Calcific Tendinitis Pain


Q: I've recently been diagnosed as suffereing from calcific tendinitis in my right shoulder. My GP got my shoulder x-rayed which shows there are large calcific deposits in the supraspinatus tendon on my right shoulder. I also have a large calcium deposit adjacent to my AC joint. It can be quite painful at night and disturbs my sleep. I'm taking 50 mg of Diclofenac Sodium tablets twice daily. My GP is referring me to a specialist in orthopaedic and rheumatology for treatment. Is it likely that the calcium is going through the resorption phase? Any thoughts would be useful.

Symptoms:  Please see above

A:   Hi.
Thanks for your and an elucidate history.
Noted your history of calcific tenditinits of supraspinatus and large calcium deposit adjacent to my AC joint, disturbing the sleep and Taking Diclofenac.

This is a peculiar disease wherein the calcium gets deposited in such areas and are not governed by the normal cycle of deposition and re-absorption.

Hence the only treatment is removal of such deposits as are causing the pain.
I would advise you to consult an Orthopedic Surgeon for proper counselling and further management, which is most probably surgery.
Diclofenac works here to reduce the edema and the associated pain.

I hope this answers your query and clears your doubts, please feel free to ask further queries if you feel that there is a gap of communication.

Comments / Follow Ups

Patient: Do you think ultrasound guided lavage/barbotage will work? My GP is referring me on to an Orthopedic Surgeon for treatment. However the soonest he can see me is November. Any advice on how I can manage the pain at night?
Doctor: I do not think that the ultrasound guided lavage/barbotage will work as the disease is in the tendon and tissues.

Does the appointment take so much time? (November)
Well, the ways the pain can be reduced are:
- Support the right elbow and forearm in sling in such way that the weight of the right upper limb is transferred to the left neck-shoulder area. This will help in a few ways:
By transferring the weight the right shoulder area will get relaxed to cause least possible wear and tear.
Give rest to the right shoulder area

Diclofenac can be taken three times a day. Take PPI like Omeprazole to avoid the possibility of gastritis.

Painkiller like tramadol or so under the prescription of your Doctor to be taken at bedtime.

Please discuss with your GP about a short course of oral steroids in tapering dosages if you are not diabetic.

All these measures together may give you a sound sleep.
Patient: Unfortunately November is the soonest the orthopedic surgeon will see me. I've been told I don't need to wear a sling.
Doctor: Please try the sling and I have given the explanation, let you try and please let me know. Apply properly to support the elbow which should be sufficient to transfer the weight of right upper limb.
Patient: My computer chair doesn't have elbow support. All other chairs in the house do
Patient: When I was talking to my GP the other day about the pain. I asked him would I need surgery for it. He was quite emphatic that I didn't need surgery. I presume he has seen the x-ray's himself. So it might be possible that some of the calcific deposits are reabsorbing into the tendon.
Doctor: Thanks for your feedback.
Calcium deposits can take years together for reabsorption.
Since you have symptoms, you need an active treatment.
Ultrasound guided lavage/barbotage needs a Specialist who had done this many times before to get you the proper results and ultimately the decision will depend upon the opinion, experience and expertise of the Orthopedic Surgeon.
Other treatments:
- Anti-inflammatory - you are already taking Diclofenac.
- Physiotherapy is very painful and helps in restoring the strength of the shoulder girdle muscles, does not help in cure of the disease.
- Steroid by oral route or local injection helps by reducing the inflammation and hence the pain too, does not help to get rid of the calcium deposits.
- Barbotage needs special experience and depends upon the factors we already discussed above.
Hence ultimate resort is the surgical excision.
I hope this answer helps you to take a proper decision in consultation with your Orthopedic Surgeon, Till then the conservative management needs to be followed as we have discussed above.
I can not really say why did you GP think so what he had said to you.
Patient: The orthopedic surgeon I'll be seeing is professor and he specialises in ultrasound guided needling of the joints and tendons. He is in charge of the orthopedic departments in 3 large hospitals here in my city.
Doctor: This is a great news, please try for an earlier appointment and get treated to get a cure.
Wishing you all the best.
Take care.
Patient: I will do my best to get an earlier appointment.
Doctor: I shall be happy to get the feedback from once you consult and get treated.
You can put the reference q ID 309965.

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