Calcific tendinopathy

When calcium builds up in the rotator cuff tendons, it could become inflamed and painful. This could also present with other symptoms of rotator cuff disease such as weakness and reduced range of motion.

It is not clearly known why this happens although some association with diabetes and thyroid disorders have been noted. Women appear to be more susceptible and the common age group is 30-60 years.

Investigations:

These calcium deposits are best seen on X-ray and Ultrasound scans. MRI is not very sensitive for identifying calcific tendinopathy.

Treatment:

Sometimes the condition is self limiting. Other modalities like anti-inflammatory and pain 

medications can be used to help with the pain. 

Extra-corporal shockwave therapy could also be helpful in certain cases.

If conservative management fails then Barbotage or needle levage could be considered under ultrasound guidance.

Resistant calcific lesions would need surgical decompression.

Barbotage:

This is a medical technique using saline and local anaesthetic to break down the calcium in the tendons under ultrasound guidance. A corticosteroid injection is usually administered to reduce the inflammation and pain at the end of the procedure.

Barbotage is performed under local anaesthetic and takes about 15 to 20 minutes. It usually takes several syringes of saline to absorb the calcium.

As the calcium is absorbed, the saline in the syringes and will appear turbid and chalky (white) colour. Towards the end of the procedure the saline will become more clear indicating that that the calcium deposits have been removed.

Sometimes all calcium deposits cannot be broken down and residual deposits of calcium may remain. Occasionally the procedure may need to be repeated after several weeks if the pain  or other symptoms persists.