The calcareous shoulder

Synonyms

Tendinosis calcarea, Tendinitis calcarea

definition

A lime shoulder is a shoulder in which lime has deposited.
This happens most often in the area of ​​the tendon of the supraspinatus muscle, but in principle it can also affect any other tendon of the shoulder muscles. The result is an inflammatory process in the shoulder joint, which sometimes leads to severe pain.

Epidemiology

The typical point in time at which a calcareous shoulder becomes noticeable is between the ages of 35 and 50, although it is difficult to say when it actually developed, as symptoms do not appear in many patients until a few years after the onset of the disease.
Women are affected somewhat more often than men on average.

causes

There are different causes that can be considered for a calcareous shoulder. These include on the one hand external influences such as:

  • Excessive mechanical stress (for example in certain sports or other work that places heavy strain on the shoulder in everyday life and / or at work)
  • Accidents or falls
  • Tears in one of the shoulder tendons
  • but also the body's own processes such as weak tissue blood flow or
  • degenerative processes in the context of aging processes

Appointment with a shoulder specialist

I would be happy to advise you!

Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of Dr. Gumpert.

The shoulder joint is one of the most complicated joints in the human body.

The treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) therefore requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

  • Lumedis - your orthopedic surgeon
    Kaiserstrasse 14
    60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
You can find more information about myself at Carmen Heinz.

Are there psychological causes for the development of a calcareous shoulder?

The psyche plays an important role in the development of many diseases. The shoulder movement can also be restricted by the psyche through poor posture. Limescale deposits caused by the psyche are unlikely, however. Pain symptoms can, however, be aggravated by psychological problems.

How is the calcareous shoulder created?

The process that can result from all of these different causes is ultimately the same:
The tissue in the corresponding area is not supplied with sufficient blood. This transforms the tendon's tissue into fiber cartilage. Later, when this fiber cartilage dies, it can happen that lime is deposited in this place. If this "calcification" is pronounced, the tendon swells and can press on surrounding structures, such as bursa or tendons of the surrounding muscles, which ultimately leads to inflammation and ultimately to pain. This swelling can also lead to a lack of space within the joint and thus to a collision of its components, which is known as an impingement syndrome, which is almost always associated with a calcified shoulder.

Sometimes, however, it also happens that the body resorbs the calcium focus by itself, the calcium deposit dissolves and disappears again unnoticed. Because of the relatively high spontaneous healing rate of this disease, it is also so important to always carefully weigh the treatment options. However, why calcifications form in people and not in others with a roughly comparable risk profile has not yet been fully clarified.

Symptoms

The main symptom of a calcareous shoulder is (sometimes very severe) pain.
These occur primarily during movements that involve the muscle of the affected tendon. Since this is usually the supraspinatus tendon, most patients with a calcified shoulder experience particular pain when the arm is moved over the head or outwards / backwards, as the supraspinatus muscle plays an important role in these movements. The pain often has a stabbing character and can radiate into the neck or the wider arm. There is also typically pain on the affected side when sleeping at night. This pain is usually accompanied by more or less pronounced restrictions on movement of the shoulder joint. In the worst case, paralysis of the entire arm can develop.

It happens that symptoms develop slowly over a longer period of time, become steadily worse or at some point go away on their own, and that severe pain suddenly appears without any recognizable acute trigger.

Read more on the topic: Inflammation of the shoulder blade

Pain in the upper arm

With a calcareous shoulder, the pain initially occurs directly in the shoulder joint, especially when working overhead or with heavy loads, but over time pain also occurs in the upper arm. On the one hand, this can happen through the calcification of the biceps, which also pass through the shoulder joint; on the other hand, compensatory overloading of the upper arm muscles can occur if the rotator cuff is more and more restricted in its strength by the calcium deposits.

Pain at night

Those affected suffer from shoulder pain, especially at night, especially when they are lying on the affected shoulder. The pressure on the joint leads to increased pain, blood circulation is also impaired and the symptoms can worsen.

In the case of bursitis associated with the calcareous shoulder, pulsating pain can also occur at night, regardless of the lying position.

Read more on the topic: Bursitis of the shoulder

Acute phase of the calcareous shoulder

The acute phase of a calcified shoulder is to be expected after the actual calcification phase. When the body begins to dissolve the calcium deposits, an immune reaction begins in which cells leak into the tissue and break down the calcium deposits. This releases inflammation mediators and leads to severe pain, warming, redness, swelling and functional impairment of the shoulder. The processes can also inflame surrounding structures, such as the bursa.

therapy

There are various options for treating a calcified shoulder, which should be discussed jointly by patient and doctor. Different treatment plans should be used depending on the stage of the disease and the individual suffering.

