnostic process
• Follow the path of long bodies like muscles, fascia, bones and nerves
• Make a bilateral comparison between injured and uninjured tissues and joints
• Leverage sonoelastography to gauge tendon stiffness
• Use superb microvascular imaging (SMI) to detect signs of tendon healing
• Progressively monitor the success of treatment
• Confirm successful rehabilitation

Calcific Tendinopathy Treatment Approaches

Traditional treatment of calcific shoulder tendinopathy includes:

• Use of NSAIDs to manage pain and inflammation
• Corticosteroid injections
• Physical therapy to restore strength, stability and range of motion

However, conventional treatment approaches typically fall short of resolving the condition, and surgery should only be considered as a last resort after alternative treatment approaches have been exhausted.

New innovative approaches show greater promise for eliminating tendon calcification and restoring pain-free shoulder function, such as:

• Extracorporeal shockwave therapy (ESWT) to help break up calcium deposits, especially in the formative and resting phases.
• Ultrasound-guided needle lavage in the later stages of calcific tendinopathy, to break up deposits into smaller pieces and flush them out.

Ultrasound guidance of ESWT and needling procedures ensures that the therapies precisely impact the targeted tissues. Without ultrasound, such therapies can be inaccurate and less effective.

In addition, rehabilitation measures should address scapular dyskinesis, where the scapula’s position and range of motion is altered. Dyskinesis can arise from issues involving the shoulder itself, the cervical spine, and factors related to suboptimal posture. Scapular dyskinesis can cause subacromial impingement that contributes to shoulder pain.

Tips for Avoiding Shoulder Tendon Calcification

• Stay physically active. Sports like swimming and ballet that engage the shoulders through multiple planes of motion help to maintain balanced tension in the rotator cuff. Resistance training helps to strengthen the shoulder stabilizers.
• Guard against repetitive overuse of the shoulder rotators by allowing sufficient time for post-exercise recovery.
• Avoid sugars, grains and processed foods, to manage weight and avoid type 2 diabetes.
• Eat enough protein to support collagen synthesis, for healthy tendon remodeling.

• Stay hydrated by drinking ample amounts of plain spring water.
• Watch your posture! A slumped-forward posture can cause imbalanced tension in the rotator cuff and shoulder girdle muscles, contributing to shoulder pain.
• Be mindful of tension in your neck and shoulders, and take time to stretch and relax the muscles of the shoulder girdle and cervical spine.

Get Advanced Diagnosis and Treatment of Shoulder Calcific Tendinopathy in NYC

Your shoulder joints are designed to move freely through multiple planes of motion, without pain or restriction. Seeking early treatment at the first signs of shoulder tendinopathy can dramatically reduce your symptoms and shorten your recovery time.

At NYDNRehab, we use the highest-resolution diagnostic ultrasound to visualize your shoulder in motion, in real time. Diagnosis takes place on your very first visit, in the comfort of our clinic, so we can start the rehabilitation process right away.

Don’t let shoulder pain keep you from doing the things you love. Contact NYDNRehab today, and restore healthy shoulder function with holistic personalized calcific tendinopathy treatment that really works!

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