DIAGNOSIS:

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The diagnosis of calcific tendonitis is made by taking a x-ray of your shoulder after examining your shoulder in clinic. There are many other causes of shoulder pain that present in a similar fashion

 

TREATMENT:​

The first line treatment of Calcific in my practice is a Cortisone injection and needling of the calcium. This procedure is called a barbotage and is performed under ultrasound guidance in clinic.

The success rates for relieving your symptoms are 70-80%.

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Shockwave (Pulsed ultrasonic waves) is an alternative treatment but the evidence is lacking to determine the efficacy. 

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Surgery can be considered if your symptoms still persist. In my practice this will usually be decided after seeing you 3 months after you barbotage with a repeat examination and x ray of your shoulder.

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Surgery is performed 'key hole' to surgically remove the calcium and clear the inflamed Bursal tissue. In some instances where calcific deposit is very large removal may leave a small defect in the rotator cuff tear which will require a repair.  

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The decision to undergo surgery is dependent on the severity of symptoms. Persistent daily night time pain and restricted shoulder movements affecting daily activities such as washing/ dressing are a good indication to consider surgery.​

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It is vital that you fully understand the benefits and risks which are outlined below.

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• Persistent/ recurrent symptoms <10%

• Stiffness/ frozen shoulder (1-2%)

• Infection (<1%)

• Nerve/ Vessel injury (<1%)

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General anaesthesia is very safe but still carries a small risk (<1%) of Heart Attack, Stroke, Deep Vein Thrombosis, Pulmonary embolism. It is important to have all details of your medications and past medical history so you can be optimised for surgery and these risks can be assessed individually.

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How long do I wear a polysling after my operation?

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You should wean your self off the polyling after 48 hours and ideally discontinued by 7 days. Pendular exercised will be shown to you and these should start as soon as pain allows.

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If your rotator cuff needs a repair at the time of surgery then you will be in a sling for 3-4 weeks to protect the tendon repair.

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Is it normal for my shoulder to be swollen & wound to leak fluid?

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You will notice that after surgery that your shoulder has a bulky padded dressing. This is designed to absorb excess fluid from the arthroscopy (Saline is pumped into your shoulder to allow visualisation) for 24 hours and then can be taken off. Your shoulder will appear swollen which is very normal and this will reduce over a few days. Leaking fluid from your key hole wounds will be blood tinged but not frank blood. 

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Can I get my dressings wet?

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For the first 7 days you must keep your dressings/ wounds dry. 

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When Can I start driving?

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It  is  illegal  to drive while wearing  a sling.  You may  start  to drive once  the sling  has  been discarded  but  not  until  you can safely  control  the vehicle.  This  is  normally  between 1- 2  weeks  after  the operation.  It  is  advisable to start  with short  journeys.

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When can I go back to work?

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This  will  depend on the  type of  work  you do  and the  extent  of  the surgery.  If  you have a non-manual job and do not need to drive you may  be  able  to return within 2 weeks.  If  you have a heavy  lifting  job or  one with sustained  overhead arm  movement  you may  require  6 or more weeks off.  

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How am I Likely to progress?

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It is important to recognise that improvement is slow and that this is not a quick fix operation. By 3 weeks after operation you will not have noticed much improvement. However, you should have recovered nearly full movement. Getting your hand up your back usually takes a little longer. By 3 months after the operation most people have noticed improvement in their symptoms. Everything continues to improve slowly and by 9 to 12 months after the operation your shoulder should be back to normal / feeling like the other shoulder. 

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When can I resume heavy lifting/ recreational activities?

 

 Timings for returning to functional activities are approximate and will differ depending upon the individual. However, the earliest that these activities may commence are:

• Lifting: as able

• Swimming: breaststroke: from 6 weeks; front crawl: when able

• Golf: 8 weeks (but not driving range)

• Contact sports: sport specific training when comfortable. Competitive play when able.

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