A bag of lubricating fluid surrounds the muscles and tendons of the shoulder. This bag is called a bursa. Inflammation in a bursa is called bursitis.
The mineral calcium is dissolved in our blood at all times. It stays dissolved until something happens to change the conditions in a region of the body. The inflammation reaction after injury to shoulder tendons or the shoulder bursa will change the local conditions and can lead to calcium coming out of solution and forming calcium crystals in the muscles or in the bursa around the shoulder. This is called shoulder calcification.
Shoulder calcification does not always develop after bursitis or tendonitis but - if it does develop - it can become a major cause of ongoing chronic pain around the shoulder.
The symptoms of shoulder calcification often begin gradually over some weeks or months. Pain is the main problem. Rarely the problem can start with severe pain and progress rapidly but this is not common. More often it starts with a gradual pain in the region of the outer part of the shoulder - over the deltoid muscle. When asked about it, the patient can nearly always remember a previous episode of injury. This previous episode was the trigger for the shoulder calcification process and the current pain is due to the calcification causing nipping or impingement against the nearby bones.
The pain of shoulder calcification is felt over the deltoid muscle area around the shoulder. It may spread down the arm towards the elbow or wrist. The pain is made worse by lying on the affected side or by trying to use the arm above the head.
Some people become aware of a "painful arc" of movement. This means that they have no pain when their arm hangs by their side but they develop a pain as they lift their arm up and outwards. The pain often arises when their arm reaches about sixty degrees of elevation. Once they get a bit beyond the ninety degree point, the pain eases again or goes away completely. This differs from the pattern of pain and limitation seen in other conditions like frozen shoulder.
If a doctor or therapist resists the patients attempt to lift their arm outwards from the side then the pain will become more pronounced.
Your doctor may perform a maneuver called the Impingement Test to determine whether there is inflammation in the bursa or the tendons of the shoulder. The impingement test will usually be strongly positive if shoulder calcification is present.
An X-ray or an ultrasound or an MRI scan may be required to diagnose shoulder calcification
Rarely a longstanding deposit of calcification in the bursa or in the shoulder tendons can rupture and release a chalky toothpaste like material into the bursa space. This calcium material is highly irritant and can cause a severely painful shoulder to develop very suddenly. This is called acute calcific tendonitis.
Shoulder calcification is a common cause of shoulder impingement.
One of the most important aspects of treating shoulder impingement is to stop doing the movement or activity that provoked it in the first place. Of course this may be easier said than done but you might consider changing your technique or equipment if you are involved in sport. If your impingment reaction has been triggered by work then give some thought to changing the way that you tackle your job tasks and activities.
Treatment options for shoulder calcification include:
- painkiller or anti-inflammation medication
- physical therapy from a physiotherapist, chiropractor or osteopath
- injection of a steroid drug
- strapping or taping of the shoulder
- arthroscopic surgery
- surgical removal of the calcium tissue is often required to obtain long lasting pain relief from shoulder calcification
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