Patient resources
NHS Lothian MSK Self Help Resources Webpage
Definition
Calcific tendinopathy (or calcific tendonitis) refers to a build up of calcium within a viable and well vascularised rotator cuff tendon, most often the supraspinatus tendon.
Typical signs and symptoms
Formative phase: may extend from 1 to 6 years and is usually asymptomatic.
Resorptive phase: extends from 3 weeks up to 6 months. During the acute resorptive phase the patient may present with sudden, insidious, severe shoulder pain that can spread to the arm, along with reduced movement/function and sleep disturbance due to pain.
- Usually unilateral, can be bilateral in up to 25% of cases
- More persistent symptoms may be similar to those of rotator cuff related shoulder pain
- Symptoms may wax and wane
- May have a non-capsular restriction in movement
Prevalence and risk factors
- Approximately 10% of patients with shoulder pain
- Mean age 30-60 years, slightly more prevalent in females than males
- Risk factors: uncertain; possibly some genetic and biological factors e.g. diabetes, gout
Prognosis/ risk factors for poor outcome
- Usually a self-limiting condition that resolves spontaneously
- May take weeks, months or years to resolve
- Those with endocrine disease/ biological contributing factors may respond more poorly to conservative measures
Other considerations
Consider red flags relating to the shoulder as the signs & symptoms associated with acute calcific tendinopathy often mimic malignant pain.
Dystrophic calcification may occur within a non-viable and poorly vascularised rotator cuff or in those with cuff tears; this is common to see with other signs of degenerative change and may not be the primary cause of symptoms, especially in older patients.
Incidental calcification can be found in 2.5-20% of ‘normal’ healthy shoulders on imaging.
Loose bodies: associated chondral defect; associated secondary osteoarthritis.
Differential diagnoses Main differential diagnosis is Rotator Cuff Related Shoulder Pain. Patient history/ story/ onset is key in distinguishing.
P.A & M.A – 16-7-26
Who can refer:
- All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners
- Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP Where To Find Us – Musculoskeletal Physiotherapy)
- Secondary care consultants and associated teams
- MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes NHS Lothian Integrated Shoulder & Elbow Service
Who and How to refer:
| Condition | Referral Type | Referral destination and process |
|---|---|---|
| Suspected septic arthritis/ septic bursitis | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected facture or dislocation | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute distal biceps rupture | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute traumatic rotator cuff tear in the younger patient | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected malignancy/ tumour specific to shoulder* | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected inflammatory condition | Consider referral to Rheumatology – see RefHelp Rheumatology. | |
| Suspected neurological condition | Consider referral to Neurology – see RefHelp Neurology. |
* Please also see Sarcoma – RefHelp. If clinical assessment leads to a very strong suspicion of suspected underlying malignancy, with no specific localising signs or symptoms to suggest a specific underlying primary, consider recommendations and referral options detailed on GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) – RefHelp
Who not to refer:
- Patients who have the presence of significant red flags/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition – see serious shoulder & elbow conditions
- Age <16
Other considerations
It is key to distinguish a traumatic rotator cuff tear in the younger patient (typically <65) as this is a red flag and requires urgent referral to Orthopaedics. Atraumatic degenerative rotator cuff tears can occur in older patients. In these cases, patients usually experience pain and weakness in the absence of significant trauma.
For further information see associated sections
- Link to NHS Lothian patient internet site including patient information resources – https://services.nhslothian.scot/ISES/Pages/default.aspx
- Link to NHS Inform page shoulder problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/shoulder-problems
- Link to NHS Inform shoulder problems- Patient self help guide https://www.nhsinform.scot/self-help-guides/self-help-guide-shoulder-pain
- Link to NHS Inform page elbow problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/elbow-problems
- Link to intranet site NHS Lothian Integrated Shoulder and Elbow Service http://intranet.lothian.scot.nhs.uk/Directory/physiotherapy/NHSLIntegratedShoulderandElbowService/Pages/default.aspx
