Acute calcification:

This causes severe pain, in fact some of the most severe pain known! Sharp crystals of calcium salts are laid down in the tendons of the rotator cuff and any movement of the shoulder causes excruciating pain. This is caused by a fall in the acidity or pH of the tissue either by damage or lack of blood flow (lying on it in an unusual position) and has a very sudden onset. Patients often look fearful and very unwell with this condition.

Dont put up with it! Seek urgent medical help and insist on strong pain relief usually narcotics are necessary.

An injection of local anaesthetic and steroid is worth a trial in the early stage to try to break the membrane about the calcium crystals and allow the body's protective mechanism in ie. the blood supply to wash away those crystals. If this doesnt work within 24 hours an operation is indicated to remove the calcium deposit usually with the arthroscope. Depending on the damage to the surrounding tissues in may be necessary to remove part of the cuff and repair with stitches necessary. In this case the arm will be rested in a sling for 6 weeks afterwards. If no cuff repair is necessary recovery is much faster with very quick resolution of severe pain.

Chronic calcification:

This condition presents in the same way as a chronic impingement syndrome with longstanding ache, especially at night, catching sharp pain with reaching and sudden movements.

Investigations: Xrays show this very nicely and a dynamic ultrasound with demonstrate just how the lump of calcium catches on the bone and ligament of the coracoacromial arch (just ask the radiologist to show you!).

Treatment: This mechanical problem usually needs a mechanical solution. Excise the hard lump of calcium with any damaged cuff and repair the defect if needed. At the same time a decompression is performed to open up the space and allow the cuff to move without any further rubbing especially if there are sutures in the cuff because of the repair. If there is a repair of the cuff necessary a sling will be necessary for 6 weeks, no driving for 8 weeks, no lifting 3 months, no heavy lifting or repetitive overhead work/ sport for 6 months. If no repair is necessary a sling is only used for comfort for a day or so and immediate movement is encouraged but no repetitive overhead work/sport for 3 months, until all the inflammation has settled