As a rule, conservative therapy is started, so an attempt is first made to avoid surgery. In the following you will find an overview of possible therapy methods.

  • Physical therapy (physiotherapy),
  • Muscle strengthening exercises
  • conservative therapy with cortisone
  • Cold therapy
  • Heat therapy
  • radiotherapy
  • Shock wave therapy
  • Needling
  • X-ray depth irradiation
  • Osteopathy
  • homeopathy
  • acupuncture
  • Therapy with home remedies
  • surgery

Wearing a splint can also help relieve the shoulder. For many of those affected, these simple methods are already very successful. Otherwise you can work with painkillers and / or narcotics, which are either administered in tablet form or can be injected directly into the corresponding tissue.

Helpful muscle exercises

A calcareous shoulder manifests itself in severe movement-dependent pain. The calcium deposits in the tendons painfully restrict the movement of the joint. Exercise can therefore be difficult to perform because it can cause joint pain. There are gentle stretching exercises that stretch the tendons and muscles slowly and gently and ensure more flexibility in the joint. Careful mobilization can also relieve pain and improve movement. The movements should be relaxed and pain-free. If there is pain, consideration should be given and the exercise should be interrupted. Large sweeping movements are ideal for mobilization. However, it can only begin with a small range of motion and then slowly increase the movement. Strengthening the rotator cuff can also help reduce the symptoms of the calcified shoulder. In order not to put additional strain on the tissue, static holding exercises are available to improve strength; this is known as isometric strength training.

Read on about this: Which exercises help with a calcified shoulder?

physical therapy

Physiotherapy is very important in conservative therapy of the calcified shoulder. Depending on the stage of the disease, intensive exercises and techniques are used to improve or maintain the mobility of the shoulder and to counteract muscle breakdown. This also stimulates the blood circulation, which can accelerate the breakdown of the lime crystals. However, the crystals cannot be eliminated directly through physiotherapy.

Cortisone injection

Cortisone is a pain reliever and anti-inflammatory drug that is often used for joint pain. This is also the case with the calcareous shoulder when severe pain cannot be treated, or cannot be treated sufficiently, with drug therapy. Cortisone can be injected directly into the joint, but it should be borne in mind that cortisone can have a damaging effect on ligaments and cartilage and should therefore only be used in precisely dosed quantities if there is an appropriate indication.

Read more on the topic: Cortisone injection - areas of application and side effects

radiotherapy

Radiation therapy can make sense when pain occurs for the first time. However, it is only promising in the early phase of the disease. Radiation therapy is low-dose and is considered to have few side effects.

With radiation therapy, rays are thrown into the tissue, which serve to break up the calcium deposits. The lime fragments that arise here can be transported away more easily. In addition, a new inflammatory reaction occurs, which leads to increased blood flow. More immune cells reach the shoulder and the breakdown of existing calcium deposits is improved. Radiation therapy, however, increases the risk of secondary tumors, even if only very slightly, and should therefore be discussed primarily with young people affected. Radiation therapy is an IGeL service, so it must be borne by the person concerned.

Shock wave therapy

The best known is probably extracorporeal shock wave therapy (ESWT). This has only been used for about 10 years, but shows a very good success rate.
Shock waves are short, high-energy waves that only discharge their energy when they hit solid tissue. In this special case, the skin and muscles are simply penetrated, while the calcium deposit is then hit by all the energy. The shock waves are focused on the painful area with the help of a pillow filled with water, penetrate as far as the calcification and break the calcium into tiny particles, which can then be absorbed by the body. In addition, the shock wave therapy stimulates the blood flow in the tissue, which also ensures that the body's own healing process is promoted. Normally, this therapy can be carried out on an outpatient basis, so the patient does not have to be admitted to the hospital and can go home immediately after the session. Pain during this treatment is minimal and the side effects, such as bruising or swelling, are very rare when used properly.

How often ESWT has to be repeated depends heavily on the severity of the disease. For many, however, it amounts to three appointments. If there is still no success after three months, it usually makes sense to discontinue the treatment and still perform an operation.
The success rates for shock wave therapy are around 40-70%.

However, shock wave therapy is an IGeL service. In other words, a service that is not covered by health insurance and has to be borne by the patient himself.

