By: Jonathan Fenton, MD, FRCS, Celina Dunn, MD, CCFP, CIME
Updates from WorkSafeBC
Issue: BCMJ,
vol. 50, No. 2, March 2008,
Page 65 WorkSafeBC
Diagnosis and treatment of calcific tendonitis
Calcific tendonitis is a condition of calcium deposits within the rotator cuff tendons. The name is a misnomer because calcium, while appearing on an X-ray, may not necessarily be associated with the tendonitis. The deposit may be an incidental finding in an asymptomatic shoulder joint or, although present on an X-ray, may not be the cause of shoulder symptoms. Rarely are these calcium deposits the cause of acute shoulder pain.
The calcium is most commonly found 1 to 2 cm from the insertion of the supraspinatus tendon and, less frequently, in the other rotator cuff tendons.
Calcific tendonitis is seen in 2% to 3% of adults aged 30 to 50, most commonly in females. The condition is not associated with heavy-duty activities.
Cause
The cause of calcific tendonitis is unknown and not due to degenerative changes. The condition is seen in adults with no history of trauma, and is not associated with tendon tears. If present, calcific tendonitis does not usually affect shoulder function.
Diagnosis
Do not assume that calcific tendonitis is the cause of the complaint until all other causes have been ruled out. First, look for other causes. Local ones may include impingement, frozen shoulder, or osteoarthritis of the shoulder or acromioclavicular joint. Remote causes include referred pain from the diaphragm. X-ray appearance of chronic calcific tendonitis is usually well defined with a sharp outline, while in the acute stage it appears “fluffy,” with an outline that is sometimes indistinct. The latter is associated with acute shoulder pain.
Treatment
Treat the other causes appropriately. For strains, tendinopathy, and/or impingement, an active physiotherapy plan is recommended for at least eight weeks. If there is acute inflammation of the deposit, treat with rest, analgesics, and nonsteroidal anti-inflammatory drugs. If pain from calcific tendonitis persists, evacuation of the calcium—by needling under local anesthetic or by surgical incision—may be necessary to provide relief. The application of ultrasound can also be beneficial, but will not provide the immediate relief that comes from evacuation of the deposit.
—Jonathan Fenton, MBBS, RCPSC
WorkSafeBC Orthopaedic Consultant
Practice-based small group learning sessions
The Foundation for Medical Practice Education, a nonprofit national organization that provides practice-based learning programs, offers two practice-based small group learning sessions that WorkSafeBC will sponsor for groups of 7 to 10 physicians at a location of your choice. The two topics are Approaches to Adult Low Back Pain and Work-related Asthma. Each of these 1.5-hour sessions is accredited for 1.5 Mainpro-C credits (=3 Mainpro-M1 credits).
The foundation provides case studies, discussion materials, and a facilitator for the sessions. If possible, a WorkSafeBC medical advisor with expertise on the subject will also attend. If you and a group of other physicians would like to take advantage of these accredited learning opportunities, please contact WorkSafeBC Manager of Medical Services, Celina Dunn, MD, at 604 232-5825 or toll free 1 888 967-5377, extension 5825.
New WorkSafeBC chief medical officer
In January 2008, Peter Rothfels, BEd, MD, ASAM, was appointed WorkSafeBC director of clinical services and chief medical officer. Dr Rothfels joined WorkSafeBC as a medical advisor in 2002 and more recently was senior medical advisor for Vancouver Island, Nelson, Terrace, and Abbotsford. Dr Rothfels and his Clinical Services team are committed to supporting BC’s physicians in providing quality health care services to their injured worker patients.
—Celina Dunn, MD, CCFP
WorkSafeBC Manager, Medical Services