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Calcific tendinosis
Treatment for calcific tendinosis is available privately at The Edinburgh Clinic Shoulder Service. Enjoy fast access to appointments with specialists within the calming, unique and quality clinical environment at The Edinburgh Clinic.
What is calcific tendinosis?
Sometimes calcium forms in tendons where it would not ordinarily occur. In the shoulder it most often forms in the ‘supraspinatus’ tendon. No one really understands why, but it can appear following an episode of tendon inflammation. It can cause severe pain, particularly in the early, acute phase. Typically, the calcium will cause pain as long it is present. The natural course is for the calcium to eventually disappear, but this may take years.
How is it treated?
The most common and successful treatment for patients with calcific tendinosis is to use a needle to either suck the calcium out, called ‘barbotage’, or break the calcium up using ‘dry needling’. This is carried out by a consultant radiologist using ultrasound to guide the needle into the calcium. Barbotage is only possible in the early stages of calcific tendinosis when the calcium is soft.
What does dry needling consist of?
- The procedure typically takes around 20 minutes.
- An ultrasound scan of the shoulder tendons is conducted to confirm where and how much calcium is present in the tendons.
- Steroid and local anaesthetic is injected into the lining above the shoulder tendons – the ‘bursa’. The local anaesthetic helps to take the pain away as the procedure is performed while you are awake. The steroid acts as an anti-inflammatory and usually works within a week to reduce pain and inflammation.
- More local anaesthetic is injected into and around the lump of calcium in the tendon to numb the area.
- The calcium is ‘dry needled’ for one or two minutes, breaking it into small pieces.
What happens after the injection?
Following the dry needling procedure, the calcium will begin to disappear. This is called the ‘resorptive phase’. The resorptive phase can be painful and last several months. It is important to keep the shoulder moving during this period, therefore a physiotherapy session two weeks following the procedure is useful.
What are the side effects of injection?
- Steroid can cause irritation following injection, creating the so-called ‘flare response’.
- With any injection into a joint there is a risk of infection. This risk is greatly minimised however, as the injection is done under ‘sterile’ conditions.
- Some of the steroid will travel around the body to other tissues and makes insulin work less well for this short period of time. Patients with diabetes must monitor their sugar levels for up to two weeks after the injection.
What are the success rates?
Analysis of 50 patients (NHS Lothian) treated with dry needling showed that 80% of patients were symptom-free at one year. Usually, most or all of the calcium had disappeared on X-ray at three months following the injection. Even so, it is stressed again that complete resolution of symptoms can take several months.
How can I access this service?
The diagnosis of calcific tendinosis is usually made by an orthopaedic surgeon, specialist physiotherapist or a GP with a special interest in musculoskeletal problems, after examination and X-ray.
You can self-refer for specialist physiotherapist-led shoulder assessment at The Edinburgh Clinic Shoulder Service directly. If identified as suitable, your specialist physiotherapist can refer you for treatment to a consultant radiologist or orthopaedic surgeon.
You can be referred for Consultant Orthopaedic shoulder assessment at The Edinburgh Clinic Shoulder Service by your GP or healthcare provider. The orthopaedic surgeon will assess the shoulder to confirm the diagnosis and, if appropriate, the referral for ultrasound-guided dry needling will be made to our specialist consultant radiologist.