BONES & JOINTS

FREQUENTLY ASKED QUESTIONS

Q:

Any advice for easing symptoms of calcified tendonitis when it flares up? My neck and left shoulder have been painful for about a week and heat, rest, robax and voltaren are only getting me so much relief. Rx muscle relaxers knock me out cold so they aren’t a great option.

A:

A/
Is the calcified tendonitis in the left shoulder?
It would make sense to do a detailed biomechanical examination of your cervical, thoracic spine and your shoulder girdle. Chances are, there are biomechanical problems that can be addressed. Superimposed upon the calcified tendonitis there are probably myofascial trigger points in the various muscles that can be worked on and afford you considerable relief. Very specific strengthening exercises would be prescribed to address the primary underlying issue as well. Acupuncture along with orthopaedic manual  therapy can be a helpful adjunct for relieving inflammation. A thorough clinical history and physical examination to accurately diagnose the problem would be the first step.
– Orthopaedic Physiotherapy Specialist

 

B/
As often happens,  your question leads to questions on our part. Firstly we assume you have been diagnosed with HPP and this is a confirmed diagnosis.  Calcific tendonitis is one form of a broader condition known as Calcium Hydroxyapatite Deposition Disease (CHDD). In CHDD, calcium phosphate crystals, specifically hydroxyapatite, deposits in the soft tissues around joints. The signs and symptoms of CHDD differ from individual to individual. Calcific tendinitis which you refer to is usually the term used when the deposition of the crystals occurs in the rotator cuff muscles which hold the shoulder joint in place. Calcific Tendonitis most often involves the supraspinatus tendon.

 

Does your condition involve other tissues or tendons in the body besides the tendon(s) around the shoulder? Are you known to have frank arthritis or other bone manifestations of HPP such as stress fractures? How long have you had this calcific tendonitis for? We presume you are having attacks of shoulder pain that last 3-4 weeks involving your shoulder specifically, and attacks come and go.

 

You mention the usual treatment modalities like heat or NSAIDS do not seem to be working. At this stage it would be very important to be assessed by an orthopaedic specialist to ensure the diagnosis is correct and that there are no other associated problems or complications  like bursitis, joint dislocation or subluxation or even impingement of tendons in the joint. A treatment regime would be developed depending on the exact details of your condition.

 

Additional treatments could involve a complete physiotherapy assessment and a physiotherapist could coordinate a stepwise rehab program to strengthen the rotator cuff muscles, exercises to increase range of motion, massage therapy, ultrasound treatment or shock wave therapy.  Surgical options may also exist depending on the specifics of your condition.  Again any recommendations should be made by your health professional such as an orthopaedic specialist and be tailored to the exact details of your condition. Please let us know how things are going and we would be happy to continue this dialogue.
–  Clinical Geneticist, Metabolic Specialist and Paediatrician

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