Lime shoulder

The calcified shoulder refers to a continuous calf deposit in the shoulder joint.

Normally, these calcium deposits form above the arm, where the tendons of the rotator cuff attach, especially the supraspinatus tendon.

The size of these limescale deposits ranges from 2 – 3 millimeters to a few centimeters, depending on how long the lime has been deposited.

Calcification of the shoulder can be part of a natural inflammatory response to infections, trauma or athletic or occupational overuse of the joint.
In a bone fracture, the production and deposition of lime is part of the natural process of bone repair.

The calcium deposit becomes a problem when its position, shape or size impairs shoulder functions due to restricted movement or causes shoulder pain.

As a rule, the calcified shoulder occurs on the right side in right-handed people and on the left side in left-handers.

Causes of calcium deposits in the shoulder

The calcium deposits can be caused by inflammation or an increased calcium level in the blood (hypercalcemia).
Or they arise as a result of the healing process of a skeletal muscle injury.
The calcium deposits are often found along the rotator cuff tendons, especially where the tendon attaches to the bone.

What are the risk factors for the formation of limescale deposits?
Various risk factors can increase the likelihood of calcium deposit:

• overloading of the shoulder joint due to professional or sporting activities;
• Alcoholism;
• Autoimmune diseases;
• Some patients believe that diet is a cause, but dietary habits do not matter in this case;
• familial predisposition with regard to calcium metabolic disorders.

What are the symptoms of calcium deposits in the shoulder?

Limescale deposits often occur symptom-free and are discovered by chance during an X-ray examination.
Depending on where the calcium deposit has formed, it can restrict certain movements of the shoulder, cause pain and inflammation of soft tissue structures, such as muscles, tendons, joint capsule, bursae, etc. The pain caused by calcified shoulder is neither present at night nor at rest.

Only rarely is a nerve pinched by the deposits, causing pain in the arm and tingling in the hand.

Calcifying tendinitis

Calcifying tendinitis (tendinitis calcarea) is the storage of calcareous foci in a tendon; this happens mainly in the rotator cuff, but can also occur in the arm, elbow, hip and pelvic level.
The size of the lime deposit ranges from a few millimeters to about two centimeters.
These calcifications occur in patients from 30 – 40 years of age, diabetics are particularly affected.
Pathological calcium deposits in the fibrous tissue occur mainly in the shoulder joint and in the tendon plate of the sole of the foot.
Calcium deposits are not always painful and even if pain occurs, they usually disappear on their own over the course of 3 to 4 weeks.

Causes of calcifying tendinitis

The cause of calcium deposits in the tendons of the shoulder has not yet been determined with certainty.
There are different theories, such as lack of blood supply and signs of aging of the tendon, but the evidence for these claims is insufficient so far.
As a rule, the course of calcifying tendinitis is predictable and it can almost always be cured without surgery.

How is it created? Course of calcification
The typical phases of the disease are:

Cell conversion
There are no significant complaints. The cells undergo changes that make the tissue structures receptive to the formation of calcium deposits.

Calcification
In this phase, lime is shed by the cells, which is deposited. When this happens, the calcification of the shoulder does not seem to have a hard consistency, less hard than a bone, more like plaster.
With the calcium deposition in the shoulder, a resting phase begins, which is painless and lasts for different lengths of time. After the resting phase, the resorption or dissolution of the lime hearth begins; this is the most painful phase of calcifying tendinitis. The lime deposit is now increasingly loosened, it has a consistency like toothpaste.

Repair
As a rule, this phase, in which the calcium deposits disappear and are replaced by tendon tissue, is painless.
Usually, treatment begins in the calcification phase. Some patients learn that they suffer from impingement syndrome.

The diagnosis of a calcified shoulder is made by X-rays; it is also visible on an ultrasound, an anechoic spot is indicated.

What can be done? Treatments

Treatment of a calcified shoulder usually begins with a few simple measures, such as rest, ice packs, medication and physiotherapy (laser and ultrasound therapy).
If the symptoms do not subside, surgery may also be considered.
However, surgical intervention is not part of the standard treatment of calcium deposits.

Conservative (non-surgical) treatment is always a priority.
The treatment protocol is similar to that of impingement syndrome of the shoulder and includes:

Physiotherapy and physiotherapy
Movement and stretching exercises can prevent a stiff shoulder. One of the most unpleasant side effects of calcifying tendinitis is the pain-causing frozen shoulder. The exercises can help prevent this problem.

Anti-inflammatory drugs
Anti-inflammatory drugs from the group of nonsteroidal anti-inflammatory drugs can be used to treat the pain of the calcified shoulder. Studies could not show a significant change in symptoms in the long term, but patients felt better.
At the initial stage of calcification, the orthopedist may prescribe cortisone infiltration into the shoulder to relieve the pain and prevent surgery.

Moist heat packs
The application of moist heat has an analgesic effect. A warm cloth is the best way to warm the shoulder.

As already indicated, the symptoms can be kept under control by these measures in most cases until the cure has taken place.
The calcium deposit often remains, but the aim of the treatment is only to alleviate the symptoms, not to remove the calcium deposit; these disappear on their own over time.

When is surgery necessary?

Surgery is recommended in the following cases:

• If the symptomatology worsens despite treatment.
• When constant shoulder pain interferes with everyday activities (dressing, hairdressing).
• If the symptoms do not respond to conservative treatment.

The surgical treatment options are the suction of the calcium deposit or the removal of the calcified shoulder.
Suction is performed under sedation (sedative) or local anesthesia.
The surgeon inserts a large needle into the calcium deposit and tries to suck off the limescale. Then he injects a physiological saline, an anesthetic or a cortisone preparation into the calcium deposit.
Shortly after the procedure, patients can return to their usual everyday activities.

The clearing of the limescale deposit is a more complex procedure, but sometimes necessary, especially in chronic calcification. Through a small incision or shoulder arthroscopy, the calcium deposit is identified and removed.
This procedure is followed by follow-up treatment in the form of physiotherapy and rehabilitation to regain the strength and mobility of the shoulder concerned.

Are there any other methods of treating calcarea tendinitis?
In the last decade, various reports have confirmed the successful treatment of chronic calcifying tendinitis of the shoulder by shock waves. The high-energy ultrasound waves cause ‘microtrauma’ and stimulate the formation of new blood vessels in the affected region.
The majority of studies show that 50 – 70% of patients improve after two or three applications.
Shockwave therapy to treat calcifying tendinitis can be very painful, but the newer devices cause less discomfort.
This method of treatment entails few complications.

Contraindications of shockwave therapy are: pregnancy, malignant tumors and taking anti-coagulants for coagulation disorders (e.g. Coumadin).

• Inflammation of the shoulder tendon
• Lateral shoulder pain and arm pain
• Inflammation of the long biceps tendon of the shoulder