Calcium deposits
around the shoulder are a fairly common occurrence. Frequently they do
not cause problems, but if they increase in size or become inflamed, then
very severe pain may result. This collection of questions and answers
is intended to explain this common shoulder problem and describe the methods
we recommend for treatment in different situations.
What is the cause
of calcium deposits around the shoulder?
In most situtations, there is no known cause for calcium deposits.
Many people ask if their diet should be changed to reduce calcium intake.
This should never be used as a form of treatment, since a normal balanced
diet with a calcium supplement up to 1000mg a day is healthy in a normal
patient, particularly senior citizens and post-menopausal females.
Who most commonly
gets calcium deposits?
Calcium deposits occur most frequently in females between 35 and 65
years of age, but may occur in males as well.
Do all calcium
deposits cause problems?
Many calcium
deposits are present for years without causing any symptoms. Only when
the deposit becomes large enough to pinch between the bones when the shoulder
is elevated, does it cause pain. Sometimes smaller deposits cause pain
if they become acutely inflamed, especially when the calcium salts leak
from the lesion into the sensitive bursal tissues.
Does a calcium
deposit damage my shoulder?
Some calcium deposits can cause erosion with the destruction of a portion
of the rotator cuff tendon. Most calcium deposits remain on the outside
of the rotator cuff tendon in the bursa and only cause problems because
of their pain and catching.
Is the calcium
deposit hard like a rock?
Most early calcium deposits are very soft like toothpaste, but sometimes
after being present for a long period of time, they do dry up and become
chalk-like, sometimes even turning to bone.
What is the best
treatment for a calcium deposit?
When a calcium deposit becomes acutely inflamed, either because it ruptures
and leaks calcium salts into the bursa, or because it pinches the bursa
or rotator cuff, the symptoms can be quite severe. The acute inflammation
can be treated with localized ice packs and rest in a sling, but oral
anti-inflammatory medications are also helpful. A cortisone injection
directly into the area of the calcium deposit may give relief within a
few hours, when without it the acute severe pain may last for several
days.
Do calcium deposits
need removal?
If a patient has two or three recurrent episodes of painful symptoms
in the shoulder, or if the calcium deposit appears on x-ray to be enlarging,
then it may be appropriate to consider arthroscopic surgery to remove
it.
What is involved
in arthroscopic surgery to remove calcium?
The surgery is done in the outpatient department under a general anesthesia.
There is no pain at all during the operation and afterwards a mild aching
sensation is usually present for a few days until the skin puncture sites
heal. If the calcium erodes a hole in the rotator cuff, then a decompression
is necessary (removing a portion of the overhanging bone arthroscopically)
and this will cause a little more discomfort for a few days.
Will calcification
return once it is removed?
I have never seen a calcification return in the same shoulder once
it has been removed.
Can there be any
permanent damage caused by calcification?
Yes. A long term calcification may cause pressure on the rotator cuff
tendon which can damage portions of the tendon permanently.
