Tendon Calcification Therapy

Calcific tendinosis is a disorder characterized by deposits of hydroxyapatite (a crystalline calcium phosphate) in any tendon of the body, but most commonly in the tendons of the rotator cuff (shoulder), causing pain and inflammation. Calcium build-up can also irritate the adjacent soft tissues, such as bursa.

We require an ultrasound before any intervention. Calcium deposits in the shoulder tendons are common, but often the adjacent soft tissues are the actual cause of pain. We advise an initial steroid injection into the adjacent bursa (a small fluid-filled sac or saclike cavity), which is less invasive.

If the pain is truly due to the calcium, the pain will be persistent and warrant direct treatment. In these cases, a radiologist uses an ultrasound to guide a needle into the tendon to try to remove the remaining calcium. After the treatment, we will inject steroids to reduce inflammation. We will arrange a follow-up ultrasound six months after your treatment for reassessment.

HOW DO I PREPARE FOR MY EXAM?

  • Arrive 15 minutes prior to your appointment.
  • Wear comfortable clothing.
  • If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin etc.) you may need to have an international normalized ratio (INR) test and stop your medication prior to the procedure. Please inform our booking coordinators of any blood thinners you may be taking, so that they can discuss further instructions with you.
  • Prior to your injection, you must have an ultrasound and X-ray of the area of concern.
  • For calcium in the shoulder tendons, we advise a conservative approach with an initial steroid injection to the bursa. This may be adequate to treat the symptoms.

WHAT HAPPENS DURING MY EXAM?

  • We may provide you with a comfortable clinic gown to change into (depending on the area being treated).
  • A technologist will go over the consent form, explain the procedure, and answer any questions.
  • We will then escort you to our treatment suite where you will be greeted by the radiologist who will clean the area and inject a local anesthetic, similar to the freezing you would get at the dentist.
  • Ultrasound will be used to guide the needle into the area of interest. Once in position the radiologist will attempt to extract or aspirate the calcium deposit from the affected tendon and an anti-inflammatory may then be injected.
  • Any remaining calcium deposits will be gradually reabsorbed by your body.
  • After the injection is complete and you have spoken with the technologist, you will be free to leave.

POST-EXAM INSTRUCTIONS

  • After the procedure is complete the treated area may feel inflamed or sore. These symptoms should disappear over the next 24-72 hours.
  • Pain may increase for a few days post-injection as the body mounts an inflammatory response and absorbs calcium, but should then subside.
  • Pain can be treated with a cold pack and non-steroidal anti-Inflammatory medication.
  • Rest and avoid overuse of the affected area.
  • A mild increase in blood sugar levels can be noticed in patients with diabetes that can last several days or up to one week.
  • We will schedule you for a six-month follow-up ultrasound to re-evaluate the tendon calcium deposit and your symptoms.

WHEN WILL I SEE RESULTS?

  • The injection includes a long-lasting local anesthetic (freezing) so your relief may be immediate. The pain can return as the freezing wears off and before the other medication takes effect, use Tylenol as needed. The steroid typically takes on average 2-10 days to start working and may take up to a week to take full effect.
  • Results vary from weeks to months depending on the joint or body part involved, severity of the disease, and the cause of your pain. Some patients get complete relief that is permanent, while others have no significant effect. If an injection does not help relieve your pain, then you may need further evaluation.

HOW MUCH WILL IT COST?

This exam is covered under your Alberta Health Care Plan. It is not currently offered at our Saskatchewan clinic.

 

For Your Appointment

Please ensure that you bring your requisition with to your appointment.

Questions?

Duration

30 minutes

FREQUENTLY ASKED QUESTIONS

How long does the procedure take to work?

There may be mild tenderness or bruising at the injection site. As the calcium is resorbed, your pain should gradually decrease. Take Tylenol or anti-inflammatories if pain persists.

How long will the treatment last?

The goal of the injection is to permanently treat the tendon calcium causing your symptoms.

How many procedures can I have and how often?

We will arrange a follow-up ultrasound to re-assess the tendon after six months to ensure the calcium is reabsorbing and your symptoms are improving. Rarely, a repeat procedure will be recommended. If your pain persists, a repeat bursal steroid injection may be considered at six weeks post-treatment.

What are the side effects?

A common side effect of the procedure is mild pain or bruising around the area. Over-the-counter pain medication or icing the area can help. Very rare side effects may include infection or tearing of the tendon.