What is Rotator Cuff Calcification?

Rotator cuff calcification is the abnormal accumulation of calcium deposits in rotator cuff muscles and tendons. The rotator cuff is a group of 4 muscles and tendons in the shoulder joint that join the head of the humerus to the shoulder. It forms a sleeve around the humeral head and glenoid cavity, providing additional stability to the shoulder joint while enabling a wide range of mobility. Calcium accumulation in this region obstructs and limits the normal range of motion of your arm and causes significant shoulder pain and discomfort.

Rotator cuff calcification is one of the most common causes of shoulder pain. This condition most often affects people in the age group of 40 to 60 years, and women are more likely to be affected than men. It is also more common in individuals involved in overhead sports or workers whose job requires routine rising of arms up and down.

Causes of Rotator Cuff Calcification

Physicians are unsure what exactly causes rotator cuff calcification and why some individuals develop it and others do not. However, many physicians suspect it to be a result of:

• Abnormal cell growth
• Genetic predisposition
• Metabolic conditions, such as diabetes
• Abnormal thyroid activity
• Production of anti-inflammatory agents in the body

Signs and Symptoms of Rotator Cuff Calcification

Some of the common signs and symptoms of rotator cuff calcification include:

• Mild to moderate to severe pain
• Shoulder stiffness
• Loss of shoulder motion
• Difficulty in lifting arm
• Pain interfering with sleep
• Shoulder disability
• Difficulty with overhead activities

Diagnosis of Rotator Cuff Calcification

Your doctor will review your symptoms and medical history and perform a physical examination to check for range of motion, stability, flexibility, and strength of your shoulder. To confirm the diagnosis, your doctor will likely order imaging studies such as x-rays and ultrasound to look for calcium deposition, the site of build-up, and any other abnormalities. While x-ray can show larger deposits, ultrasound can reveal smaller deposits that the x-ray cannot pick up.

Treatment for Rotator Cuff Calcification

Treatment for rotator cuff calcification depends upon the severity of the condition and the size of the deposits and involves both conservative treatment measures as well as surgical options.

Conservative Treatment

• Medications: Use of analgesics and anti-inflammatory medications, such as naproxen and ibuprofen to control pain and inflammation
• Cortisone Injection: Injection of corticosteroid medication directly into the affected joint to relieve pain and swelling. Cortisone is a very effective anti-inflammatory medicine and long-term pain reliever.
• Extracorporeal shock-wave therapy (ESWT)/Radial shock-wave therapy (RSWT): Your physician will employ a small hand-held device to deliver mechanical shock waves on the affected area to break down the calcium deposits so that they are easily absorbed by the body.
• Therapeutic ultrasound: In this method, a handheld device is used to point high-frequency sound waves on the affected area to help break down calcium deposits.
• Lavage procedure: This involves insertion of two needles into the affected area to flush the calcium deposits with saline solution repeatedly to loosen them and aspirate the loosened deposits with a needle.
• Percutaneous needling: In this procedure, local anesthetic is used to numb the affected area and a needle is used to make multiple small holes on the skin to manually remove the calcium deposits.

Surgical Treatment

Arthroscopic surgery is the most preferred surgical option for the removal of accumulated calcium crystals in the rotator cuff. This is a minimally invasive surgery in which your surgeon will make 2 to 3 small key-hole incisions and insert an arthroscope (a flexible tube with a lighted camera) into the shoulder joint. Small miniature instruments are inserted through the other incisions and the camera images displayed on a monitor will guide the surgical instruments to remove the calcium deposits.

Recovery post surgery depends upon the location, size, and quantity of the calcium deposits and you may have very minimal pain and some activity restrictions, but most people can resume all of their normal activities within a week.