Calcific Tendonitis Vignette
Patient Vignette – Calcific Tendonitis
M.M. is a 58-year-old right-hand dominant male. He is an active person, but has never had any specific injuries to his left shoulder or arm. He first came to clinic to have his left shoulder pain of about 3-4 months evaluated. His chief complaint was difficulty lifting and reaching with his left arm. He stated if he tried to lift his arm to the side he could only lift to shoulder height because of pain. He was also having pain at night. This was the first time he had problems with his shoulder, so he had never had therapy, injections or surgery.
Clinic Visit #1
M.M. had X-rays before he was seen by the provider. Even though he had some X-rays done before he came to clinic, more views were ordered to capture all the pertinent information needed for his visit. When the provider entered the room, they started by giving a history related to the shoulder injury. M.M. expressed frustration that he had never “done anything wrong” with his shoulder. He also described a gradual worsening of symptoms over several months, mixed with episodes of more severe pain with the activities above. The provider did a series of exams, including a careful look at both shoulder, and several maneuvers to test for discomfort (present with forward and side motion) and weakness (there was none).
Calc Ten Pre AP Arrow
showed an abnormal collection of calcium adjacent to the proximal humerus (upper end of the arm bone) at the location of the rotator cuff insertion. (Red arrow points to calcification.)
The provider diagnosed calcific tendonitis, and recommended an ultrasound-guided procedure to extract the calcium.
Clinic Visit #2
M.M. blocked out 60 minutes on a Monday afternoon for his next visit. On arrival he read and signed consent for the injection, and asked questions that were not addressed. The procedure was done with M.M. lying on his back. Both the area to be injected and the ultrasound machine were prepared in a sterile fashion. The needle was inserted into the lateral side of shoulder. Lidocaine was used to numb the skin, and then a second needle was used to enter the calcium deposits in the rotator cuff. More lidocaine was used which served to numb the rotator cuff.
The needle was then used to break up the calcium deposits, and aspirate (remove) the contents of the deposit. In the two ultrasound pictures, the needle is seen in the calcium, and later the calcium is noted to be significantly reduced. (Red arrows point to needle, yellow arrows to calcification.)
Calc Ten US Pre
Calc Ten US Post
At the conclusion of the procedure, a steroid was injected to help calm inflammation and manage pain. M.M. was able to see the calcium deposits in the syringes at the conclusion of the procedure (example pictured).
Calcific Tendinosis Lavage
After the Procedure
When the effects of the Lidocaine wore off, M.M. reported some discomfort, but this was managed well with over-the-counter medication. Over the next few days the degree of pain in the shoulder decreased. Therapy was started about one week after the procedure, with an emphasis on regaining range of motion and increasing strength and stability of the shoulder.
Clinic Visit #3
M.M. reported back to the provider about 6 weeks after the original procedure. New X-rays were taken, which showed essentially complete resolution of the calcium deposit (pictured).
Calc Ten Post AP
While M.M. reported some persistent discomfort, this continued to improve. Today the patient reports complete resolution of symptoms, and no further problems with his shoulder.