Some people deposit calcium crystals within the substance of their rotator cuff tendons, normally the supraspinatus tendon. This calcium is later reabsorbed and the tendon repairs itself. The resoprtive phase can be excruciatingly painful, often so bad that it stops patients from sleeping.
Calcium deposit in the Supraspinatus rotator cuff tendon - white arrow
Patients often report a rapid onset of pain, or an exacerbation of a previously grumbling pain. The pain is severe, often sharp, with an underlying deep ache. The pain is normally made worse by shoulder movement and it is felt felt deep within the shoulder and over the upper outer arm. It is characteristically worse at night, frequently causes difficulty sleeping.
This condition tends to affect 30-60 year olds and is more common in females. The reason why some of us deposit calcium in our tendons remains unclear - it is probably related to hormones or tendon degeneration. Calcium crystals are deposited in the rotator cuff tendon substance: this calcium later liquefies and is reabsorbed and this is what causes the pain
Rest, activity modification, painkillers and anti-inflammatories are the first step and you've probably tried these already.
The next option is a Subacromial (Cortisone) Steroid Injection with dry needling of the calcium deposits. This is done with you awake as an ultrasound-guided procedure (takes approximately10 min). A needle is passed in and out of the deposit to try to decompress the calcified cavity. Cortisone is injected into the inflamed overlying bursal space. This procedure has a 70% success at 6 months, and often gives rapid relief. There is very low risk of harm and the procedure is moderately uncomfortable.
Mr Granville-Chapman does not perform shock wave for Calcific tendinopathy, as the evidence suggests this is inferior to needling and injection: (Kim YS et al JSES 2014)
Surgery is indicated if needling and injection has failed to improve you pain. It is done as a keyhole technique under general anaesthesia +/- regional nerve block. After a standard arthroscopy of your joint, your subacromial space is entered and cleared of inflamed bursal tissue. This allows visualization of your rotator cuff tendons and identification of your calcium deposit. Once found, this deposit is de-roofed to allow the calcium to escape form the tendon. Often a decompression is performed at the sam time if there are signs of impingement.
Arthroscopic excision of calcium. Deposit identified within tendon substance of supraspinatus. 'toothpaste' or chalk-like calcified deposits excised from within tendon
You will normally go home the same day. Please begin taking painkillers straight away. You can remove bulky padding at 3 days, but leave your tiny wounds covered for 12 days. You may shower with dressings on after 4 days. Your sling can be discarded after a few days. Try to begin your rehabilitation shoulder as soon as you are able - the physiotherapist will advise you in this regard.
Patients vary in their recovery. The following timelines are for guidance only.
Driving – You must be confident and competent to handle a steering wheel for routine and emergency manoeuvres. This will take 4-6 weeks for most
Office work - 2 weeks, but you may still be sore at this point
Light manual work - 4-8 weeks
Heavy manual work - 8-12 weeks
Overall very good. This is generally a self-limiting condition. For those with severe symptoms, dry needling and cortisone injection is 70% effective. For those who go on to require an operation, over 80% are happy, but like a subacromial decompression, it can take several months to recover fully.
If you have developed stiffness or motion problems in the shoulder due to your calcific tendinopathy, physiotherapy may be needed after treatment
Shoulder arthroscopic surgery is very safe, but specific risks related to calcium excision include:
Rotator cuff tendon injury - the calcium deposits lie within your tendon. The tendon has to be opened from the top to excavate the calcium. If the deposit is very deep, this could potentially cause perforation of the tendon.
Stiffness (5%) - Occasionally patients develop a stiff shoulder (frozen shoulder) after calcific tendinopathy or the surgery to treat it. this sometimes requires treatment
Lack of benefit, failure of resolution - this is rare, but occasionally patients will still suffer with pain despite surgery. Remember that it can take several months for your shoulder to recover fully after surgery.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
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