Calcification in the shoulder is a common pathological condition of the shoulder joint, affecting mainly the population between 30-50 years of age, but more often occurring in women. Risk factors for shoulder calcification include diabetes mellitus, previous injury to the shoulder, especially to the muscles and tendons of the rotator cuff, or shoulder dislocation, incorrect posture, prolonged immobilisation of the arm, e.g. after a fracture.
There are two types of calcinations in the shoulder, degenerative calcinations in the shoulder and reactive calcinations in the shoulder. The former is typical of the elderly and occurs gradually due to loss of quality of the collagen fibres of the connective tissue of the shoulder and the gradual formation of micro-damages. Reactive calcification of the shoulder occurs as a result of previous injury, trauma, thyroid problems or in association with other typical risk factors.
Calcification in the shoulder, if not treated with appropriate physiotherapy, can develop into frozen shoulder syndrome, which causes more severe shoulder pain.
Shoulder calcification is characterised by a trophic cycle that can last up to 5 years, or up to 8 years if hormonal disturbances are present and no treatment is provided.
Calcification of the shoulder is characterised by pain that is aggravated by resting and not moving the shoulder, typically nocturnal pain that interferes with sleep and causes intense pain when lying on the affected shoulder. Pain due to calcification of the shoulder usually starts suddenly, is sharp and restricts the movement of the arm above the head. Often, the standing position is more favourable than the supine position for patients with calcification of the shoulder.
Calcification of the shoulder is characterised by intense pain in the front or back of the shoulder, often radiating to the upper arm, possibly to the level of the elbow and wrist. If you also have tingling sensations in your fingers, this is not a problem related to shoulder calcination, but carpal tunnel syndrome is suspected.
Calcification of the shoulder occurs in 3 stages, the third stage is the most painful, when calcium crystals are released from the tendon into the surrounding area. Physiotherapy and kinesiology are usually performed during the third phase of shoulder calcification, as most of the time it is asymptomatic, meaning that we have no contact with the patient before that time.
A reliable diagnostic method for examining the shoulder where calcinations are suspected is ultrasound (US) by a specialist radiologist. Ultrasound imaging can pinpoint the location of calcium crystals and their size, and can also be used as a method of monitoring the progress of conservative treatment of shoulder calcination.
The treatment of shoulder calcification is complex, requiring an integrated conservative approach combining physiotherapy and kinesiology. Surgical treatment is only performed in 5-10% of patients when physiotherapy treatment is unsuccessful after at least 9 months of continuous rehabilitation.
The primary method of physiotherapy for the treatment of shoulder calcification is shockwave therapy combined with active shoulder mobilisation and rotator cuff strengthening exercises. TECAR and LASER therapy are also used, as well as electrotherapy, which must be high-pitched; at the Medicofit clinic we use HiTop. Treatment of shoulder calcifications must ultimately include exercises to develop the strength of overhead pushing and pulling, as failure to gain strength in the final ranges of overhead movements risks the recurrence of calcifications.
It is important that the treatment is combined with each therapy, shock waves must be precisely dosed in intensity and must not trigger an intense pain response to the therapy, despite being one of the more invasive methods of instrumental therapy. Deep shock waves are the most effective means of conservative treatment of shoulder calcification, but they should always be accompanied by specific exercises that strengthen key muscle groups.