Read more about the topic here: Shock wave therapy for a calcareous shoulder

Home remedies

In addition to drug therapy and immobilization, home remedies are often used to alleviate the symptoms associated with a calcified shoulder. Apple cider vinegar, heat applications using hot water bottles or grain pillows or massages are popular. Other home remedies include bitter salt baths, ginger and turmeric. These substances are said to have a muscle-relaxing or anti-inflammatory effect and they are said to help with the calcified shoulder.

Does a treatment with apple cider vinegar make sense?

Therapy with apple cider vinegar is in no way a substitute for conventional medical diagnosis and treatment. However, it can be used alongside. In addition to some valuable electrolytes, apple cider vinegar contains so-called pectin (from the apple peel), which is said to have a medicinal effect. Apple cider vinegar is best taken mornings and evenings, diluted slightly with water. Allegedly, existing limescale deposits should be reduced and the appearance of new ones should be prevented. Everyone should decide for themselves whether or not the therapy with apple cider vinegar will help. There are usually no side effects.

Should you cool or warm a lime shoulder?

Basically, you should test individually whether warm or cold is good for you. As a rule, warmth is perceived as pleasant. It ensures an increase in blood flow and relaxation of the muscles. In acute stages of inflammation, e.g. however, heat is contraindicated in bursitis. Then the joint should rather be cooled.Most of the time, however, the patient himself feels what is good for him.

Osteopathy

Osteopaths can treat a calcified shoulder. They can deal with joint problems and treat them specifically using appropriate techniques, but they can also look at and treat the organism holistically. Fascia therapy is often used. In the calcareous shoulder, the immobilization of the joint can cause the connective tissue to stick together, which then leads to problems in other areas of the body, e.g. the neck. Such problems can be treated by an osteopath.

homeopathy

Homeopathy can be used to support medical therapy for a calcified shoulder. There are a large number of preparations that are used for pain and musculoskeletal problems. Let your doctor or alternative practitioner advise you.
Calcium phosphoricum, Rus toxicodendron and Bryonia alba are some preparations that can be used. Since homeopathy strongly depends on the individual type, an exact dosage and the selection of the preparation should be made by a specialist in order to achieve the greatest possible treatment success.

Does acupuncture help?

Acupuncture is performed by appropriately trained doctors or alternative practitioners and can relieve pain, especially in acute painful conditions. The needles are located in the appropriate place and sometimes remain in the tissue for a few days. This should stimulate the flow of energy in the treatment area, support removal and promote blood circulation.

Whether the battery pack is successful depends heavily on the individual.

When does an operation make sense?

Surgery is rarely an option for a calcified shoulder. As a rule, the disease heals on its own after a while. This is the reason why one often waits a long time before an invasive procedure. Indications for an operation are persistent severe pain that does not improve even after conservative therapy, or particularly large and firm calcifications in the shoulder are often the reason to initiate an operation. In most cases, however, no surgical treatment is necessary.

surgery

In the treatment of a calcareous shoulder, the operation is almost always the last resort when everything else could not reduce the symptoms, or only inadequately. The operation is only recommended in exceptional cases, for example if the pain occurs very suddenly and very severely. The surgical procedure for a calcareous shoulder is normally minimally invasive, i.e. through a very small incision through which an arthroscope is inserted. This includes a small camera with which the surgeon can recognize both the calcium deposits and any other damage to tendons or other joint components or the onset of osteoarthritis. As part of this operation, not only the calcium focus causing the disease, but also the surrounding tissue can be removed if it is inflamed. Often it is one of the shoulder bursa (bursa subacromialis).

You can find much more information under our topic: Operation of a calcareous shoulder

Diagnosis of a calcified shoulder

The possibilities for diagnosing a calcified shoulder vary depending on how advanced the disease is at the time of the doctor's visit. Often the diagnosis is even a chance diagnosis that is made during another examination, as it sometimes has a very long painless interval.

On the one hand, the patient's exact anamnesis is important, i.e. the exact inquiry into the pain:

  • when
  • how often
  • how strong
  • Where
  • since when
  • in which way they mainly occur.

It can help the doctor if the patient brings a pain diary to his appointment in which he has noted these points over several days. During the physical examination, the orthopedic surgeon performs various tests that are intended to check the range of motion of the shoulder joint and to show whether and to what extent a movement restriction has already developed.

In addition to the detailed questioning, imaging methods represent the most important pillar of the diagnosis for a calcified shoulder. Both the ultrasound and the X-ray image can be used to identify and precisely localize any calcium deposits that may be present.
Magnetic resonance imaging of the shoulder (MRI) can also show the calcifications, but is not primarily performed due to the greater effort and expense. One must always keep in mind that the size and number of calcareous deposits do not always necessarily correlate with the extent of the patient's complaints. Furthermore, calcium is not so easy to see in magnetic resonance imaging of the shoulder.

