Shoulder calcification, a cause of shoulder pain.

Shoulder calcification refers to a calcification that forms in the rotator cuff tendon at the insertion on the humeral head. This is a very common cause of shoulder pain that can be severe in some cases.

These patients presents with shoulder pain that starts out of the blue, usually mild at night getting progressively worse.

Rotator cuff calcifications can be grouped in two clear groups.

In the first group the patients have shoulder pain and typically they can’t lift the arm up to reach to the ceiling. They also find it difficult to reach behind the back. They also have night pain. This group has a calcification that has a grainy appearance and can be scraped out with spoon like sea sand.

The other form of calcifying tendonitis presents as an acutely painful shoulder with severe pain. This is in some cases a medical emergency as the pain can be so severe that the patient needs urgent attention usually in the form of arthroscopic surgery. ( Keyhole surgery). In these cases the shoulder calcification is removed. The reason for the pain is probably that the rotator calcification softens and start leaking into the surrounding tissue and causes a severe inflammation.

The less recognised group are those in the early stage and can only be seen on x ray as a very fine almost not visable area. This group can only be diagnosed on suspision and should not be operated as it cant be removed. This should be treated will shoulder rehab exercises and other conservative measures.

Treatment is usually very successful, either conservatively or with arthroscopic shoulder surgery.

The reason why the calcification developes is unknown but the most common assumption is that it forms secondary to a piece of the tendon that dies of because of bad blood supply in the area right where the rotor cuff inserts on to the humerus. This necrotic area then calcifies. Other theories suggests that it might be secondary to small tears that happens in the cuff or even secondary to impingement. Whatever the case may be this can lead to severe Shoulder pain and can end in being operated using arthroscopic shoulder surgery or keyhole surgery.Usually one would try conservative treatment first,like shoulder rehab exercises, fisio therapy, cortisone injections and medicines like anti inflammatory drugs.

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