Shoulder's calcification

Definition

It is a deposit of calcium inside the tendons of the shoulder often indicating a tendinous affection.

However, we find more and more calcifications in very healthy tendons. This pathology is called calcifying tenopathy. 10% of the whole population are reported to be affected.

The tendon of the sub-spinal muscle is affected most of the time.

Anatomy

Anatomie de l'épaule
Anatomie de l'épaule

The shoulder joint or glenohumeral joint is a synovial joint between the humeral ball and the glenoid cavity, strengthened by the fibro-cartilaginous ring, the glenoid ring. The joint’s capsule is reinforced by 2 or 3 ligaments. It is wide and loose on its lower part.

Most of the joint’s stability is ensured by the muscles of the head :

Anatomie de l'épaule
Anatomie de l'épaule

They are inserted into the proximal part of the humerus via their tendons which form a fibrous tissue blade difficult to separate from the joint capsule below: the head of the rotators.

Above the head, but separated from the latter by the sub-acromial purse, lies the arc constituted by the acromion (a bone structure of the scapula located just above the humeral head ) and the coraco-humeral ligament.

Clinical Symptoms

Radiographie de l'épaule
Radiographie de l'épaule

The clinical stages are described thus:

The asymptomatic stage:
It is the discovery of the calcification of the head on X-rays done for another purpose.

The acute stage: there is a sudden, very intense pain along with a total functional impotence. The least movement triggers a sudden pain and the examination of the shoulder is impossible for the surgeon. Plain X-rays show the calcifications but special incidences, in various rotating positions, are often necessary.

There are several forms of calcification,Some are very dense, regular and with a clear outline, others are irregular, more blurred, more diffuse.

The chronic stage:
The symptoms cannot be distinguished from those of degenerative tendinitis of the tendons (refer to the clinical symptoms of the tendons’ disease).

Evolution without any Treatment

If the calcification is not evacuated, the pains will persist for several months and it is not possible to assess the duration. 

Surgical Treatment

Traitement chirurgical de la calcification de l'épaule
Traitement chirurgical de la calcification de l'épaule

The operation is of course carried out under arthroscopy. It allows for an evacuation of the calcification which has been there for several months and has caused pain.

The operation is carried out in the operating theatre under general anaesthesia.

Complications

Anaesthetic complications:


They are not specific to arthroscopic surgery. The anaesthetist will provide you with all relevant information during the pre-operation consultation.

local complications:


Vascular complications:
The main blood vessels: (arteries, veins) can exceptionally be affected, which may have serious consequences; with less serious consequences, other little veins may be hurt, which will lead to a haematome of the shoulder called haemarthrosis.

Complications of the nerves:
It may be possible to have an area of skin anaesthesia round the scar and even localized itches because of small nervous ramifications under the skin being affected. Generally, these unpleasant sensations diminish with time.

Arthritis:It is a post-op infection of the joint. It is not so frequent: -0.4% of all arthroscopies. The treatment requires another operation with an arthroscopic cleansing of the joint and a suitable antibiotics treatment.

Haemarthrosis:
It is a serious and painful blood flow in the joint.

A stiffness (retractable capsulitis) of the shoulder may appear.

A swelling or a serious oedema may appear and usually regresses during the first post-op night without any serious consequences.

Rare scar problems.

Algodystrophy:
This complication in surgery may also occur outside of all operation gesture. It often seems to affect women over 40. Its symptoms are a decalcification of the shoulder joint along with invalidating pains. We often observe a redness of the skin, a rising of the sweating, heat, a stiffness in the joint. It requires a functional and medical treatment by easy re-education. It can also be provoked by unadapted physiotherapy. It usually disappears spontaneously. The recovery can be achieved over a few weeks but can also take up to 2 years.

Stay in Clinic

The patient will leave the clinic the same day as the operation without being immobilized and without any plaster. An immediate mobilization of the upper limb might be done depending on the pain.

Pain care will be shared between the anaesthetists, your surgeon and the nurses on duty.

When you leave the clinic, your surgeon will give you the prescriptions for painkillers, dressing, re-education, work-leave if necessary and your next appointment. Of course your GP will receive an account of the operation as well as a mail explaining the therapeutic act carried out and the operating consequences to foresee.

On leaving, you will have to make quickly an appointment with your physiotherapist. Your surgeon will give you a prescription with a re-education protocol; the latter will have to be easy, done with care and progressive.

Incapacity

Generally, you may consider resuming your activities only after about 6 weeks. It will naturally be in relation with your degree of physical activity and your profession.

Everyday gestures will be carried out quickly, but without any strenuous work.

Results

The patient usually feels a significant improvement about his shoulder after about 2 months, both regarding the functioning and the pain.

The patient will have re-education sessions as long as pains or a functional impotence of the shoulder persist.

Shoulder calcification : surgical treatment in France