If you feel pain when you raise your arm over your head or buckle your
seatbelt or have difficulty raising your arm over your head or behind your
back, if you wake up with shoulder pain at night and your pain starts to
radiate down towards your elbow, this may be due to calcific tendonitis, a
condition that causes a build-up of calcium and inflammation in the tendons.
The condition and thus the pain can be treated with a non-surgical
ultrasound-guided shoulder puncture, a method that is well-established around
Calcific tendonitis is a condition where a calcium deposit causes the
surrounding tissue to become inflamed, often resulting in intense pain. It is a
relatively common problem – studies have shown that it affects up to 20% of
people between 40 and 65 years of age, though it sometimes occurs in younger
people as well, with women being more likely to have it than men.
Calcium crystals are deposited in parts of the rotator cuff tendon that
have degenerated due to impaired blood flow. When the calcium deposit reaches a
critical volume, or following repeated injury to the affected area, the
crystals begin to be released into the area surrounding the tendon, causing
Who is it for?
The procedure is recommended for all those experiencing pain in the
calcified area, preferably as quickly as possible after the pain starts. People
who perform repetitive movements (lifting, carrying, computer work etc.) and
those who have previously injured their tendon are particularly at risk.
When making an appointment, the patient needs to bring a recent
ultrasound image to confirm that the pain is located in the calcified part of
the tendon (usually accompanied by inflammation in the surrounding tendon) and
rule out other causes, such as a tendon rupture or bursitis. A shoulder
ultrasound can also be performed at the Diagnostic Centre Bled.
How is the procedure performed?
The procedure takes 20 to 40 minutes, depending on the size and hardness
of the calcium deposit. The calcium deposit in the tendon needs to be larger
than 8 mm for the procedure to be performed. The deposit is punctured under
ultrasound guidance and irrigated to flush out part of the crystals. More than
80% of the deposit can be removed. A pain reliever (paracetamol or a
non-steroidal anti-inflammatory drug) is recommended to be taken on the first
day to relieve any pain caused by the swelling of the tissue surrounding the
puncture site. A significant improvement in shoulder mobility is seen
immediately after the procedure, and the pain will disappear completely after a
The procedure does not have to be repeated for most patients. However,
in some 20% of patients, the pain may return in a milder form in 3 to 6 months.
In those cases, the shoulder is examined using ultrasound. If the tendon still
contains calcium deposits larger than 8 mm, the procedure is repeated. If there
are only individual smaller crystals (a few mm in size) remaining, shock wave
therapy is recommended.
An ultrasound-guided shoulder puncture is not possible in patients
allergic to xylocaine, a numbing agent that is also used in dentistry.
After the procedure
We recommend performing everyday activities as usual for four to eight
weeks following the procedure, avoiding, however, any repetitive movements
involving raising the arm above head level, or lifting heavy weights. It is
recommended to perform shoulder girdle strengthening exercises with gradually
increasing intensity under the supervision of a physical therapist. Other
physical therapy procedures aimed at improving tendon regeneration (ultrasound,
magnetic therapy) are also beneficial.