I could not lift my arm and was
in severe pain!
Several weeks ago I woke up with my
right shoulder feeling tight and achy. I thought back to the previous
day’s activities and could not determine any movements out of the
ordinary. I recalled working with my morning clients, going home to
labor over my computer, and then off to work with my afternoon clients
followed by a short evening run with my husband. The only thing I could
contribute to the tenderness was the pull-ups I demonstrated for my
morning client. However, I perform pull-ups regularly and did not experience
an acute injury. Shrugging it off, I went about my day. As the day progressed,
the pain and stiffness become severe and as the weekend progressed,
I lost strength and range of motion in my shoulder. The pain seemed
to encompassed the entire rotator cuff and down my biceps tendon. I
could not lift my arm, was in severe pain, and knew something was not
right. After a visit to the doctor, the x-ray came back to reveal Calcific
Tendonitis.
Diagnosis: Calcific Tendonitis
– What is it?
Calcific Tendonitis is inflammation
caused by calcium deposits, and come to find out, is verily common in
middle-aged (30-40 years) adults. The syndrome can present as
chronic recurring symptoms of pain and disability of varying severity
or an acute on set of severe pain and tenderness. The calcification
can be seen on an x-ray and the most frequent location is the shoulder,
commonly the rotator cuff. Additional locations include the hip, elbow,
wrist, and knee, and may also present in the hands, ankles and feet.
The syndrome is not always painful
or symptomatic. In fact, many people are not even aware they have calcium
deposits until an acute inflammatory response occurs. There are three
stages associated with calcific tendonitis. Stage I usually resolves
within 1-4 weeks. The subsequent stages represent progressive deterioration
of the tissues and may result in tendon tears and occasionally produce
erosion of the bone immediately beneath the insertion of the tendon
involved.
Treatment
Acute calcific tendonitis usually resolves
itself, however anti-inflammatory medication and ice therapy can reduce
both pain and inflammation. As soon as possible, range of motion exercises
should be introduced to help prevent frozen shoulder or loss of mobility
in other joint locations. Additionally, rehabilitation exercises can
be used to improve joint strength and stability. Other treatments that
may shorten the duration of the symptoms include, local cortisone injections
to relieve inflammation, and needle aspiration to relieve pressure on
the tendon. The majority of people do not require surgery. However,
in the case of frequently reoccurring attacks and decreased joint mobility,
surgery can remove the deposits and provide relieve.
How does Calcific Tendonitis Develop?
The exact pathogenesis of calcific
tendonitis is not clear and remains controversial. Several events
have been suggested, such as ischemia (lack of blood supply), trauma,
and genetic and metabolic factors. What is known is that excess calcium
in the diet is not a factor. In fact, restricting dietary calcium will
result in our bodies leaching calcium from our bones causing bone weakness
and subsequent disease. Age does seem to be a factor, as the syndrome
is rarely seen in people under the age of thirty. Physical activity
does not seem to be a factor since then syndrome has been diagnosed
in both sedentary individuals and athletes.
Take Home Message
Until my experience I was not aware
of the syndrome. Interestingly, my primary care physician indicated
that I would never perform pull-ups again and was doomed to progressive
joint deterioration. After several discussions with a sports medicine
radiologist and physical therapists, I had another perspective. Although
the potential for continued degeneration is present, by creating a healthier
shoulder joint through physiotherapy, adequate rest for recovery, and
anti-inflammatory therapies when needed, I should be able to successfully
continue with my workouts and active lifestyle. If the condition does
becomes persistent and debilitating, surgical options are available
and I understand have been very successful.
Karen Moreno, MA Candidacy Kinesiology/Exercise
Physiology
BA Social Science/Education
Co-Founder Fitness In Action
Cluett, J. Calcific Tendonitis: What
is calcific tendonitis? About.com June 20, 2006. Retrieved June 23,
2009, from
http://orthopedics.about.com/od/rotatorcuff/a/calcific.html
Hayes, C.W., & Conway, W. F. (1990)
Calcium Hydroxyapatite Deposition Disease.
RadioGraphics,
10(6), 1031-1048.
Shoulder Pain Management (2006-2009).
Calcific tendonitis. Retrieved June 23,
2009,
from
http://www.shoulder-pain-management.com/CalcificTendonitis.html
Recent Comments