In this article, we will discuss calcification and shoulder pain.
In the absence of trauma, shoulder pain can be caused by a variety of factors, not the least of which is calcification.
This is also called calcific tendonitis, and it is difficult for judo therapists such as myself to treat it because most of these cases are treated in hospitals.
It is generally assumed that it is caused by the rotator cuff tendon, but I would like to introduce a case where this is not the case.
What is calcific tendonitis?
Calcinosis tendinitis is a common condition that is also believed to cause shoulder pain.The calcium deposits involved in the condition, hydroxyapatite crystals, are found in the rotator cuff tendons, but rarely in other tendons around the shoulder.
Of the reported cases, no cases of calcification around the proximal insertion site of the deltoid muscle have been reported in the literature.
Here, we present a case of calcification at the insertion site of the left deltoid muscle into the anterior acromion that was successfully treated with conservative management.
Case
A 45-year-old man
Right-handed
Two mornings before his first visit, he woke up and felt a sudden pain in his left shoulder.
Later, he came to see the doctor complaining that the pain had worsened.
The man has no history of metabolic disease or trauma around the shoulder.
Physical examination revealed 110° of restricted anterior flexion, 30° of extension, 110° of abduction, 30° of external rotation, and internal rotation to L2.
The numerical rating scale for pain is 3/10 at rest, 7/10 with exercise, and 5/10 at night.
Tenderness was noted near the front of the acromion.
Simple radiographs with the left arm in an elevated position showed calcification on the anterior aspect of the acromion, but anteroposterior (AP) radiographs showed a normal appearance.
Ultrasonography revealed a small hyperechoic lesion at the insertion of the anterior acromion of the left deltoid muscle and hypervascularity around the calcium deposits.
In addition, no rotator cuff tear or subacromial bursitis was observed on ultrasonography.The patient was treated with a non-steroidal anti-inflammatory drug (NSAID) and local injection of triamcinolone acetonide (15 mg) and 1% lidocaine (3 cm3) around the calcification.
After a few days of treatment, the patient's pain improved dramatically and full range of motion was restored.
There was no recurrence of symptoms for the next three years, and simple radiographs at follow-up showed complete resolution of the calcification.
Yukata K, Suthar A, Suetomi Y, Yamazaki K, Doi K, Fujii H. Calcification of the Anterior Acromial Insertion of the Deltoid Muscle. Case Rep Orthop. 2020; Published 2020 Oct 10. doi:10.1155/2020/8895801
Conclusion
In this case, the pain improved and the calcium deposits were successfully absorbed with the introduction of medication to reduce the inflammation caused by calcification.
I've heard of cases with this condition where the same conservative treatment improved with manual therapy! But I couldn't find the information on the Internet, and I didn't know where it came from.
I don't know how effective manual therapy is, but at the clinic where I received my clinical training, I was taught that if you suspect you have calcific tendonitis, you should be referred to a specialized facility immediately! That's what I was taught.
In the future, even if I suspect that I have the same condition, if I can get relief with an injection as in this case, I would prefer to do so, because I think that would be more appropriate.
I would like to do so. However, I have to learn not to assume the part of calcium deposition in this case.