Ultrasonic

A calcareous shoulder can be shown well in the ultrasound. In addition, the sonographic examination is a fast, uncomplicated and side-effect-free method. The calcium deposit appears as an echo-rich, i.e. light structure in the image, which may also cast typical shadows in the image. The deposit is mostly found in the middle of the tendon.

MRI

On the MRI, you can see a calcified shoulder based on the thickened tendons and the calcium deposits in the tissue. However, because of the better availability, a radiological examination is often carried out. A sonographic examination (ultrasound) is also a good addition to X-rays and MRI. With Sono, the patient is not exposed to any radiation, which is an advantage compared to X-rays, an ultrasound device is also available in every medical facility and the examination can be carried out quickly and easily, which is a clear advantage over MRI.

prophylaxis

Since you don't know exactly why a calcareous shoulder occurs, it is also difficult to prevent it. Since it is assumed that it often arises in connection with mechanical overloading of the shoulder joint (especially when working overhead), this type of stress should be kept as low as possible. Otherwise, unfortunately, there is not much you can do to protect yourself from this disease.

Does the diet affect a calcareous shoulder?

The calcareous shoulder (Tendinosis calcarea) is actually a calcium deposit in the tissue. However, these are probably not directly related to increased calcium consumption. Diet does not seem to have any influence on the development of the disease.

Nevertheless, inflammation-related symptoms can possibly be alleviated through a healthy, balanced diet. At least in the case of shoulder osteoarthritis, it is assumed that a healthy, low-meat diet (especially pork) improves the inflammation. Large quantities of eggs, butter, alcohol and coffee should also be avoided. Certain types of vegetables and fruits as well as some herbs (anise, fennel, turmeric ...) can have anti-inflammatory effects. These recommendations are considered helpful in the case of shoulder osteoarthritis, but since the tendinosis calcarea can also lead to inflammation in the joint, symptoms can also be improved through a conscious diet.

forecast

The prognosis of a calcareous shoulder is as quite good to classify.
In many patients, the calcium deposits dissolve on their own without any treatment. For those in whom this does not happen, the disease can usually be brought under control through one of the various therapy options or a combination of these. If a calcareous shoulder has been left untreated for a long time, there is a risk that the tendon and thus the affected muscle will remain permanently weakened, which can sometimes lead to a arthrosis can lead. Therefore one should not wait too long with therapy, even if spontaneous healing is not unlikely.

Can a shoulder of lime dissolve on its own?

The calcareous shoulder dissolves on its own in a large number of cases. First the calcium crystals are absorbed by the body and then the tissue is regenerated. In rare cases, a calcified shoulder remains so long that it has to be treated surgically.

Duration of a calcareous shoulder

The course of the calcareous shoulder varies individually, the disease is divided into 4 stages.

A painless initial stage during which there are remodeling in the joint, the calcium deposit phase in which movement-dependent pain occurs, the absorption phase in which the pain is often at its greatest. This is followed by the repair phase, in which the calcium deposits have already disappeared, and the body tries to restore the tissue.
Not all patients go through all stages. As a rule, however, the calcareous shoulder heals on its own after a few weeks or months. After an operation, you can expect about 3-4 weeks of rest.

Rehabilitation after surgery

Following an operation, the aim should be to immobilize the shoulder joint for about 3 weeks. Thereafter, a longer period of physiotherapy is necessary to restore full mobility and freedom from pain in the shoulder.

How long are you on sick leave after the operation?

How long one is on sick leave after an operation for a calcareous shoulder depends heavily on the individual stresses to which the patient is exposed. The operation is often performed arthroscopically, but there is also a so-called needle lavage (needling), in which lime crystals are first crushed and then suctioned off. Depending on the course of the operation and the individual healing process, a rest of about 3 weeks may be indicated. Patients who are exposed to heavy shoulder loads in their job may have to reckon with a somewhat longer absence.

Summary

The calcareous shoulder is not a rare disease, the causes of which are still not fully understood. The calcium, which is particularly often deposited on the tendon of the supraspinatus muscle in the shoulder, causes the tendon to swell and thus to a lack of space in the joint. Different structures can become irritated, to which they react with inflammation and / or scarring, which leads to pain and a restriction in the mobility of the joint. In many cases the lime forms back again without outside help. If he does not do this, you can usually remove all of the calcium carbonate with the help of physiotherapy, extracorporeal shock wave therapy or, if necessary, an operation and thus cure the disease completely, since the risk of relapse is very low here.